Terminal lucidity: why do some critically ill patients suddenly recover before dying? | infodesk4n

 When Elita Porto Reis died at the age of 70, she was living off the support of the people and, with Alzheimer's disease, she needed the help of the people around her to carry out basic daily activities.

Towards the end of her life, her illness had become so severe that she was unable to eat or drink on her own and she needed help with washing and changing. She could hardly recognize anyone.

However, in the last days of her life, her condition began to improve.

"One day suddenly she started talking to my mother," said her niece Samantha. We felt like they remembered everything. Although my grandmother has always had a strong personality, she has forgotten who she is due to her illness, but in the last few days she seems to have come back to life.

This return also had a special meaning for her daughter Anna Lucia.

"She lovingly assured my mom that she would be okay on the 31st," recalled Samantha. My mother was crying a lot because she didn't want to lose them. And then on August 31, 2011 she died. "

"In a way, she helped my mom a lot because she was able to satisfy her desire for her mother of hers. She was able to sit with him again, talk to him and say hello.

Dr Frederico Fernández of the University of Sao Paulo (USP) is not surprised to hear this story, as he claims that "everyone who works in hospitals has a similar story".

A 2008 survey of hospital staff in the UK found that seven out of ten employees noticed a slight improvement in their health just days before the deaths of patients with dementia or mental illness.

Different terms have appeared in different languages ​​and times to describe such a phenomenon, but it remains an indescribable topic for science. It was called Improvement Before Death, Last Goodbye, Enlightenment Before Death, End of Life, Healthcare Visit, Improvement of Goodbye, Episodes of Perseverance, Contradictory Relaxation, Terminal Relaxation or Last Sunbeams in Chinese

But in some chronic disease patients, even in the recent Code 19, the pattern was observed in some people who died from the virus, meaning they felt better for some time before death.

 

Transcendental subject

This question has been going on since the time of the Greek physician Hippocrates, born in the 4th century BC. C., Hippocrates is considered the founder of medicine.

Hippocrates and other ancient Greek physicians believed that a person's soul retains its identity and that, in fact, it is the brain that is affected by any physical ailment (i.e. no physical disease affects the human soul).

Explaining this to THE NEWS AGENCY Brazil, German biologist Michael Neiham said: "He believed that as soon as death comes, the soul regains its full potential and frees itself from material limitations."

Michael coined the term "terminal leukemia" to refer to the mental retardation and recovery of people with mental illness shortly before death, based on hundreds of years of historical fiction.

Although there are many hypotheses regarding this that offer explanations for events that occurred before death, none of these hypotheses have been formally tested to date to determine whether or not they are true.

One hypothesis is based on a chemical reaction in critically ill patients that explains a survival problem before death.

 

As well as the persistence of consciousness during an opportunity or death. Or confirmation bias means that people are dying all the time, but we remember the wonderful stories of people who got better before they died.

There are many obstacles, including ethics, in examining these assumptions, such as invasive examination in critically ill patients, but what is the importance of understanding all of this?

For Nehemiah, theoretical studies can open the door to understanding the mechanisms surrounding memory as it moves away from the nervous system.

"If memories are not just stored in the brain, it certainly increases our understanding of memory processing and the human brain, because it cannot be considered a product of stimulus neurons alone."

 

What do the studies say?

Researchers and experts say that fluctuations in consciousness are common in patients with dementia in the early or moderate stages of the disease.

Researchers and experts say that fluctuations in consciousness are common in patients with moderate-stage dementia from the onset of the disease.

Most studies and reports on this topic focus on patients with neurodegenerative diseases, but they also include people who have had tumors, brain abscesses, meningitis, lung disease, coma or stroke.

And this sudden improvement isn't always on the verge of death.

In 2009, Michael Neham and Bruce Grayson of the Department of Psychiatry and Neuro-Visual Sciences at the University of Virginia in the United States collected 49 cases described in the medical literature.

Such a small sample does not provide broad conclusions on the subject, but it does provide some clues.

Of the 49 cases, 43% had a sudden improvement the day before death, 41% had a two-day improvement, and 19% had an improvement within 8-30 days.

 

Most dementia patients have Alzheimer's disease.

A study by Alexander Bathini, a philosopher and scientist from Hungary, Austria, Russia and Liechtenstein, also found an outbreak of dementia in patients who suddenly got better after death.

They analyzed 38 cases of patients with dementia.

A total of 44 improvement events occurred one day before death and 31 two or three days before. Furthermore, 43% lasted less than an hour, while 16% lasted a day or more.

But so far there is no research showing how many of these accidents occur each year.

 

Important assumptions Important

A group of ten researchers, including Ninth and Bethany, analyzed the evidence in 2018 and concluded that this was unlikely to be due to the regeneration of affected neurons over time.

Fernandes of the University of Sao Paulo believes that when the body realizes it is close to death, a situation called "fight or flight" is a kind of physical protection instinct.

He explains that the immediate next stage releases adrenaline and other substances that cause changes in the body, such as increased heart rate and blood pressure, which improves the functioning of other organs, such as improved neuronal activation and even patient understanding. .

"We just realized the body was going to die," he said. It will then be released, but it is temporary and when these compounds are depleted, the patient's condition worsens and he dies.

According to him, if this theory is confirmed, it can also give an indication of why this sudden improvement is so rare.

For example, patients with severe respiratory disease have already taken stress hormones before they have a chance to achieve such improvements. But some patients who have this stock can use this physical device.

Stafford Butty, a professor of religious studies at California State University, says the problem lies with what people call spirits.

The reason for the improvement at the moment, he said, is that the awareness of existence (which some call the soul) is able to free itself from the mind and function independently of the nervous system۔ '.

Could it also happen during what we call "death"? "Maybe so," says Jemo Bourgeois, a neuropsychologist at the University of Michigan in the United States.

He conducted a study with rats in 2013 that found that the brain continues to function even after the heart and blood have stopped circulating. In particular, there were gamma waves associated with consciousness in humans. This could illustrate, for example, the experience of terminal lucidity.

According to Bourgeois, changes in oxygen levels cause the brain to wake people who have difficulty breathing while they sleep so they can start breathing again, and the same procedure is used for patients with chronic illness.

In these cases, when a threshold is crossed, the brain becomes activated and temporarily increases its activity with a higher level of consciousness that allows it to speak and act rationally, and perhaps the reason is the cause of the terminal locality.

One of the assumptions cited in Bourgeois's study is that when oxygen and glucose levels drop or fluctuate, so do neurotransmitter levels, causing the brain to start moving temporarily or erratically.

"But this increase in electrical activity or neurotransmitter emissions will not explain how communication or coordination can be improved in the brain."

 

Mind and mind

Peter Fanwick, professor at King's College London Institute of Psychiatry and author of The Art of Diving, concluded that humanity does not yet adequately and fully understand the difference between mind and brain. Ski

The term "terminal locality" is associated with an ancient concept called "transmission theory", which was introduced by the American psychologist and philosopher William James in the late 19th century.

According to Fanwick, the brain will be like television, but the mind will be elsewhere as part of a universal consciousness. The brain picks up the signal from the mind but does not produce it.

A television does not produce a program by itself, but displays it as if it were filtering out external information.

And when the brain isn't functioning properly, the signal is present but distorted. Shortly before death, the brain stops distorting the signals and the mind clearly emerges.

There are logistical, scientific and ethical barriers to examining any of these hypotheses. For example, patients can no longer participate in scientific studies.

Another thing is that experiences at this stage of life (offensive or not) can affect their health or prevent people from experiencing this important time with their loved ones.

If scientists can find a solution to these obstacles, there are several possible ways to do so, according to the U.S. National Institute on Aging (NIA), which sponsored the study to understand the duration of leukemia in patients with advanced dementia. . it must be before he dies.

For this reason, the institute's experts speak of 'paradoxical leucidity' and not of 'terminal leucidity'.

These periods include audio and video monitoring studies of these patients or previous questionnaires with healthcare professionals and family members providing data on their frequency, genetic factors, conversation content, drug use, etc.

Understanding this for the NIA Eldada medical supervisor basics will completely change the information available so far on dementia and lack of knowledge.

"We can also broaden our awareness and personality of people with dementia, which can affect how we care for them," she said. And a better understanding of paradoxical lightness can help caregivers address ethical and decision-making concerns.

 

Find meaning

The key assumptions made for this trend are not definitive and there is always room for more evidence to support our thesis.

Studies over the decades have shown that we are more likely to investigate, pay attention, and remember something that corrects our beliefs.

Dr Fernandes of the University of Sao Paulo says: “The fact is that they are remarkable stories and we increase the number of them in our memory and at the same time we give the impression that it is the opposite. There are many more. And perhaps this can be explained. There may be pleasant events that we easily turn into normal events. '

According to Dr Seolon Madeiros de Mesudo, coordinator of stroke care services at the Lebanese Cerebro Hospital in Brasilia, consciousness fluctuations are part of the journey to end the lives of patients with serious illness.

“There are days when the patient gets better and other days when his condition worsens. And it can be any random, random near-death condition.

But because the relationship between cause and effect is unclear, patients who get better but then die are more likely to die than those who get better and don't die sooner.

According to him, the number of sudden improvements before death in his ward is very low and therefore it is not possible to understand the relationship between the causes and effects of this matter according to him.

Mediros, on the other hand, says that as a doctor, it is not his job to refute spiritual beliefs or try to explain the 'questions of family members:' is it better to say goodbye? Or "Will you be discharged and be able to go home?"

"When I am faced with a situation where there are no technical explanations, I try to understand what it means for the family and how to deal with this experience," he said. How can it help?

He says he spent many years looking for technical explanations for end-of-life patient experiments, but eventually he realized he didn't need them.

"I say we should enjoy it. The patient is talking. Say what you want to say, listen to what he has to say. Because this moment changes life. This is a gift. If death comes tomorrow or if the situation improves, we will live tomorrow. .

I remember the case of a patient who fell asleep shortly before he died and barely reacted. This is usually the case when death is near.

Their family wanted them to survive until their two grandchildren arrived so that they could pray for them.

When the grandchildren arrived, they opened their surprised eyes, sat down and prayed for each child in a very low voice. It was a sacred moment for his family and his wife would look at me smiling as if to say 'this is what we wanted.

Then he died a few hours later.