Lucidity in the Context of Advanced Neurodegenerative Disorders: A Concept Analysis

Abstract

Individuals with advanced dementias resulting from neurodegenerative disorders (NDs) occasionally surprise caregivers with episodes of clarity and cognitive function that are not usually present. Lucid episodes—aptly named paradoxical lucidity in the literature—seem to involve a return of the “old self” during advanced neurodegenerative changes. Lucid episodes pose a problem for theories of neurological degeneration, which position dementias as progressive, incurable, and irreversible. In addition, lucid episodes raise ethical questions about whether information gleaned during lucid episodes is appropriate to direct future patient-centered care. The concept requires analysis and clarification if it is to guide future theorizing and research. The underlying goals of the current concept analysis are twofold: (a) to clarify the meaning of lucidity in the context of advanced NDs; and (b) to develop a theoretical definition that can guide future practice, research, and policy development. Walker and Avant's method is used to identify uses of the concept, defining attributes, antecedents, consequences, and empirical referents. [ Journal of Gerontological Nursing, 46 (12), 42–50.]

Toward harmonization of strategies for investigating lucidity in AD/ADRD: A preliminary research framework

“…Meta-awareness or insight into one's own situation and condition has been identified by some as a key attribute of ELs. 11 Meta-awareness and insight are not explicitly addressed in the provisional definition of Mashour et al, but may be implied in "connectedness," contingent upon how one interprets that attribute. 1 Peterson et al suggest a broad interpretation of connectedness that may not just define the person with AD/ADRD's sense of connection to their milieu.…”

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

“…Following initial publications that highlighted new fields of research in dementia diseases (Eldadah et al, 2019;Mashour et al, 2019), six research projects with a funding volume of about two million dollars have lately been launched by the National Institute of Health (NIH, 2020). Furthermore, several recent publications have examined lucid episodes in dementias from different angles (Bostanciklioğlu, 2021;Gilmore-Bykovskyi et al, 2021;Morris & Bulman, 2020Ney et al, 2021;Peterson et al, 2021). However, there seems to exist uncertainty regarding the precise understanding of the concept of terminal lucidity.…”

“…Characterizing paradoxical lucidity, that is episodes of lucidity in the context of advanced neurodegenerative disorders, would then require additional specifications, such as the "key attributes" suggested by Morris and Bulman (2020).…”

What is paradoxical lucidity? The answer begins with its definition

“…Second, some might argue that our conceptual analysis is premature. According to this view, refining the definition of paradoxical lucidity ought to be data‐driven, akin to the survey methods used by Morris and Bulman 14 . More data are needed to make substantive refinements that advance the field, not the theorizing we have outlined here.…”

“…There are at least two approaches to refining the definition of paradoxical lucidity. One approach, used by Morris and Bulman, 14 surveys extant literature to identify conceptual similarities, or “concept clusters,” in how paradoxical lucidity is described. This data‐driven approach seeks consensus.…”