Paradoxical lucidity: A potential paradigm shift for the neurobiology and treatment of severe dementias

George A. Mashour, Lori Frank, Alexander Batthyany, Ann Marie Kolanowski, Michael Nahm, Dena Schulman-Green, B. Greyson, Serguei Pakhomov, J. Karlawish, R. C. Shah

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


Unexpected cognitive lucidity and communication in patients with severe dementias, especially around the time of death, have been observed and reported anecdotally. Here, we review what is known about this phenomenon, related phenomena that provide insight into potential mechanisms, ethical implications, and methodologic considerations for systematic investigation. We conclude that paradoxical lucidity, if systematically confirmed, challenges current assumptions and highlights the possibility of network-level return of cognitive function in cases of severe dementias, which can provide insight into both underlying neurobiology and future therapeutic possibilities.

Original languageEnglish (US)
Pages (from-to)1107-1114
Number of pages8
JournalAlzheimer's and Dementia
Issue number8
StatePublished - Aug 2019

Bibliographical note

Funding Information:
The authors thank Basil A. Eldadah, MD, PhD, as well as his team members from the National Institute on Aging for catalyzing and supporting discussions related to lucidity in dementia.

Publisher Copyright:
© 2019 The Authors


  • Alzheimer's disease
  • Cognition
  • Consciousness
  • Dementia
  • End-of-life care
  • Lucidity
  • Recovery


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