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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Sunflower Corn Burger
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Burgers are rarely a health food, but in this case, everything in the patty is healthy, and it’s packed with protein, fiber, and healthy fats.
You will need
- 1 can chickpeas
- ¾ cup frozen corn
- ½ cup chopped fresh parsley
- ⅓ cup sunflower seeds
- ⅓ cup cornichon pickles
- ⅓ cup wholegrain bread crumbs (gluten-free, if desired/required)
- ¼ bulb garlic (or more if you want a stronger flavor)
- 1 tbsp extra virgin olive oil, plus more for frying
- 1 tbsp nutritional yeast (or 1 tsp yeast extract)
- 2 tsp ground cumin
- 2 tsp red pepper flakes
- 2 tsp black pepper, coarse ground
- 1 tsp Dijon mustard
- To serve: 4 burger buns; these are not usually healthy, so making your own is best, but if you don’t have the means/time, then getting similarly shaped wholegrain bread buns works just fine.
- Optional: your preferred burger toppings, e.g. greenery, red onion, tomato slices, avocado, jalapeños, whatever does it for you
Note: there is no need to add salt; there is enough already in the pickles.
Method
(we suggest you read everything at least once before doing anything)
1) Combine all the ingredients except the buns (and any optional toppings) in a food processor, pulsing a few times for a coarse texture (not a purée).
2) Shape the mixture into 4 burger patties, and let them chill in the fridge for at least 30 minutes.
3) Heat a skillet over a medium-high heat with some olive oil, and fry the burgers on both sides until they develop a nice golden crust; this will probably take about 4 minutes per side.
4) Assemble in the buns with any toppings you want, and serve:
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Sunflower Seeds vs Pumpkin Seeds – Which is Healthier? ← pumpkin seeds have more micronutrients; sunflower seeds have more healthy fats; feel free to use either or both in this recipe
- What Omega-3 Fatty Acids Really Do For Us
- Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)
- Making Friends With Your Gut (You Can Thank Us Later)
- Our Top 5 Spices: How Much Is Enough For Benefits?
Take care!
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Optimal Black Pepper Dosage and Supplement
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝I may have missed it, but how much black pepper provides benefits?❞
So, for any new subscribers joining us today, this is about two recent main features:
As for a daily dosage of black pepper, it varies depending on the benefit you’re looking for, but:
- 5–20mg of piperine is the dosage range used in most scientific studies we looked at
- 10mg is a very common dosage found in many popular supplements
- That’s the mass of piperine though, so if taking it as actual black pepper rather than as an extract, ½ teaspoon is considered sufficient to enjoy benefits.
❝I loved the health benefits of pepper. I do not like pepper. Where can I get it as a supplement?❞
You can simply buy whole black peppercorns and take a few with water as though they were tablets. Your stomach acid will do the rest. Black pepper is also good for digestion, so taking it with a meal is best.
You can buy piperine (black pepper extract) by itself as a supplement in powder form, but if you don’t like black pepper, you will probably not like this powder either. We couldn’t find it readily in capsule form.
You can buy piperine (black pepper extract) as an adjunct to other supplements, with perhaps the most common/popular being turmeric capsules that also contain 10mg (or more) piperine per capsule. Shop around if you like, but here’s one that has 15mg piperine* per capsule, for example.
*They call it “Bioperine®” but that is literally just piperine. Same go
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Your Brain on Art – by Susan Magsamen & Ivy Ross
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The notion of art therapy is popularly considered a little wishy-washy. As it turns out, however, there are thousands of studies showing its effectiveness.
Nor is this just a matter of self-expression. As authors Magsamen and Ross explore, different kinds of engagement with art can convey different benefits.
That’s one of the greatest strengths of this book: “this form of engagement with art will give these benefits, according to these studies”
With benefits ranging from reducing stress and anxiety, to overcoming psychological trauma or physical pain, there’s a lot to be said for art!
And because the book covers many kinds of art, if you can’t imagine yourself taking paintbrush to canvas, that’s fine too. We learn of the very specific cognitive benefits of coloring in mandalas (yes, really), of sculpting something terrible in clay, or even just of repainting the kitchen, and more. Each thing has its set of benefits.
The book’s main goal is to encourage the reader to cultivate what the authors call an aesthetic mindset, which involves four key attributes:
- a high level of curiosity
- a love of playful, open-ended exploration
- a keen sensory awareness
- a drive to engage in creative activities
And, that latter? It’s as a maker and/or a beholder. We learn about what we can gain just by engaging with art that someone else made, too.
Bottom line: come for the evidence-based cognitive benefits; stay for the childlike wonder of the universe. If you already love art, or have thought it’s just “not for you”, then this book is for you.
Click here to check out Your Brain On Art, and open up whole new worlds of experience!
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When BMI Doesn’t Measure Up
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When BMI Doesn’t Quite Measure Up
Last month, we did a “Friday Mythbusters” edition of 10almonds, tackling many of the misconceptions surrounding obesity. Amongst them, we took a brief look at the usefulness (or lack thereof) of the Body Mass Index (BMI) scale of weight-related health for individuals. By popular subscriber request, we’re now going to dive a little deeper into that today!
The wrong tool for the job
BMI was developed as a tool to look at large-scale demographic trends, stemming from a population study of white European men, who were for the purpose of the study (the widescale health of the working class in that geographic area in that era), considered a reasonable default demographic.
In other words: as a system, it’s now being used in a way it was never made for, and the results of that misappropriation of an epidemiological tool for individual health are predictably unhelpful.
If you want to know yours…
Here’s the magic formula for calculating your BMI:
- Metric: divide your weight in kilograms by your height in square meters
- Imperial: divide your weight in pounds by your height in square inches and then multiply by 703
“What if my height doesn’t come in square meters or square inches, because it’s a height, not an area?”
We know. Take your height and square it anyway. If this seems convoluted and arbitrary, yes, it is.
But!
While on the one hand it’s convoluted and arbitrary… On the other hand, it’s also a gross oversimplification. So, yay for the worst of both worlds?
If you don’t want to grab a calculator, here’s a quick online tool to calculate it for you.
So, how did you score?
According to the CDC, a BMI score…
- Under 18.5 is underweight
- 18.5 to 24.9 is normal
- 25 to 29.9 is overweight
- 30 and over is obese
And, if we’re looking at a representative sample of the population, where the representation is average white European men of working age, that’s not a bad general rule of thumb.
For the rest of us, not so representative
BMI is a great and accurate tool as a rule of thumb, except for…
Women
An easily forgotten demographic, due to being a mere 51% of the world’s population, women generally have a higher percentage of body fat than men, and this throws out BMI’s usefulness.
If pregnant or nursing
A much higher body weight and body fat percentage—note that these are two things, not one. Some of the extra weight will be fat to nourish the baby; some will be water weight, and if pregnant, some will be the baby (or babies!). BMI neither knows nor cares about any of these things. And, this is a big deal, because BMI gets used by healthcare providers to judge health risks and guide medical advice.
People under the age of 16 or over the age of 65
Not only do people below and above those ages (respectively) tend to be shorter—which throws out the calculations and mean health risks may increase before the BMI qualifies as overweight—but also:
- BMI under 23 in people over the age of 65 is associated with a higher health risk
- A meta-analysis showed that a BMI of 27 was the best in terms of decreased mortality risk for the over-65 age group
This obviously flies in the face of conventional standards regards BMI—as you’ll recall from the BMI brackets we listed above.
Read the science: BMI and all-cause mortality in older adults: a meta-analysis
Athletic people
A demographic often described in scientific literature as “athletes”, but that can be misleading. When we say “athletes”, what comes to mind? Probably Olympians, or other professional sportspeople.
But also athletic, when it comes to body composition, are such people as fitness enthusiasts and manual laborers. Which makes for a lot more people affected by this!
Athletic people tend to have more lean muscle mass (muscle weighs more than fat), and heavier bones (can’t build strong muscles on weak bones, so the bones get stronger too, which means denser)… But that lean muscle mass can actually increase metabolism and help ward off many of the very same things that BMI is used as a risk indicator for (e.g. heart disease, and diabetes). So people in this category will actually be at lower risk, while (by BMI) getting told they are at higher risk.
If not white
Physical characteristics of race can vary by more than skin color, relevant considerations in this case include, for example:
- Black people, on average, not only have more lean muscle mass and less fat than white people, but also, have completely different risk factors for diseases such as diabetes.
- Asian people, on average, are shorter than white people, and as such may see increased health risks before BMI qualifies as overweight.
- Hispanic people, on average, again have different physical characteristics that throw out the results, in a manner that would need lower cutoffs to be even as “useful” as it is for white people.
Further reading on this: BMI and the BIPOC Community
In summary:
If you’re an average white European working-age man, BMI can sometimes be a useful general guide. If however you fall into one or more of the above categories, it is likely to be inaccurate at best, if not outright telling the opposite of the truth.
What’s more useful, then?
For heart disease risk and diabetes risk both, waist circumference is a much more universally reliable indicator. And since those two things tend to affect a lot of other health risks, it becomes an excellent starting point for being aware of many aspects of health.
Pregnancy will still throw off waist circumference a little (measure below the bump, not around it!), but it will nevertheless be more helpful than BMI even then, as it becomes necessary to just increase the numbers a little, according to gestational month and any confounding factors e.g. twins, triplets, etc. Ask your obstetrician about this, as it’s beyond the scope of today’s newsletter!
As to what’s considered a risk:
- Waist circumference of more than 35 inches for women
- Waist circumference of more than 40 inches for men
These numbers are considered applicable across demographics of age, sex, ethnicity, and lifestyle.
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Women’s Strength Training Anatomy Workouts – by Frédéric Delavier
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We’ve previously reviewed another book of Delavier’s, “Women’s Strength Training Anatomy“, which itself is great. This book adds a lot of practical advice to that one’s more informational format, but to gain full benefit of this one does not require having read that one.
A common reason that many women avoid strength-training is because they do not want to look muscular. Largely this is based on a faulty assumption, since you will never look like a bodybuilder unless you also eat like a bodybuilder, for example.
However, for those for whom the concern remains, today’s book is an excellent guide to strength-training with aesthetics in mind as well as functionality.
The exercises are divided into sections, thus: round your glutes / tone your quadriceps / shape your hamstrings / trim your calves / flatten your abs / curve your shoulders / develop a pain-free upper back / protect your lower back / enhance your chest / firm up your arms.
As you can see, a lot of these are mindful of aesthetics, but there’s nothing here that’s antithetical to function, and some (especially for example “develop a pain-free upper back” and “protect your lower back“) are very functional indeed.
Bottom line: Delavier’s anatomy and exercise books are top-tier, and this one is no exception. If you are a woman and would like to strength-train (or perhaps you already do, and would like to refine your training), then this book is an excellent choice.
Click here to check out Women’s Strength Training Anatomy Workouts, and have the body you want!
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Ready… Set… Flow!
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Time to make your new year plans? Or maybe you’ve already made a list, and you’re checking it twice. If so, now’s the time to make sure that your new year’s plans will flow:
“Flow”, as you may be aware, is the psychological state generally defined as “a state in which we feel good about what we’re doing, and just keep doing it, at a peak performance level”; the term was coined by psychologist Mihaly Csikszentmihalyi and has risen to popularity since.
We wrote about it a little before, here:
Morning Routines That Just Flow
The above article details how to start the perfect day, but how to start the perfect year? Firstly, it’s good to get the jump on the new year a little; see:
The Science Of New Year’s Pre-Resolutions
…and we also agree with Dr. Faye Bate, who preaches taking the path of least resistance when it comes to healthy habits:
How To Actually Start A Healthy Lifestyle In The New Year
Because…
Getting into the flow
The most hydrating drink is the one that [contains adequate water and] you will actually drink. The best exercise is the one you’ll do. The best sleep is the sleep you can actually get. And so on.
We see this—or rather its evil counterpoint—a lot in diet culture. People frame their willpower against the temptations of donuts and whatever, and make Faustian bargains whereby they will eat food they find boring in the hopes it will bring them good health. And it won’t. Because, they’ll give up quickly.
Instead, each part of our healthy life has to be engaged with with a sense of flow. Again, that’s: “a state in which we feel good about what we’re doing, and just keep doing it, at a peak performance level”
So we need to find healthy recipes we like (check out our recipe section!), we need to find exercise that we like, we need to find an approach to sleep that the Geneva Convention wouldn’t consider a kind a torture, and so forth. And, ideally, not just “like” in the sense of “this is tolerable” but “like” in the sense of “I am truly passionate about this thing”.
And that’s going to look different for each of us.
Running is a great example of something that some people truly love, whereas others will do almost anything to avoid.
And food? We’ve written before about the usefulness of a “to don’t” list; it’s like a “to do” list, but it’s things we’re not going to even try to do. For example, a person with two addictions is usually advised to quit one at a time, so quitting the other would go on a “to don’t” list for now. The same goes for food; you need to enjoy what you’re eating or you won’t “feel good about what we’re doing, and just keep doing it”, per flow. So, do not deprive yourself; it won’t work anyway; just pick one healthy change to make, and then queue up any other changes for once the first one has started feeling natural to you.
For more on “to don’t” lists and other such tricks, see: How To Keep On Keeping On… Long Term!
Staying in the flow
…is not usually a problem, you would think, because “…and just keep doing it, at peak performance level” but the fact is, sometimes we get kicked out of our flow by something external. We covered some of that in the above-linked “How To Keep On Keeping On” article, such as figuring out showstoppers in advance (for example, “if I get an injury, I will rest until it is healed”) and ideally, back-up plans.
For example, let’s say you have your dietary plan all worked out, then you are invited to someone’s birthday celebration a couple of weeks in, and you don’t want to rain on their parade, so you figure out for yourself in advance how you are going to mitigate any harm to your plans, e.g. “I will simply choose the healthiest option available, and not worry if it doesn’t meet my usual standards” or “I will simply fast” if that’s an appropriate thing for you (for some it might be, for some it might not be).
For more on this, see:
How To Avoid Slipping Into (Bad) Old Habits
Take care!
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