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We present Dr. Manuel Sánchez Pérez, an expert in Psychiatry who specialized in the mental health of elderly and psychogeriatrics, particularly in the field of affective disorders and dementia. Specifically, he is an expert in depression, anxiety, phobias, and personality disorders; and works on lines of research on the effectiveness of non-pharmacological therapies in psychological and behavioral disorders of dementia.
He is currently working in one of our hospitals, the Sagrat Cor Hospital in Martorell (Barcelona).
As an expert in the field of affective disorders and dementia in the elderly, what has surprised you most about your patients?
Something recurrent in them is lucid behavior in patients with advanced dementia. It is surprising because these are people with severe cognitive problems and yet they respond well in areas such as orientation, memory, and calculation.
It is interesting because sometimes when patients are exposed to unusual stimuli in non-pharmacological therapies such as music therapy, animal-assisted therapy, reminiscence therapy, or multisensory stimulation therapy (Snoezelen); surprisingly coherent and lucid spontaneous reactions can be observed, which, supposedly, seem incompatible with the severity of the deterioration these patients present.
This is a challenge for science because it has not yet found a satisfactory answer.
You often talk about terminal lucidity and near-death experiences. What exactly does that mean?
Terminal lucidity refers to a striking episode of coherent and effective communication just before death in an insane person, unable to interact socially. Episodes of terminal lucidity may be accompanied by near-death experiences (NDEs). For example, sensations such as floating above the body or inner peace, visions of a figure at the end of a tunnel or of deceased relatives or friends, visions of moments in life, and also the disappearance of the fear of death.
What can you tell us about paradoxical lucidity?
Paradoxical lucidity states have been defined as brief periods of mental clarity in people with advanced dementia, as well as in patients with stroke, brain tumors, meningitis, coma, or severe mental disorders. These episodes may last minutes, hours, or possibly a day, but they are very brief.
The existence of paradoxical lucidity suggests the possibility that, under certain circumstances, the brain may temporarily recover some cognitive functions that were considered lost and irreversible. In this way, a revision of the concept of dementia, which is understood as an irreparable structural neuropathological process, is proposed, and to understand it as a reversible and functional physiopathological dimension, even in the final stages of the disease.
However, the origin and exact mechanism of paradoxical lucidity remains unknown. Various theories and studies have been postulated on this issue, but they do not fully explain how synchronization or communication can be improved through an impaired brain.
In these cases, how do the patient’s family and environment experience it?
These behaviors can have a strong emotional impact on family members as they witness unexpected abilities re-emerge in their loved ones who are severely ill and cognitively impaired.
On the one hand, they feel joy and excitement as they unexpectedly experience a moment of lucidity in their relatives, as if they were free from the illness that has affected them for years. However, sometimes, it affects them negatively because it is something very brief and then “it is time to return to reality.”
Our job is to accompany, care for and, as far as possible, cure the sick person. However, we also must to accompany their relatives, since the emotions they feel in the process of their loved ones’ illness are significant.
Thank you very much, Doctor, for your time and your great work! We need professionals who see their work as an opportunity to care for and accompany people – we need more hospital hearts!