Paradoxical Lucidity

A Potential Paradigm Shift for the Neurobiology and Treatment of Severe Dementias

Published in: Alzheimer's & Dementia (2019). doi: 10.1016/j.jalz.2019.04.002

Posted on RAND.org on July 17, 2019

by George A. Mashour, Lori Frank, Alexander Batthyany, Ann Marie Kolanowski, Michael Nahm, Dena Schulman-Green, Bruce Greyson, Serguei Pakhomov, Jason Karlawish, Raj C. Shah

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Unexpected cognitive lucidity and communication in patients with severe dementias, especially around the time of death, have been observed and reported anecdotally. Here, we review what is known about this phenomenon, related phenomena that provide insight into potential mechanisms, ethical implications, and methodologic considerations for systematic investigation. We conclude that paradoxical lucidity, if systematically confirmed, challenges current assumptions and highlights the possibility of network-level return of cognitive function in cases of severe dementias, which can provide insight into both underlying neurobiology and future therapeutic possibilities.

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