The unexpected return of mental clarity and memory shortly before death is a curious phenomenon that has so far received only little attention. I refer to this phenomenon as Terminal Lucidity.


The most remarkable cases involve patients whose brains were destroyed by diseases such as tumors and Alzheimer’s disease, but who seemed to recover shortly before death with their memory being intact.

Despite their potential to trigger the development of new forms of therapies and to contribute to an enhanced understanding of cognition, memory processing, and the nature of the human mind, terminal lucidity in patients with psychiatric and neurologic disorders was largely ignored by psychiatrists and other physicians.

Moreover, Terminal Lucidity often comes as a complete surprise to those who attend the dying, and thus, they might miss the last opportunity to optimally relate to a dying loved one who was non-responsive for a long time, sometimes for years.






To stimulate research into this fascinating phenomenon, and to bring it to the attention of physicians, laypersons, and those who attend dying persons, I wrote a book and different papers on Terminal Lucidity, some of them together with Bruce Greyson and Emily Kelly of the University of Virginia, and with Erlendur Haraldsson of the University of Iceland.



  
    >>The events of terminal lucidity even in Alzheimer patients who were barely conscious, who were barely
   responsive, well, we hear them all the time. How suddenly a patient can, just before death, say their
   goodbyes to their loved ones, remembering their names, maybe recalling an event after a decade or so of
   not learning, of having lost first their short term memory and then their long term memory.
   It is a complete mystery. […] But it is undeniable that it happens, and it is amazing.<<

                                                             Harvard Alzheimer's disease specialist Rudolph Tanzi (2012)





Examples of Terminal Lucidity



Example involving Alzheimer's disease

A 91-year old woman suffered from Alzheimer's disease for 15 years and was cared for by her daughter. The woman was unresponsive since long and showed no sign of recognizing her daughter or anybody else for five years. One evening, however, she started a normal conversation with her daughter. She talked about her fear of death, difficulties she had with the church, and her family members. She died a few hours later.
                                                                                                                               (case reported to me in person)

                                               

                                      Example involving brain tumors                                              

A young man suffered from lung cancer that had spread to his brain. Toward the end of his life, a brain scan showed little brain tissue left, the metastasized tumors having destroyed and replaced it. In the days before his death, he lost all ability to speak or move.  According to a nurse and his wife, however, an hour before he died, he woke up and said good-bye to his family, speaking with them for about five minutes and patting their hands before losing consciousness again and dying.

                                                                                                                                                        (Haig, 2007)

Example involving strokes
 
A woman aged 91 suffered from two strokes. The first stroke paralyzed her left side and deprived her of clear speech. After a few months, the second stroke rendered her entirely paralyzed and speechless. A daughter cared for her. An exclamation from her mother brought her to instant attention. The old woman’s face was smiling brightly, although her facial expression had been frozen since her second stroke. She turned her head and sat up in bed with no apparent effort. Then, she raised her arms and exclaimed in a clear, joyous tone the name of her husband. Her arms dropped again, she sank back and died.

                                                                                                                                                         (Noyes, 1952)



 Publications on Terminal Lucidity


 Book:

Nahm M (2012). Wenn die Dunkelheit ein Ende findet. Terminale Geistesklarheit und andere Phänomene in Todesnähe.
       Amerang: Crotona; 286 pp.


Articles and book chapters:

Nahm M, Greyson B (2013-2014). The death of Anna Katharina Ehmer. A case study in terminal lucidity. Omega, 68, 77-87.

Nahm M (2013). Terminale Geistesklarheit und andere Rätsel des menschlichen Bewusstseins. In: Serwaty A, Nicolay J (eds).
       Nahtoderfahrung und Bewusstseinsforschung. Goch: Santiago, pp. 78-134.

Nahm M, Greyson B, Kelly EW, Haraldsson E (2012). Terminal lucidity: A review and a case collection. Archives of Gerontology
       and Geriatrics, 55, 138-142.

Nahm M, Greyson B (2009). Terminal lucidity in patients with chronic schizophrenia and dementia: A Survey of the Literature.
       Journal of Nervous and Mental Disease, 197, 942-944.

Nahm M, Haraldsson E (2009). Geistige Klarheit von psychisch kranken Menschen kurz vor dem Tod. Tattva Viveka, 40, 70-75.

Nahm M (2009). Terminal lucidity in people with mental illness and other mental disability: An overview and implications for
       possible explanatory models. Journal of Near-Death Studies, 28, 87-106.