Lucid Moments, Fluctuating Awareness and Dementia
I recall a psychiatric nurse telling me about a patient with dementia who had not spoken for years and appeared to show little awareness of changing circumstances. They were on a trip out from the hospital and the bus they were sitting in was backing up very near a sheer drop. The patient suddenly swore and cried out that the driver should '....... stop or we will all die.' Everyone was shocked.
Most caregivers will be able to tell you about a patient or loved one with dementia who suddenly has lucid moments. They seem more aware of themselves, their surroundings and are able to express and communicate themselves in ways they used to.
These apparent fluctuations in their features of dementia can at times be explained simply. Tiredness, mood changes, the effects of drugs or changes in their physical health, can all influence episodes where people do something with meaning and clarity. At other times the reasons seem less obvious.
When I worked with people with acquired brain damage one patient's level of consciousness dramatically changed when he was taken on funfair rides. He was able to chat to people and enjoy himself. At other times his lucid moments resulted in violence. These changes were thought to be a result of improved blood flow to areas of the brain when he was physically flung about on the rides. It is true that appropriate drug treatments for older people cardiac and vascular problems can improve both skills and cognitive performance.
It has been suggested that periods of lucidity and fluctuating awareness may be due to a 'complex constellation of factors' that need to coincide to show their greater awareness and allow the person with dementia to express themselves properly. There are the internal factors like mood and it is suggested even dreams might be a factor. Then there are external factors such as physical environments and the behaviour of others.
For the caregiver these lucid episodes, these flashes of the person prior to their illness, a moment of humor, sudden recognition of family members or friends, an insightful remark about a situation or person, can be a great joy. For other caregivers it can be disturbing and confusing. Does the ability to communicate during lucid moments demonstrate awareness of their situation, their deteriorating physical and mental state than previously supposed? Does it mean they may be tortured souls stuck in some sort of awful limbo of changed consciousness?
Having worked in this area over many years I do not subscribe to occasional lucidity equating to someone in a state of great unhappiness for long periods. It does highlight the need for caregivers to always keep up your levels of communication, to provide people with dementia with as stimulating a life as possible and to continue treating them with respect, love and kindness.
Killick J. Allen K. 2002. Communication and the Care of People with Dementia. Open University Press, Philadelphia.