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
|
Bangerter LR, Griffin JM, Kim K, Finnie DM, Lapid MI, Gaugler JE, Biggar VS, Frangiosa T. A Delphi Approach to Define Lucid Episodes in People Living With Dementia. Alzheimer Dis Assoc Disord 2024; 38:147-151. [PMID: 38757575 DOI: 10.1097/wad.0000000000000621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/07/2024] [Indexed: 05/18/2024]
Abstract
PURPOSE Lucid episodes (LEs: unexpected episodes of spontaneous, meaningful, and relevant communication or behavior) in Alzheimer disease and related dementias are a new area of scientific inquiry that lacks clinical consensus and require more conceptual attention. METHODS We aimed to measure consensus from an expert group on: (1) potential medical or clinical explanations for LEs; (2) necessary medical and clinical context to LEs; and (3) interpretation of LEs. PATIENTS We convened 13 experts from different disciplines (neurology, psychiatry, psychology, pharmacy, palliative care, hospice, nursing, social work, primary care, geriatrics, and professional home caregivers) to identify elements of LEs. RESULTS Experts provided a range of opinions on medical and clinical explanations and questions to understand LEs. Consensus on LEs when presented with clinical vignettes was not reached. Panelists highlighted key medical and contextual factors needed to make a definitive judgement about LEs. CONCLUSION There is variability in how LEs are interpreted by clinical experts, which complicates the identification of LEs in Alzheimer disease and related dementias.
Collapse
Affiliation(s)
- Lauren R Bangerter
- Health Economics and Aging Research Institute, MedStar Health Research Institute, Hyattsville, MD
| | - Joan M Griffin
- Division of Health Care Delivery Research and Kern Center for the Science of Healthcare Delivery
| | - Kyungmin Kim
- Kern Center for the Science of Healthcare Delivery
| | - Dawn M Finnie
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester
| | - Maria I Lapid
- School of Public Health, University of Minnesota, Minneapolis, MN
| | - Joseph E Gaugler
- Department of Child Development and Family Studies, Research Institute of Human Ecology, Seoul National University, Seoul, Korea
| | | | | |
Collapse
|
3
|
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
|
4
|
Benson C, Fehland J, Botsch M, Block L, Gilmore-Bykovskyi A. The Impact of Episodes of Lucidity on People Living With Dementia and Their Caregivers: A Case Report. Alzheimer Dis Assoc Disord 2023; 37:142-144. [PMID: 36988619 PMCID: PMC10238644 DOI: 10.1097/wad.0000000000000553] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/30/2023] [Indexed: 03/30/2023]
Abstract
People living with dementia (PLWD) may experience the episodes of lucidity (ELs), defined as a sudden return of abilities presumed to have been lost and presenting as meaningful communication and connection. Early research on ELs in advanced disease stages suggests these are predominantly positive events. This case report draws from 1 outlier case from a descriptive qualitative study on caregivers of PLWDs' experiences with ELs. The caregiver-reported events perceived as an EL being accompanied with unexpected self-awareness, leading to a negative emotional reaction and feelings of loss. This case report contributes insights to the current understandings of ELs as exclusively relevant in advanced stages of dementia, as similar events may present in earlier disease stages, and may be associated with the negative emotional experiences among PLWD. Future research is needed to consider the ethical implications surrounding ELs and to support the caregivers in anticipating and responding to ELs.
Collapse
Affiliation(s)
| | | | | | - Laura Block
- BerbeeWalsh Department of Emergency Medicine
| | - Andrea Gilmore-Bykovskyi
- BerbeeWalsh Department of Emergency Medicine
- Center for Health Disparities Research, University of Wisconsin-Madison School of Medicine & Public Health, Madison, WI
| |
Collapse
|
5
|
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
|
6
|
Teresi JA, Ramirez M, Ellis J, Tan A, Capezuti E, Silver S, Boratgis G, Eimicke JP, Gonzalez-Lopez P, Devanand DP, Luchsinger JA. Reports About Paradoxical Lucidity from Health Care Professionals: A Pilot Study. J Gerontol Nurs 2023; 49:18-26. [PMID: 36594915 PMCID: PMC11100277 DOI: 10.3928/00989134-20221206-03] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Although clinicians caring for persons at the end of life recognize the phenomenon of paradoxical/terminal lucidity, systematic evidence is scant. The current pilot study aimed to develop a structured interview instrument for health care professionals to report lucidity. A questionnaire measuring lucidity length, degree, content, coinciding circumstances, and time from episode to death was expanded to include time of day, expressive and receptive communication, and speech during the month prior to and during the event. Thirty-three interviews were conducted; 73% of participants reported ever witnessing paradoxical lucidity. Among 29 events reported, 31% lasted several days, 20.7% lasted 1 day, and 24.1% lasted <1 day. In 78.6% of events, the person engaged in unexpected activity; 22.2% died within 3 days, and 14.8% died within 3 months of the event. The phenomenological complexity of lucidity presents challenges to eliciting reports in a systematic fashion; however, staff respondents were able to report lucidity events and detailed descriptions of person-specific characteristics. [Journal of Gerontological Nursing, 49(1), 18-26.].
Collapse
Affiliation(s)
- Jeanne A. Teresi
- Research Division, Hebrew Home at Riverdale by RiverSpring Living, Riverdale, New York, USA
- Columbia University Stroud Center at New York State Psychiatric Institute
| | - Mildred Ramirez
- Research Division, Hebrew Home at Riverdale by RiverSpring Living, Riverdale, New York, USA
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College
| | - Julie Ellis
- Nursing and Midwifery Department, La Trobe University
| | - Amil Tan
- Graduate Center, City University of New York
- School of Nursing, Hunter College
| | | | - Stephanie Silver
- Research Division, Hebrew Home at Riverdale by RiverSpring Living, Riverdale, New York, USA
| | - Gabriel Boratgis
- Research Division, Hebrew Home at Riverdale by RiverSpring Living, Riverdale, New York, USA
| | - Joseph P. Eimicke
- Research Division, Hebrew Home at Riverdale by RiverSpring Living, Riverdale, New York, USA
| | - Paloma Gonzalez-Lopez
- Research Division, Hebrew Home at Riverdale by RiverSpring Living, Riverdale, New York, USA
| | | | | |
Collapse
|
7
|
Griffin JM, Kim K, Gaugler JE, Biggar VS, Frangiosa T, Bangerter LR, Batthyany A, Finnie DM, Lapid MI. Caregiver appraisals of lucid episodes in people with late-stage Alzheimer's disease or related dementias. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2022; 14:e12313. [PMID: 35775022 PMCID: PMC9219100 DOI: 10.1002/dad2.12313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 06/15/2023]
Abstract
Introduction Little is known about how family caregivers who witness unexpected and spontaneous communication among people in late stages of Alzheimer's disease and related dementias (ADRD) appraise these episodes of lucidity (EL). Methods In an electronic, cross-sectional survey for former and current caregivers who participate in UsAgainstAlzheimer's A-LIST®, participants who reported witnessing an EL were asked how positive and stressful ELs were, if they made or changed decisions based on an EL, and what resources they sought out to explain ELs. Results Caregivers reported 72% of ELs to be quite a bit or very positive, 17% to be stressful, and 10% to be both stressful and positive. Twelve percent of caregivers changed care plans because of ELs and 13% sought out information about ELs. Discussion These exploratory data suggest caregiver reactions to EL vary. Caregivers may change or postpone care decisions due to EL, and few resources exist to address caregiver queries about EL.
Collapse
Affiliation(s)
- Joan M. Griffin
- Division of Health Care Delivery Research and Kern Center for the Science of Healthcare Delivery, Mayo ClinicRochesterMinnesotaUSA
| | - Kyungmin Kim
- Department of Child Development and Family StudiesResearch Institute of Human EcologySeoul National UniversitySeoulKorea
| | - Joseph E. Gaugler
- School of Public HealthUniversity of MinnesotaMinneapolisMinnesotaUSA
| | | | | | | | | | - Dawn M. Finnie
- Kern Center for the Science of Healthcare Delivery, Mayo ClinicRochesterMinnesotaUSA
| | - Maria I. Lapid
- Department of Psychology and Psychiatry, Mayo ClinicRochesterMinnesotaUSA
| |
Collapse
|
8
|
Peterson A, Clapp J, Largent EA, Harkins K, Stites SD, Karlawish J. What is paradoxical lucidity? The answer begins with its definition. Alzheimers Dement 2022; 18:513-521. [PMID: 34338400 PMCID: PMC8807788 DOI: 10.1002/alz.12424] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 11/19/2022]
Abstract
Paradoxical lucidity in dementia is a clinically significant but understudied phenomenon. A provisional definition was proposed by the 2018 National Institute on Aging expert workshop and published in Alzheimer's and Dementia. However, several conceptual features of this definition remain vague, creating barriers to robust clinical research. Here, we critically analyze the provisional definition and present a refined definition that can be applied in clinical research. The refined definition is based on an analytic process our research group recently undertook to operationalize paradoxical lucidity for our own study protocol. Our goal is to facilitate debate and potentially harmonize interpretations of paradoxical lucidity among research groups.
Collapse
Affiliation(s)
- Andrew Peterson
- Penn Program on Precision Medicine for the BrainPenn Memory CenterUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Philosophy, Institute for Philosophy and Public PolicyGeorge Mason UniversityFairfaxVirginiaUSA
| | - Justin Clapp
- Penn Program on Precision Medicine for the BrainPenn Memory CenterUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Anesthesiology & Critical CarePerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Medical Ethics and Health PolicyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Emily A. Largent
- Penn Program on Precision Medicine for the BrainPenn Memory CenterUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Medical Ethics and Health PolicyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Kristin Harkins
- Penn Program on Precision Medicine for the BrainPenn Memory CenterUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Shana D. Stites
- Penn Program on Precision Medicine for the BrainPenn Memory CenterUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of PsychiatryPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Jason Karlawish
- Penn Program on Precision Medicine for the BrainPenn Memory CenterUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Medical Ethics and Health PolicyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| |
Collapse
|
9
|
Gilmore-Bykovskyi A, Block L, Benson C, Griffin JM. The Importance of Conceptualizing and Defining Episodes of Lucidity. J Gerontol Nurs 2021; 47:5. [PMID: 34038253 DOI: 10.3928/00989134-20210326-01] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
| | | | - Clark Benson
- University of Wisconsin-Madison, School of Nursing, Madison, Wisconsin
| | - Joan M Griffin
- Professor of Health Services Research Mayo Clinic Rochester, Minnesota
| |
Collapse
|