Expert reveals mysterious reason why a third of dementia patients regain ‘lost’ memories in the days before death

Experts have identified a fascinating feature of dementia that can often give loved ones false hope that the person’s memory is improving.

They found that about a third of dementia patients experience remarkable moments of clarity beginning in the last few days of life.

The phenomenon, called terminal lucidity, allows the dementia patient to suddenly remember people’s names, loved ones’ faces and inside jokes.

And doctors say they often have to manage family expectations, seeing the sudden change as a sign that their loved one is doing better.

Terminal lucidity is not well studied or understood, but doctors believe it is part of the brain’s last-ditch effort to keep itself alive while other physiological processes slow or stop.

Dementia is a chronic, unstoppable disease, but the brief periods of clarity are turning that standard orthodoxy on its head, with some doctors optimistic that it indicates the condition can actually be reversed.

Dr. Sam Parnia, a critical care physician at NYU Langone Health, said: ‘When you die, your brain runs out of oxygen and nutrients, so it shuts down.

“This shutting down process takes the brakes off…, and what suddenly seems to happen is it gives you access to parts of your brain that you normally don’t have access to.”

Normally, the ‘brakes’ allow us to filter out irrelevant information to help us carry out normal daily tasks.

But when the brain is deprived of oxygen, these inhibitory mechanisms become weaker, and suddenly people with dementia can gain unfettered access to parts of their brain that were previously off-limits.

Julie McFadden, hospice nurse, said: ‘Sometimes we call it the wave, or the rally. It occurs in about a third of all dying patients.

‘It’s exactly what it sounds like. (Patients) have been really bad, going downhill, looking like they’re going to die. And suddenly they get better… they start talking, their personality comes back, maybe they’re walking, maybe they’re eating. Usually it only lasts a few hours to maybe a few days, and then they suddenly die.”

Julie McFadden, a hospice nurse, said the fleeting brightness lasts for hours to just a few days and is almost always followed by death

Studies have shown that up to 90 percent of patients those who experience this final bout of clarity die within a week.

Even though the moments of clarity are fleeting, they can be incredibly meaningful. An end-of-life doula wrote about a client who was a highly successful intellectual and owner of companies and 40 patents. But Alzheimer’s disease, in his eighties, forced him to stop working.

His wife had been sitting by his hospital bedside for months, talking to him and saying goodnight the same way every night. One night she went to say goodbye, held both sides of his face in her hands and whispered, “I love you.”

Suddenly he woke up from his coma, looked at her with complete recognition of who she was and said, “I love you too” before falling back into his coma-like state.

His wife told the doula, “He looked straight into my eyes with such meaning. I know he knew me. I’ve been saying goodnight to him the same way for months, without an answer. I can’t believe what just happened.’

Dr. Andrew Peterson, professor of philosophy and bioethics at George Mason University, said, “One thing that seems to be quite profound for family members who perceive clarity is something we call the ‘old self’ emerging.

“There seems to be clear evidence that they are not only aware of their surroundings… but also understand their relationships with other people.”

There have been reports of terminal lucidity in the medical literature for more than 250 years. Although it is most often seen in people with dementia and Alzheimer’s disease, it can happen to anyone nearing death.

Understanding the mechanisms underlying these bouts of lucidity could usher in a new field of research in Alzheimer’s disease and dementia.

The phenomenon suggests that even in the throes of dementia, the brain retains some ability to form new neural connections, raising the possibility that boosting the brain’s ability to do this with new drugs could lead to long-term improvements to lead.

Dr. Peterson said it suggests that neural networks and/or accessory pathways may persist in the late stages of the disease, which “could potentially help restore cognitive abilities in individuals who we otherwise think are permanently affected.”