Is there a difference between terminal lucidity and paradoxical lucidity?

Abstract

In the past 36 months, Andrew Peterson received support for travel and research from the Greenwall Faculty Scholars Program, R21-AG-069805, and George Mason University; all payments were made to AP's institution. Justin Clapp: In the past 36 months, Justin Clapp received support from R21-AG-069805, R01-AG-063954, U54-AG-063546; all payments were made to JC's institution. Kristin Harkins: In the past 36 months, Kristin Harkins has no funding or conflicts of interest to report. Melanie Kleid: In the past 36 months, Melanie Kleid has no funding or conflicts of interest to report. Emily A. Largent: In the past 36 months, Emily A. Largent received support from the Greenwall Faculty Scholars Program and K01-AG-O64123; all payments were made to EAL's institution. Emily A. Largent is also on the National Heart, Lung, and BIood Data and Safety Monitoring Board (DSMB) for the Sickle Cell Disease and Cardiovascular Risk-Red Cell Exchange Trial; payments for this service are made to Emily A. Largent. Emily A. Largent is also on the DSMB for the Uterine Transplant for Uterine Factor Infertility Trial at the University of Pennsylvania; no payment is received for this service. Shana D. Stites: In the past 36 months, Shana D. Stites received support from AARF-17-528934 and K23-AG-065442; all payments were made to SDS's institution. Kristin Harkins: Kristin Harkins has no financial interests to disclose. Jason Karlawish: In the past 36 months,

The Importance of the Exceptional in Tackling Riddles of Consciousness and Unusual Episodes of Lucidity

“…She died hours later. According to Barbato (2001, p. 106) Nevertheless, I agree with Peterson et al (2022) in that the characterization of terminal lucidity as occurring "before death" or "shortly before death" is not (yet) properly elaborated and open to subjective line-drawing. This precisely mirrors the situation regarding the term "paradoxical" and constitutes one reason why I used gradual shading to illustrate the onset of terminal and paradoxical lucidity episodes in Fig.…”

“…2) In order to support their argument that there would be no evidence for terminal lucidity in people without brain conditions even in my own publications, Peterson et al (2022) referred to the two already mentioned publications in which terminal lucidity was introduced as the unexpected return of mental clarity before death in patients suffering from psychiatric and neurologic disorders (Nahm & Greyson, 2014;Nahm et al, 2012). Simultaneously, they disregarded all other sources in which my co-authors and I defined terminal lucidity in general terms and in agreement with my clarification.…”

“…Commenting on my clarification of the matters (Nahm, 2022), Peterson et al (2022) nevertheless repeated their proposition that all cases of terminal lucidity must be regarded as instances of paradoxical lucidity. They argued there would be no evidence for terminal lucidity in people without psychiatric or neurological brain conditions -not even in my own publications.…”

“…We argued that "some patients with severe dementia might also experience a surge of neurophysiological activity before death, which is manifested as a lucid episode" (Mashour et al, 2019, p. 3) 2 . But because such surges in rodents without neurological conditions would be even more likely to occur also in humans without neurological conditions, one wonders a fortiori on what grounds Karlawish and his co-authors deny the existence of evidence for terminal lucidity in people without neurological conditions (Peterson et al, 2022).…”

“…Rather, it is my hope that just as researchers are now attempting to define the term "paradoxical" more precisely in the context of research projects addressing lucid episodes in dementias, a refined definition of the term "terminal" will also be developed in future. Peterson et al (2022) furthermore criticized that a "causal story relating the dying process to the lucid moment" is lacking in my current definition of terminal lucidity. Again, I agree with them in that such a causal relation needs to be captured in refined future definitions -and in fact, my explicit characterization of terminal lucidity being "process-related" (Nahm, 2022) ter displaying an unexpected episode of lucidity, as the subject in a hypothetical example they presented, does not match my criteria for terminal lucidity.…”