1
|
Álvarez-Fernández B, Marín-Carmona JM. [Paradoxical lucidity and personal identity in patients with advanced dementia: change of paradigm?]. Rev Esp Geriatr Gerontol 2024; 59:101493. [PMID: 38691896 DOI: 10.1016/j.regg.2024.101493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 03/01/2024] [Accepted: 03/13/2024] [Indexed: 05/03/2024]
Abstract
In this article we approach the concept of paradoxical lucidity (LP) (an unexpected, spontaneous, significant and relevant episode of communication or connection) in persons with advanced dementia. The existence of LP could change the paradigm of dementia as a degenerative, chronic, progressive and irreversible disease (where neuronal death plays the leading role), towards a model where functional deficits of neuronal networks acquire importance, which raises new potentially reversible therapeutic and rehabilitative possibilities. We analyze the ethical consequences that these episodes may have with respect to the implicated persons (patients, caregivers and professionals in charge of their care) and try to answer the following question: Do persons with advanced dementia continue to maintain their personal identity despite suffering cognitive impairment so severe?. The LP indicates that this is possible. In this work we make a transversal outline of the different concepts and theories of personal identity in these patients, from different areas of knowledge (philosophy, psychology, neuroscience).
Collapse
Affiliation(s)
| | - José Manuel Marín-Carmona
- Especialista en Geriatría. Programa de Memoria, Centro de Envejecimiento Saludable, Ayto, Málaga, España.
| |
Collapse
|
2
|
Ramirez M, Teresi JA, Silver S, Gonzalez-Lopez P, van Meer I, Ghaemmaghamfarahani I, Boratgis G, Devenand D, Luchsinger JA. The lucidity in dementia experience: perspectives from family and professional caregivers. Age Ageing 2024; 53:afae174. [PMID: 39158483 DOI: 10.1093/ageing/afae174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 06/10/2024] [Indexed: 08/20/2024] Open
Abstract
BACKGROUND Family and professional caregivers of individuals with dementia often witness care-receiver's lucidity events. OBJECTIVE A qualitative data analysis was performed of documented family and professional caregivers' experiences and their respective appraisals of lucidity events. RESEARCH DESIGN AND METHODS Using a reduction method of selection, data from 10 in-home family caregivers and 20 professional caregivers to long-term care residents was content-coded and analysed. Framed by a priori research questions, a summative approach to qualitative content analysis guided the interpretation of findings. RESULTS Eight of 10 family- and 15 of 20 staff caregivers gave an example of what they believed was a witnessed lucid event; 88% of family- and 40% of staff caregivers' provided examples that appeared to fit the conceptual definition of lucidity. The emotional impact that the events had on both sets of caregivers was reported. Family caregivers' characterization of lucidity events reflected appraisals of a puzzling occurrence while staff caregivers depicted elements associated with dementia, and lucidity descriptors. The enhanced verbal communication followed by the brief, unexpected quality of lucidity, were the main elements highlighted by both sets of caregivers in their description of lucidity to others. The variability and complexity of the lucidity phenomenon and the potential challenges it poses for both sets of caregivers were characterized. Commonalities and divergences across responses were highlighted. DISCUSSION Findings validated previous studies' results. The notions introduced by both types of caregivers were thought-provoking and borne practical, clinical, ethical, and assessment (measurement) applicability.
Collapse
Affiliation(s)
- Mildred Ramirez
- Columbia University Irving Medical Center Department of Medicine, New York, USA
| | - Jeanne A Teresi
- Columbia University Irving Medical Center Department of Medicine, Stroud Center, New York State Psychiatric Institute, New York, NY, USA
| | - Stephanie Silver
- Columbia University Irving Medical Center Department of Medicine, New York, USA
| | | | - Irena van Meer
- Columbia University Irving Medical Center Department of Medicine, New York, USA
| | | | - Gabriel Boratgis
- Columbia University Irving Medical Center Department of Medicine, New York, USA
| | - Davangere Devenand
- Division of Geriatric Psychiatry; Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY, USA
| | - Jose A Luchsinger
- Departments of Medicine and Epidemiology, Columbia University Irving Medical Center; Stroud Center, New York, NY, USA
| |
Collapse
|
3
|
Gilmore-Bykovskyi A, Dillon K, Coulson A, Fehland J, Benson C, Sanson-Miles L, Mueller K. An observational study protocol to capture, validate and characterise lucid episodes in people living with advanced dementia receiving hospice care. BMJ Open 2024; 14:e085897. [PMID: 38760031 PMCID: PMC11103230 DOI: 10.1136/bmjopen-2024-085897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/25/2024] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION Lucid episodes (LEs) in advanced neurodegenerative disease, characterised by a transient recovery of abilities, have been reported across neurological conditions, including Alzheimer's disease and related dementias. Evidence on LEs in dementia is extremely limited and draws predominantly from retrospective case reports. Lucidity in dementia has received growing attention given the clinical, caregiving and potential epidemiological implications of even a temporary return of abilities in advanced disease. Following a funding initiative by the National Institute on Aging, several new investigations are focused on establishing foundational evidence on lucidity in dementia. The objectives of this study are to capture, characterise and validate potential LEs via audiovisual observation, computational linguistic and timed-event coding of audiovisual data, and informant case review for face validation of LEs. METHODS AND ANALYSIS This prospective multifaceted observational study will investigate LEs in advanced dementia through longitudinal audiovisual observation within an inpatient hospice unit. Audiovisual data will be coded to generate variables of participant verbal output, verbal expressions, non-verbal communicative actions and functional behaviours to enable measurement of features that can be used to characterise LEs. Multiple methods will be used to identify potential LEs including field interviews with caregivers/clinicians who witness significant events during data collection, reports from research staff who witness significant events during data collection and detection by researchers during video data processing procedures. Potential LEs will undergo a structured case review with informants familiar with the participant to facilitate validation and enable triangulation across measures generated through coding. ETHICS AND DISSEMINATION This study will be conducted in accordance with all Federal Policies for the Protection of Human Subjects and the protocol (ID 2021-1243) has been approved by the University of Wisconsin-Madison Institutional Review Board. Findings will be disseminated via scientific conferences, journal publications and newsletters shared with participants and through dementia-focused and caregiver-focused networks.
Collapse
Affiliation(s)
- Andrea Gilmore-Bykovskyi
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kayla Dillon
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Alison Coulson
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jess Fehland
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Clark Benson
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Leah Sanson-Miles
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Kimberly Mueller
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, Wisconsin, USA
| |
Collapse
|
4
|
Roehrs P, Fenwick P, Greyson B, Kellehear A, Kothe K, Nahm M, Roe C, Tassell-Matamua N, Woollacott M. Terminal Lucidity in a Pediatric Oncology Clinic. J Nerv Ment Dis 2024; 212:57-60. [PMID: 37734159 DOI: 10.1097/nmd.0000000000001711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
ABSTRACT The sporadic occurrence of unusually enhanced mental clarity before death has been documented over time and cultures, and reported in patients with and without neurodegenerative diseases, psychiatric disorders, and other neurocognitive deficits, as well as those with nonterminal and terminal conditions. Using a purposive sampling method via existing professional networks, clinical presentations of terminal lucidity in pediatric populations, as witnessed by pediatric oncologists and medical personnel, were solicited. We document clinical presentations suggestive of terminal lucidity in children, which were compiled by their attending physician at two large tertiary pediatric hospitals. Unanticipated and unexplained changes in mental clarity, verbal communication, and/or physical capability in the days and hours before the death of the pediatric patients were observed. Each patient's medical condition should not have allowed for such changes. The phenomenon known as terminal lucidity provides a conceptual framework for these deviations, although more systematic documentation and clinical research is required before definitive conclusions can be drawn.
Collapse
Affiliation(s)
| | | | | | | | | | - Michael Nahm
- Institute for Frontier Areas of Psychology and Mental Health, Freiburg, Germany
| | - Chris Roe
- University of Northampton, Northampton, United Kingdom
| | | | | |
Collapse
|
5
|
Ross JP, Post SG, Scheinfeld L. Lucidity in the Deeply Forgetful: A Scoping Review. J Alzheimers Dis 2024; 98:3-11. [PMID: 38339937 DOI: 10.3233/jad-231396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
Background Even in severe states of Alzheimer's disease and related dementias (ADRD), accounts of an unexpected or paradoxical return of awareness and lucidity have been reported in some patients, documented formally, and studied. Objective A scoping review was undertaken to survey the literature on the topic. Methods Five databases were searched using pertinent search terms. Results were deduplicated and subsequently screened by title and abstract for relevance. Remaining reports were read and included or excluded using specific inclusion criteria. 30 results consisted of a mix of perspective papers, case reports, qualitative surveys of caregivers, law journal comments, and mechanistic speculation. Results An equal mix of primary and secondary research was identified. Conclusions The papers collected in this review provide a valuable methodological outline for researching the topic of lucid episodes in ADRD. The verified legitimacy and simultaneous inexplicability of these events promote philosophical discussion, mechanistic investigations, and sorely needed research in the field of ADRD.
Collapse
Affiliation(s)
- John Paul Ross
- Department of Family, Population and Preventive Medicine, Center for Medical Humanities, Compassionate Care and Bioethics, Renaissance School of Medicine at SUNY Stony Brook, Stony Brook, NY, USA
| | - Stephen G Post
- Department of Family, Population and Preventive Medicine, Center for Medical Humanities, Compassionate Care and Bioethics, Renaissance School of Medicine at SUNY Stony Brook, Stony Brook, NY, USA
| | | |
Collapse
|
6
|
Gilmore-Bykovskyi A, Block L, Benson C, Fehland J, Botsch M, Mueller KD, Werner N, Shah MJ. "It's You": Caregiver and Clinician Perspectives on Lucidity in People Living With Dementia. THE GERONTOLOGIST 2023; 63:13-27. [PMID: 35797987 PMCID: PMC10091484 DOI: 10.1093/geront/gnac095] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Episodes of lucidity (ELs), or a transient return of abilities believed to be lost in people living with dementia, are a growing area of interest. These events hold important implications for care, caregiving, and our understanding of underlying etiologies. Research on ELs is largely limited to retrospective reports. The perspectives of professional and family caregivers on ELs and research approaches can inform efforts to define and study lucidity. The present study examined family caregiver and hospice clinician experiences with and perspectives on ELs in people living with dementia and observational approaches to studying these events. RESEARCH DESIGN AND METHODS This exploratory, descriptive qualitative study employed semistructured interviews (N = 20 caregivers, N = 6 clinicians). Data were analyzed using Rapid Identification of Themes and subsequent duplicate review of interview data to enhance trustworthiness. RESULTS Most participants readily recalled events they perceived as ELs, describing a transient return of abilities they felt was significant and/or meaningful. Defining features, interpretations, and the perceived impact of ELs varied, although ELs were commonly conceptualized as a manifestation of self. Caregivers described extensive efforts to detect patterns and supportive social conditions for ELs. Participants supported use of audiovisual observation to study ELs and provided recommendations for privacy, workflow, and caregiver engagement. DISCUSSION AND IMPLICATIONS Interpretations of ELs are heterogeneous, and recognition of these events may necessitate close familiarity with the person living with dementia. Participants endorse observational approaches and integration of caregivers in this research.
Collapse
Affiliation(s)
- Andrea Gilmore-Bykovskyi
- BerbeeWalsh, Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine & Public Health, Madison, Wisconsin, USA.,Center for Health Disparities Research, University of Wisconsin-Madison School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Laura Block
- BerbeeWalsh, Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Clark Benson
- BerbeeWalsh, Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Jess Fehland
- BerbeeWalsh, Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Meghan Botsch
- BerbeeWalsh, Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Kimberly D Mueller
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Nicole Werner
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Mindy J Shah
- Department of Medicine Division of Geriatrics, University of Wisconsin-Madison School of Medicine & Public Health, Madison, Wisconsin, USA
| |
Collapse
|
7
|
Gilmore‐Bykovskyi A, Griffin JM, Mueller KD, Parnia S, Kolanowski A. Toward harmonization of strategies for investigating lucidity in AD/ADRD: A preliminary research framework. Alzheimers Dement 2023; 19:343-352. [PMID: 35757902 PMCID: PMC9792622 DOI: 10.1002/alz.12709] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 01/25/2023]
Abstract
Episodes of lucidity (ELs) in Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD), have garnered increasing attention as an important area of research. Efforts to study lucidity suffer from a lack of clear definitional criteria, inconsistent conceptualization, and diverse approaches to operationalizing features of these events. To advance systematic investigation of ELs in AD/ADRD, there is a need for clarity and precision in labeling event attributes, markers, and specific measurement strategies that enable operational harmonization across distinct approaches to investigating the relatively broad and nascent phenomenon. To that end, we propose a preliminary research framework to guide harmonization of approaches to investigating ELs in AD/ADRD. Our goal is to provide an initial schematic that encourages uniform labeling of operational decisions about ELs.
Collapse
Affiliation(s)
- Andrea Gilmore‐Bykovskyi
- Department of Emergency Medicine, University of Wisconsin‐Madison School of Medicine & Public HealthMadisonWisconsinUSA
- UW Center for Health Disparities ResearchMadisonWisconsinUSA
| | - Joan M. Griffin
- Division of Health Care Delivery ResearchMayo ClinicRochesterMinnesotaUSA
- Kern Center for the Science of Health Care DeliveryMayo ClinicRochesterMinnesotaUSA
| | - Kimberly D. Mueller
- University of Wisconsin‐Madison Department of Communication Sciences and DisordersMadisonWisconsinUSA
- Division of GeriatricsDepartment of MedicineUniversity of Wisconsin‐Madison School of Medicine & Public HealthMadisonWisconsinUSA
| | - Sam Parnia
- NYU Langone Medical CenterNew York CityNew YorkUSA
| | - Ann Kolanowski
- Penn State Ross and Carol Nese College of NursingState CollegePennsylvaniaUSA
| |
Collapse
|
8
|
Peterson A, Clapp J, Harkins K, Kleid M, Largent EA, Stites SD, Karlawish J. Is there a difference between terminal lucidity and paradoxical lucidity? Alzheimers Dement 2022; 18:540-541. [PMID: 35102707 PMCID: PMC10911068 DOI: 10.1002/alz.12579] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/10/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Andrew Peterson
- Institute for Philosophy and Public Policy, George Mason University, Fairfax, Virginia, USA
| | - Justin Clapp
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kristin Harkins
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Melanie Kleid
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Emily A Largent
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shana D Stites
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jason Karlawish
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|