I was introduced to this concept last week while I was attending the funeral of someone who was thought to have experienced this during his last day alive. I visited the home where he passed away and was told that the nurses and family members were in awe of his passing because he had become “another person” during his last days of life. Some aspects of his memory seemed to have come back and he was more lively that he had been in awhile. I had never heard of such phenomena and decided to look into it. Below are some of the things I found.
Terminal lucidity refers to the unexpected return of mental clarity and memory shortly before death in patients suffering from severe psychiatric and neurological disorders. This return of mental clarity usually occurs in the last minutes, hours of days before the patient’s death. Examples include case reports of patients suffering from tumors, strokes, meningitis, dementia or Alzeheimer’s disease, schizophrenia, and affective disorders. This is particularly striking considering that many of these disorders are caused by degeneration and degradation of the cerebral cortex, hippocampus, and other brain areas that are involved in memory and cognition processes.
Several accounts suggest that during terminal lucidity, memory and cognitive abilities may function by neurologic processes that differ from those of the normal brain. So far the assumption is that the improvement of brain disorders or dysfunctions is caused by the altered brain physiology of the dying. There are two ways in which terminal lucidity is thought to exist: the severity of mental disturbance can improve slowly in conjuction with the decline of body vitality (typically schizophrenia cases) or full mental clarity may appear abruptly and unexpectedly shortly before death (more common in dementia cases). Although terminal lucidity has not been attributed to a specific medical cause, some authors have suggested that a high fever prior to dying might induce terminal lucidity.
Although terminal lucidity has been reported for around 250 years, it has received little medical attention because of its complexity and transience. Not to mention the ethical guidelines for the responsible conduct of research and the fact that these patients are already mentally ill, making it even more difficult to include them in empirical studies. Academic interest in terminal lucidity declined after the mid-19th century. However, in 1975, Turetskaia and Romanenko published a detailed article concerning 3 cases of schizophrenic patients in a medical journal. According to Nahm and Greyson, this article is the only publication on terminal lucidity and mental disorders in medical journals throughout the 20th century. However, within the last few years interest in terminal lucidity in mental disorders has increased again due to recent case reports published by Brayne et. al (2008) and Grosso (2004) (see reviews below).
The authors’ goal is to stimulate research on the pathophysiology of terminal states. For example, research on terminal lucidity could help elucidate the factors influencing the relationship between the mind and the brain, particularly as the brain deteriorates. Moreover, it could further understanding of memory and cognition processes and facilitate the development of new therapies aimed towards reversing the loss of memory and cognitive function in these patients.
Nahm, M., Greyson, B., Kelly, EW., & Haraldsson, E. (2012). Terminal Lucidity: A review and case collection. Archives of Gerontology and Geriatrics, 55:138–142.
Nahm, M., and Greyson, B. (2009). Terminal Lucidity in Patients With Chronic Schizophrenia and Dementia: A survey of the literature. Journal of Nervous and Mental Disease, 197 (12): 942-4.
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