TERMINAL LUCIDITY IN END-STAGE DEMENTIA: AN UNEXPECTED WINDOW OF MEMORY AND COMMUNICATION

Abstract

Background: Terminal lucidity refers to the uncommon and surprising resurgence of mental clarity and the ability to communicate in patients suffering from severe neurological or psychiatric conditions shortly before death. Despite being documented for over two hundred years, the underlying biological mechanisms remain poorly understood, with theories ranging from surges in neurotransmitters to temporary electrophysiological or inflammatory alterations. The limited reports available from India highlight the necessity for further documentation.

Case Details: We report on a 74-year-old woman with end-stage Alzheimer’s dementia, long-term type 2 diabetes, and hypertension. Remarkably, the night before her death, she had a moment of clarity, recognising her son, conversing with family, encouraging her grandchildren, thanking her caregiver, and requesting her favourite meal, which she ate after days of refusing food. This episode lasted about 45 minutes before she returned to unresponsiveness and passed away peacefully a few hours later.

Discussion: International studies suggest clarity can occur 24 to 72 hours after death. An analysis of polypharmacy found no sedatives or antipsychotics, indicating that the absence of CNS depressants may have allowed for some neural activity. Possible explanations include temporary neurotransmitter release, reduced neuroinflammation, and a rebound in electrophysiological activity.

Conclusion: This pioneering Indian case report highlights the clinical, cultural, and pharmacological significance of terminal lucidity, reminding healthcare professionals, especially pharmacists, of their vital role in deprescribing, counselling, and supporting families during end-of-life moments.