Comment by sowbug
5 hours ago
I was recently reading about a phenomenon called terminal lucidity, where a person suffering from mental decline such as Alzheimer's spontaneously improves, recognizing loved ones, retrieving memories, and being able to carry on conversations. It's called "terminal" because the person usually dies within hours or days.
If this is a real phenomenon, then it's amazing to think that at least some of the people who suffer from Alzheimer's still have their memories inside their minds, as opposed to the disease erasing the memories from existence, which means that an effective treatment might recover their identities.
If you have cared for someone with dementia, this isn't so surprising.
It isn't a monotonic decline with memories disappearing forever. It is like wave upon wave of changing capacity at different time scales. The general trend is deterioration, but there are frequent periods that can almost seem like remission.
There is a well known daily cycle referred to as "sundowning", where the sufferer tends to come unraveled later in the day. The next morning, they'll be more functional.
Later in the progression, you can see much higher frequency variations. Like periods of disorientation and confusion interspersed with periods of lucidity all within a single sitting or conversation.
In those periods of greater lucidity, recall of the past can be more accurate. General listening comprehension, speaking, and logical thought also seem more normal.
Edit to add: I sometimes wonder if the belief in terminal lucidity is one of those logical fallacies which support lots of superstitions. Are we just fixating on the final wave in this chaotic wave train, and forgetting all the other waves that happened before it? Or is it that more caretakers are engaged and observing these waves towards the end, e.g. because the patient is known to be in the terminal phase..?
> It isn't a monotonic decline with memories disappearing forever.
Last time I visited my grandpa he was really far gone. The day we arrived and subsequent two days he didn't even recognize his daughter, my mom, or even recall he had one. He'd sit in the bedroom and watch the garden, and ask "who's that guy" every 15 minutes or so, as he'd forget about me in the livingroom.
The last day we visited before flying home. I entered first, and this time he sat in the living room, and as he saw me enter the hallway he exclaimed my name. We reminisced for hours in fluent English, his third language and my second language, as I wasn't so good in his and my moms native language. He recalled lots of details, some even I had forgotten but I confirmed later.
He passed away a couple of weeks later.
Raised with my grandmother with Alzheimer for all of my childhood she called me by her long dead brother's name.
Walked out the door one day said "See you later grandma" and she said "Have fun ______" and called me by my real name, called my older siblings and said go spend time, she died two days later.
Very common.
Same thing happens for other disease. Some kind of last honey moon period where your health improves and often followed by a catastrophic relapse.
I'm nobody but it makes me feels there's an economic system issue, the body gradually degrades but has the ability one last time to inject a final wave of change to try restore a proper state but the resources are too short and so the attempt cannot sustain itself.
I wonder if research is happening on this aspect.
My dad died of cancer(s) fifteen years ago. He spent his final month in bed at home, chatting with us and friends, knowing that he’d soon be gone, bed bound but sharp as a tack.
The day before he died, he climbed nimbly out of bed and did a little jig to show how spry he was.
Charming in its own way, although his lack of garments on his lower body (it made life easier as functions became less controlled) added a certain edginess to the event.
I’ve heard this is because a lot of symptoms are not from the disease itself but actually side effects of mounting an aggressive immune system response to the underlying condition. Once your body gives up the fight as a lost cause, you will get a burst of relief and restored function from the lack of immune activity but it happens just before total system collapse.
Oh right, that seems so logical..
i’m skeptical how much of a real thing this is vs particularly type of appealing story to the human psyche
It happened to my father, who was suffering a severe mental decline because of hydrocephalus. After weeks of trying to figure out what happened, one day he was sitting in the hospital perfectly fine, talking normally. I remember being so relieved. But then the next day he was back to not knowing anything and being half aware. He died a few weeks later.
totally believe you, but i guess i feel like that is different from spontaneous temporary recovery from a long-term neurodegenerative disorder. i'm sorry for your loss.
I saw it with a family member that had glioblastoma. It was weird, one of the nurses had seen it quite a few times apparently, it's also known as rallying. Family member's situation was similar to sibling comment's family, it wasn't right before death, just in the days and weeks leading up to it. It was like a sudden burst of vitality that came of nowhere, like their condition had dramatically reversed itself.
I'm sure it's a little different for everyone though.
Lost my grandfather to it in his late 80's. He did indeed become more responsive and engaged the day (maybe two) before he died, but he was non-verbal at that point. I recalled my mother telling me he was having a surprisingly good day on Sunday and seemed to recognize people, then getting the call from her the following evening that he had passed.
One of my grandparents had AD and became strangely lucid one day, a couple weeks before her death. It was like she finally woke from a years long fog.
I remember it vividly because I got to tell her I love her and she smiled and said it back to me. She seemed to understand me for the first time in years.
It was short lived but I'm very grateful for that single exchange it gave me.