Terminal lucidity: why do loved ones with dementia sometimes ‘come back’ before death?
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Dementia is often described as “the long goodbye”. Although the person is still alive, dementia slowly and irreversibly chips away at their memories and the qualities that make someone “them”.
Dementia eventually takes away the person’s ability to communicate, eat and drink on their own, understand where they are, and recognise family members.
Since as early as the 19th century, stories from loved ones, caregivers and health-care workers have described some people with dementia suddenly becoming lucid. They have described the person engaging in meaningful conversation, sharing memories that were assumed to have been lost, making jokes, and even requesting meals.
It is estimated 43% of people who experience this brief lucidity die within 24 hours, and 84% within a week.
Why does this happen?
Terminal lucidity or paradoxical lucidity?
In 2009, researchers Michael Nahm and Bruce Greyson coined the term “terminal lucidity”, since these lucid episodes often occurred shortly before death.
But not all lucid episodes indicate death is imminent. One study found many people with advanced dementia will show brief glimmers of their old selves more than six months before death.
Lucidity has also been reported in other conditions that affect the brain or thinking skills, such as meningitis, schizophrenia, and in people with brain tumours or who have sustained a brain injury.
Moments of lucidity that do not necessarily indicate death are sometimes called paradoxical lucidity. It is considered paradoxical as it defies the expected course of neurodegenerative diseases such as dementia.
But it’s important to note these episodes of lucidity are temporary and sadly do not represent a reversal of neurodegenerative disease.
Why does terminal lucidity happen?
Scientists have struggled to explain why terminal lucidity happens. Some episodes of lucidity have been reported to occur in the presence of loved ones. Others have reported that music can sometimes improve lucidity. But many episodes of lucidity do not have a distinct trigger.
A research team from New York University speculated that changes in brain activity before death may cause terminal lucidity. But this doesn’t fully explain why people suddenly recover abilities that were assumed to be lost.
Paradoxical and terminal lucidity are also very difficult to study. Not everyone with advanced dementia will experience episodes of lucidity before death. Lucid episodes are also unpredictable and typically occur without a particular trigger.
And as terminal lucidity can be a joyous time for those who witness the episode, it would be unethical for scientists to use that time to conduct their research. At the time of death, it’s also difficult for scientists to interview caregivers about any lucid moments that may have occurred.
Explanations for terminal lucidity extend beyond science. These moments of mental clarity may be a way for the dying person to say final goodbyes, gain closure before death, and reconnect with family and friends. Some believe episodes of terminal lucidity are representative of the person connecting with an afterlife.
Why is it important to know about terminal lucidity?
People can have a variety of reactions to seeing terminal lucidity in a person with advanced dementia. While some will experience it as being peaceful and bittersweet, others may find it deeply confusing and upsetting. There may also be an urge to modify care plans and request lifesaving measures for the dying person.
Being aware of terminal lucidity can help loved ones understand it is part of the dying process, acknowledge the person with dementia will not recover, and allow them to make the most of the time they have with the lucid person.
For those who witness it, terminal lucidity can be a final, precious opportunity to reconnect with the person that existed before dementia took hold and the “long goodbye” began.
Yen Ying Lim, Associate Professor, Turner Institute for Brain and Mental Health, Monash University and Diny Thomson, PhD (Clinical Neuropsychology) Candidate and Provisional Psychologist, Monash University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Winter Wellness – by Rachel de Thample
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Winter is often the season of comfort foods and, in much of the Western world, there’s a holiday season slide of forgotten diets and instead sugar, alcohol, pastry, and the like.
What de Thample does here is an antidote to all that, without sacrificing happiness and celebration.
Before the recipes get started, she has a chapter on “food as medicine“, and to our immense surprise, proceeds to detail, accurately, many categories such as
- Foods for immune health
- Foods against inflammation
- Foods for gut health
- Foods against aging
- Foods for energy levels
- Foods against anxiety
- Foods for hormonal balance
…and so forth, with lists of ingredients that fit into each category.
Then in the rest of the book, she lays out beautiful recipes for wonderful dishes (and drinks) that use those ingredients, without unhealthy additions.
The recipes are, by the way, what could best be categorized as “fancy”. However, they are fancy in the sense that they will be impressive for entertaining, and (again, to our great surprise) they don’t actually call for particularly expensive/rare ingredients, nor for arcane methods and special equipment.Instead, everything’s astonishingly accessible to put together and easy to execute.
Bottom line: if you’d like to indulge this winter, but would like to do so healthily, this is an excellent way to do so.
Click here to check out Winter Wellness, and level-up your seasonal health and happiness!
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Do we really need to burp babies? Here’s what the research says
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Parents are often advised to burp their babies after feeding them. Some people think burping after feeding is important to reduce or prevent discomfort crying, or to reduce how much a baby regurgitates milk after a feed.
It is true babies, like adults, swallow air when they eat. Burping releases this air from the top part of our digestive tracts. So when a baby cries after a feed, many assume it’s because the child needs to “be burped”. However, this is not necessarily true.
Why do babies cry or ‘spit up’ after a feed?
Babies cry for a whole host of reasons that have nothing to do with “trapped air”.
They cry when they are hungry, cold, hot, scared, tired, lonely, overwhelmed, needing adult help to calm, in discomfort or pain, or for no identifiable reason. In fact, we have a name for crying with no known cause; it’s called “colic”.
“Spitting up” – where a baby gently regurgitates a bit of milk after a feed – is common because the muscle at the top of a newborn baby’s stomach is not fully mature. This means what goes down can all too easily go back up.
Spitting up frequently happens when a baby’s stomach is very full, there is pressure on their tummy or they are picked up after lying down.
Spitting up after feeding decreases as babies get older. Three-quarters of babies one month old spit up after feeding at least once a day. Only half of babies still spit up at five months and almost all (96%) stop by their first birthdays.
There’s not much research out there on ‘burping’ babies. antoniodiaz/Shutterstock Does burping help reduce crying or spitting up?
Despite parents being advised to burp their babies, there’s not much research evidence on the topic.
One study conducted in India encouraged caregivers of 35 newborns to burp their babies, while caregivers of 36 newborns were not given any information about burping.
For the next three months, mothers and caregivers recorded whether their baby would spit up after feeding and whether they showed signs of intense crying.
This study found burping did not reduce crying and actually increased spitting up.
When should I be concerned about spitting up or crying?
Most crying and spitting up is normal. However, these behaviours are not:
- refusing to feed
- vomiting so much milk weight gain is slow
- coughing or wheezing distress while feeding
- bloody vomit.
If your baby has any of these symptoms, see a doctor or child health nurse.
If your baby seems unbothered by vomiting and does not have any other symptoms it is a laundry problem rather than something that needs medical attention.
It is also normal for babies to cry and fuss quite a lot; two hours a day, for about the first six weeks is the average.
This has usually reduced to about one hour a day by the time they are three months of age.
Crying more than this doesn’t necessarily mean there is something wrong. The intense, inconsolable crying of colic is experienced by up to one-quarter of young babies but goes away with time on its own .
If your baby is crying more than average or if you are worried there might be something wrong, you should see your doctor or child health nurse.
If your baby likes being ‘burped’, then it’s OK to do it. But don’t stress if you skip it. Miljan Zivkovic/Shutterstock Not everyone burps their baby
Burping babies seems to be traditional practice in some parts of the world and not in others.
For example, research in Indonesia found most breastfeeding mothers rarely or never burped their babies after feeding.
One factor that may influence whether a culture encourages burping babies may be related to another aspect of infant care: how much babies are carried.
Carrying a baby in a sling or baby carrier can reduce the amount of time babies cry.
Babies who are carried upright on their mother or another caregiver’s front undoubtedly find comfort in that closeness and movement.
Babies in slings are also being held firmly and upright, which would help any swallowed air to rise up and escape via a burp if needed.
Using slings can make caring for a baby easier. Studies (including randomised controlled trials) have also shown women have lower rates of post-natal depression and breastfeed for longer when they use a baby sling.
It is important baby carriers and slings are used safely, so make sure you’re up to date on the latest advice on how to do it.
So, should I burp my baby?
The bottom line is: it’s up to you.
Gently burping a baby is not harmful. If you feel burping is helpful to your baby, then keep doing what you’re doing.
If trying to burp your baby after every feed is stressing you or your baby out, then you don’t have to keep doing it.
Karleen Gribble, Adjunct Associate Professor, School of Nursing and Midwifery, Western Sydney University and Nina Jane Chad, Research Fellow, University of Sydney School of Public Health, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Twice-Baked Stuffed Potatoes
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Packed with protein and fiber and dosed with healthy spices, these tasty treats can be enjoyed hot as they are, or cold as part of a salad dinner.
You will need
- 4 large baking potatoes
- 2 cans chickpeas, drained
- 1 can coconut milk
- ½ cup shredded mozzarella cheese, or plant-based alternative
- 1 bulb garlic (sounds like a lot, but this is about three cloves per potato; adjust if you want, though)
- 3 tbsp chopped pickled jalapeños
- 1 tbsp black pepper
- 2 tsp ground cumin
- 2 tsp dried thyme
- 1 tsp onion powder
- Toppings: smoked paprika, finely chopped parsley
Method
(we suggest you read everything at least once before doing anything)
1) Preheat the oven to 400℉ / 200℃.
2) Wash, prick, and bake the potatoes—the latter being for an hour, or until tender.
3) Remove them from the oven and lower the temperature to 350℉ / 175℃.
4) Cut the potatoes lengthways and scoop out the insides into a food processor, leaving enough in the potato that it can hold its shape.
5) Add the remaining ingredients (except the toppings, and half the chickpeas) to the food processor, and blend until smooth.
6) Stuff the filling back into the potato shells (by simple physics of volume, you’ll have a little more than you need, but make it heaped mounds rather than a flat fill-in, and you can probably use most of it, if not all), add the other half of the chickpeas on top and then finally the paprika dusting, and bake for a further 20 minutes.
7) Serve, adding the chopped parsley garnish.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Should You Go Light Or Heavy On Carbs?
- Eat More (Of This) For Lower Blood Pressure
- Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)
- Our Top 5 Spices: How Much Is Enough For Benefits?
Take care!
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Fitness Freedom for Seniors – by Jackie Jacobs
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Exercise books often assume that either we are training for the Olympics, and most likely also that we are 20 years old. This one doesn’t.
Instead, we see a well-researched, well-organized, clearly-illustrated fitness plan with age in mind. Author Jackie Jacobs offers tips and advice for all levels, and a progressive week-by-week plan of 15-minute sessions. This way, we’re neither overdoing it nor slacking off; it’s a perfect balance.
The exercises are aimed at “all areas”, that is to say, improving cardiovascular fitness, balance, flexibility, and strength. It also gives some supplementary advice with regard to diet and suchlike, but the workouts are the real meat of the book.
Bottom line: if you’d like a robust, science-based exercise regime that’s tailored to seniors, this is the book for you.
Click here to check out Fitness Freedom for Seniors, and get yours!
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What Is Making The Ringing In Your Ears Worse?
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Dr. Rachael Cook, an audiologist at Applied Hearing Solutions in Phoenix, Arizona, shares her professional insights into managing tinnitus.
If you’re unfamiliar with Tinnitus, it is an auditory condition characterized by a ringing, buzzing, or humming sound, and ffects nearly 10% of the population. We’ve written on Tinnitus, and how it can disrupt your life, in this article.
Key Triggers for Tinnitus
Several everyday habits can make your tinnitus louder. Caffeine and nicotine increase blood pressure, restricting blood flow to the cochlea and worsening tinnitus. Common medications, such as pain relievers, high-dose antibiotics, and antidepressants, can also exacerbate tinnitus, especially with higher or long-term dosages.
Impact of Diet and Sleep
Dietary choices significantly impact tinnitus. Alcohol and salt alter the fluid balance in the cochlea, increasing tinnitus perception. Alcohol changes blood flow patterns and neurotransmitter production, while high salt intake has similar effects. Poor sleep quality elevates stress levels, making it harder to ignore tinnitus signals. Addressing sleep disorders like sleep apnea and insomnia can help manage tinnitus symptoms.
Importance of Treating Hearing Loss
Untreated hearing loss worsens tinnitus. Nearly 90% of individuals with tinnitus have some hearing loss. Hearing aids can reduce tinnitus perception by restoring missing sounds and reducing the brain’s internal compensatory signals. Combining hearing aids with sound therapy is said to provide even greater relief.
Read more about hearing loss in our article on the topic.
Otherwise, for a great guide on managing tinnitus, we recommend watching Dr. Cook’s video:
Here’s hoping your ear’s aren’t ringing too much whilst watching the video!
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Mythbusting Moldy Food
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Most Food Should Not Be Fuzzy
In yesterday’s newsletter, we asked you for your policy when it comes to mold on food (aside from intentional mold, e.g. blue cheese etc), and the responses were interesting:
- About 49% said “throw the whole thing away no matter what it is; it is dangerous”
- About 24% said “cut the mold off and eat the rest of whatever it is”
- The remainder were divided equally between “eat it all; keep the immune system on its toes” and “cut the mold off bread, but moldy animal products are dangerous”
So what does the science say?
Some molds are safe to eat: True or False?
True! We don’t think this is contentious so we’ll not spend much time on it, but just for the sake of being methodical: foods that are supposed to have mold on, including many kinds of cheese and even some kinds of cured meat (salami is an example; that powdery coating is mold).
We could give a big list of safe and unsafe molds, but that would be a list of names and let’s face it, they don’t introduce themselves by name.
However! The litmus test of “is it safe to eat” is:
Did you acquire it with this mold already in place and exactly as expected and advertised?
- If so, it is safe to eat (unless you have an allergy or such)
- If not, it is almost certainly not safe to eat
(more on why, later)
The “sniff test” is a good way to tell if moldy food is bad: True or False?
False. Very false. Because of how the sense of smell works.
You may feel like smell is a way of knowing about something at a distance, but the only way you can smell something is if particles of it are physically connecting with your olfactory receptors inside you. Yes, that has unfortunate implications about bathroom smells, but for now, let’s keep our attention in the kitchen.
If you sniff a moldy item of food, you will now have its mold spores inside your respiratory system. You absolutely do not want them there.
If we cut off the mold, the rest is safe to eat: True or False?
True or False, depending on what it is:
- Hard vegetables (e.g carrots, cabbage), and hard cheeses (e.g. Gruyère, Gouda) – cut off with an inch margin, and it should be safe
- Soft vegetables (e.g. tomatoes, and any vegetables that were hard but are now soft after cooking) – discard entirely; it is unsafe
- Anything else – discard entirely; it is unsafe
The reason for this is because in the case of the hard products mentioned, the mycelium roots of the mold cannot penetrate far.
In the case of the soft products mentioned, the surface mold is “the tip of the iceberg”, and the mycelium roots, which you will not usually be able to see, will penetrate the rest of it.
“Anything else” seems like quite a sweeping statement, but fruits, soft cheeses, yogurt, liquids, jams and jellies, cooked grains and pasta, meats, and yes, bread, are all things where the roots can penetrate deeply and easily. Regardless of you only being able to see a small amount, the whole thing is probably moldy.
The USDA has a handy downloadable factsheet:
Molds On Food: Are They Dangerous?
Eating a little mold is good for the immune system: True or False?
False, generally. There are of course countless types of mold, but not only are many of them pathogenic (mycotoxins), but also, a food that has mold will usually also have pathogenic bacteria along with the mold.
See for example: Occurrence, Toxicity, and Analysis of Major Mycotoxins in Food
Food poisoning will never make you healthier.
But penicillin is safe to eat: True or False?
False, and also penicillin is not the mold on your bread (or other foods).
Penicillin, an antibiotic* molecule, is produced by some species of Penicillium sp., a mold. There are hundreds of known species of Penicillium sp., and most of them are toxic, usually in multiple ways. Take for example:
Penicillium roqueforti PR toxin gene cluster characterization
*it is also not healthy to consume antibiotics unless it is seriously necessary. Antibiotics will wipe out most of your gut’s “good bacteria”, leaving you vulnerable. People have died from C. diff infections for this reason. So obviously, if you really need to take antibiotics, take them as directed, but if not, don’t.
See also: Four Ways Antibiotics Can Kill You
One last thing…
It may be that someone reading this is thinking “I’ve eaten plenty of mold, and I’m fine”. Or perhaps someone you tell about this will say that.
But there are two reasons this logic is flawed:
- Survivorship bias (like people who smoke and live to 102; we just didn’t hear from the 99.9% of people who smoke and die early)
- Being unaware of illness is not being absent of illness. Anyone who’s had an alarming diagnosis of something that started a while ago will know this, of course. It’s also possible to be “low-level ill” often and get used to it as a baseline for health. It doesn’t mean it’s not harmful for you.
Stay safe!
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