Have any of you watched the movie “The Notebook”? At the end, one of the characters, who has dementia, experiences an episode of lucidity. When I watched it, between tears (I’m a complete softie) I remember thinking, “Oh no! This will give people false hope! That their loved one is ‘in there.’ If only they could find the right key to unlock the lock and let them out.”

Today we talk about lucid episodes and what they might mean to the person with dementia, their family and loved ones, to philosophers, to clinicians, to neuroscientists. Our guests are Andrea Gilmore-Bykovskyi, a nurse researcher, and Andrew Peterson, a philosopher.

We had a wide ranging discussion that touched on (among many things):

• A consensus definition developed at an NIH conference, organized by the recently retired NIA program officer Basil Eldadah (we will miss you Basil!).

• Andrew complicates this definition, stating is raises more questions than answers.

• Hospice nurses know that terminal lucidity “is a thing” and have pretty much all seen it

• Family and caregiver stories of lucid episodes and what they meant to them, including early glimpses into a study Andrea is doing using video to capture episodes and show them to family.

• Potential for experiences to elicit “false hope”, misunderstanding/misinterpreting, and changing say code status from DNR to full code (rare but happens).

• Sam Parnia’s work on brain activity during CPR and near death episodes

• Ethical issues these lucid episodes raise

• Should clinicians treat people with dementia as always lucid? Having some level of awareness?

• Parallels between how we treat people with advanced dementia, who may or may not be lucid, and how we treat AI, who may or may not be conscious, or experiencing paradoxical lucidity on their way to full consciousness. I try to say please and thank you to the AI I interact with other than Alexa, who is obviously way behind.

• The Age of Aging podcast episode on lucidity, featuring Anne Bastings, Jason Karlawish, Elizabeth Donnarumma, and Justin Clapp

• Was Andrew’s song choice, “I can see clearly now” better than Eric’s suggestion “Silent Lucidity” by Queensryche?

Enjoy!

-Alex Smith