Moments of clarity in the fog of dementia

A recent Mayo Clinic study published in Alzheimer's & Dementia: The Journal of the Alzheimer's Association investigated lucid episodes in people living with later stages of dementia, providing insights into how these occurrences reveal themselves.

The findings showed that 75% of people having lucid episodes were reported to have Alzheimer’s Disease as opposed to other forms of dementia.

Researchers define lucid episodes as unexpected, spontaneous, meaningful and relevant communication from a person who is assumed to have permanently lost the capacity for coherent interactions, either verbally or through gestures and actions.

Family caregivers of people living with dementia were surveyed and asked about witnessing lucid episodes. Researchers then classified the episodes into types.

The study aimed to determine if there were distinct patterns or types of lucid episodes that could be used to understand why or when they happen.

Joan Griffin, Ph.D., lead author of the study.

"We determined the types of episodes based on the circumstances surrounding the episode, the quality of the communication during the episode, how long it lasted, the level of cognition of the person living with dementia before the episode and the proximity to death," says Joan Griffin, Ph.D., lead author of the study.

The findings revealed that of those having lucid episodes, 61% were women, with 31% living in the same household as the caregiver who responded to the survey.

"We know these lucid episodes are happening, but we didn't know if there are different types of episodes that happen at different times or under different circumstances," says Dr. Griffin.  "This study helped clarify that different types of episodes likely exist."

Contrary to findings from previous research, the conclusions of this study challenge the idea that lucid episodes may signal impending death.

"It's important for people to know that these are not necessarily harbingers for death," says Dr. Griffin.  “I think people can get anxious when they happen, so it's good to know that there are different kinds of episodes that don’t necessarily mean death is imminent."

Dr. Griffin notes that researchers now are conducting a longitudinal study to better understand lucid episodes and how caregivers react to them and take meaning from them. Longitudinal studies allow researchers to track changes or behaviors over time and to identify any relationships between these changes.  

"With this new study, we'll be able to understand better what patterns exist and determine the consequences of the episode over time," explains Dr. Griffin.

Showing compassion for caregivers and their loved ones

Dr. Griffin underscores the need to understand these episodes to help caregivers with their work and remind them of the cognitive and emotional potential of people living with dementia.

"Caregivers of people living with dementia must manage a long list of challenges and it can be overwhelming," says Dr. Griffin. "Perhaps understanding these episodes can help lighten that load."

"We have found in our research and stories from caregivers that these kinds of episodes change how they interact with and support their loved ones — usually for the better," she adds. "These episodes can serve as reminders that caregiving is challenging, but we can always try to care with a little more humanity and grace."

The Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery supported this research. Review the study for a complete list of authors, disclosures and funding.

About Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery

The Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery collaborates with clinical areas across Mayo to create and evaluate data-driven solutions to transform the experience of health and healthcare for patients, staff, and communities. It drives continuous improvement of Mayo Clinic as a learning health system, enabling always safe, evidence-based, high-quality care.