On Intermittent Lucidity
When Others Think They're Fine
It happened more than once. Someone that knew him well would call, talk with him on the phone, and later say to me that he sounded normal. Usually in the morning which was his best time by far.
If I was feeling tired or guilty or depressed or all three, I would interpret that as “you must be exaggerating.” Personalize it. And the closer that person was to him, the more it felt like an attack.
It happens to people with Alzheimer’s the same way as any other progressive disease. Heart failure—some days the pump works better than others. Plain old arthritis, some days fine, other super achy.
So, what’s up with intermittent lucidity?
Neuromodulation. Several chemicals in the brain can improve cognitive clarity, including dopamine or acetylcholine. A partially functioning brain can intermittently optimize communication when these chemicals are at the right level. The drug Aricept optimizes levels of acetylcholine for example.
Energy Redistribution. I’ve talked before about the amazing statistic that the brain makes up only 2% of body weight but requires 25% of the glucose we ingest to run all the processes in the brain. The brain circuitry may redistribute it’s energy for short periods of time to power cognition.
Reduction in Neuroinflammation. Intermittent reduction in inflammatory chemicals bathing the brain may provide windows of cognitive improvement either naturally or through medical intervention.
Triggers. Emotional or sensory triggers like talking to a family member or hearing a favorite song can stimulate the area of the brain responsible for recognition of memories, facilitating short periods of improved cognitive function.
Resilience. There is an area of intense discussion around why some brains appear to compensate for the destructive processes underway from the amyloid and tau proteins. This could be behind the intermittent lucidity.
As the primary caregiver, of course I saw the the ups and downs. In retrospect I know those times he was lucid were gifts. The folks that saw or talked to him in those moments probably triggered one of these mechanisms above to compensate for the damage in his brain.
And my awareness of what was happening in his brain, helped to soothe the personal pain as I continue my recovery from dementia caregiving. It really is a kind of trauma that co-exists with grief.
Give yourself grace.
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Reading what you write Ana is so helpful, thinking back over my mothers last two years before she died and now with my mother-in-law who is rapidly declining but at the same time exhibiting profound intermittent lucidity. My husband and his brother are having a very hard time coming to terms not only with whether what is happening is actually happening but with all the issues surrounding “now what do we do?” I try to contribute what I learn from you but I have to maintain a “take what you like and leave the rest” position or go crazy. They have so much to sort out as brothers and as sons. Thank you for your work. It means a lot to me personally AND it matters. So many people need this information. You make it so accessible. 🙏
Stuart’s mother while deep into dementia had a period of 24 hours of clarity. Her family home didn't contact me until she was 12 hours into that period. I immediately visited her and heard stories of her childhood: how her parents met, her horse Lady, how mama loved to read, and her love for little brother Sunny. The next day, all that lucidity was gone.