I have often cared for people with advanced dementia syndromes or serious brain injuries, where families and staff may question if the person is still present. The GeriPal podcast, posted May 29, titled “Lucid Episodes” ( https://geripal.org/lucid-episodes-andrea-gilmore-bykovskyi-andrew-peterson/) explored the many facets of what may become of “personhood” when major cognitive impairment becomes severe and irreversible. Out of respect for the person, I have counseled families to assume the person can still appreciate their presence, touch, and verbal communication, even when no response may be evident. 

Occasionally, there are moments of unexpected lucidity, with many examples given in this podcast. For my wife and mother-in-law, this occurred just before my father-in-law died. He had been deeply unresponsive for 5 days and had been expected to die days before he did. On the morning of his death, he awakened, looked at my mother-in-law, said “I love you,” then died almost immediately after that. This gift of lucidity has forever been a cherished memory in our family. A good friend related a similar story of his father’s unexpected lucidity before death, where he began singing “Great is Thy Faithfulness” and his family joined in. At the end of the hymn, he died. 

The evolving literature on moments of lucidity is fascinating, with much yet to be discovered and obvious challenges in research techniques. The examples I just shared are much more likely to be detected by families than by providers or non-family caregivers. Sometimes these moments may cause alarm in a decisionmaker, who may interpret the episode of lucidity as an improved prognosis and may even consider requesting a change from comfort-focused treatment back to aggressive, life-prolonging medical interventions. These moments may have external meaning to the observer but may also be an expression of internal concerns for the person who is cognitively impaired. 

As the medical director of a small hospice, I often encounter families who question whether their loved one "is still there." I prefer to answer this question in the affirmative, or at least not to give a flat “no” answer, because we really do not know. While unexpected moments of lucidity are infrequent, I suspect many of our readers have experienced or heard about such pre-death interludes, and I believe they are worth hoping for (but not expecting), as they can be such a blessing to families and caregivers.