Terminal Lucidity (also known as paradoxical lucidity or, in this case, energy surge) is a poorly understood condition where a person with existing significant cognitive decline such as Alzheimer’s or end-stage cancer suddenly improves. They may recognise their surroundings and family members again and hold meaningful, appropriate conversations.

The US National Institute of Ageing defines it as:

Episode of unexpected, spontaneous, meaningful, and relevant communication or connectedness in a patient who is assumed to have permanently lost the capacity for coherent verbal or behavioral interaction due to a progressive and pathophysiological dementing process

Terminal lucidity is often associated with impending death, often within hours or days of the event.

In this letter to the editor of Palliative Supportive Care Journal, Miguel Juliao recounts this phenomenon in 5 terminally ill patients in a home-based palliative care unit over the space of 3 years.

Each of these patients had a significant progression of their terminal illness with cognitive deterioration and physical decline. To give you some idea, here are some of the cases as reported by the palliative care team:

• A 68-year-old female with metastatic breast cancer who was bedbound, unable to talk properly and was often in a semiconscious state had a sudden onset of lucidity. She had an increase in appetite and was asking for particular foods. She was able to walk. She had articulate and fluent speech and was able to resolve issues about the burden of her funeral and say goodbye.
  The period of lucidity lasted 48 hrs.
  She died 9 days later.
• A 72-year-old male with metastatic gastric cancer who was bedbound, had no oral intake, was often semiconscious and had visual hallucinations. He had a sudden onset of increased alertness and energy. He was able to walk again. His appetite returned and he was asking for particular foods. He was able to eat at the dining table with his family. He had articulate and fluent speech and was able to watch the news. He set his affairs in order and discussed wish fulfilments with his family.
  The period of lucidity lasted 36 hrs.
  He died 9 days later.
• A 74-year-old male with metastatic pancreatic cancer. Bed-bound all day with no oral intake. Experienced nausea and vomiting and decreased levels of consciousness. Sudden onset of lucidity. Was able to walk and asked to eat particular foods. Fluent speech and was able to set bank issues in order.
  The period of lucidity lasted 20 hrs.
  He died 4 days later.

The letter to the editor concludes;

In summary, identifying the patterns of ES and its common manifestations among the dying and openly communicating about the phenomenon can effectively reduce caregivers’ suffering and distress, offering the opportunity to embark on a shared and meaningful last journey.

Miguel Juliao et al.

Read the full letter: Energy surge: A deathbed phenomenon that matters

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Photo by Vladimir Soares