# Paradoxical lucidity in severe end stage dementia: a mixed methods prospective study

> **NIH NIH R21** · NEW YORK UNIVERSITY SCHOOL OF MEDICINE · 2020 · $428,229

## Abstract

Project Summary/Abstract
Dementia is expected to impact 75 million people by 2030. It is inevitably considered progressive and irreversible
in nature and culminates into an advanced stage. However, paradoxical episodes of unexpected cognitive
lucidity (paradoxical lucidity [PL]) especially near the end of life have been reported anecdotally for years in
patients with advanced dementia. Although, little is known about PL, yet if confirmed systematically, its
occurrence may challenge current assumptions and highlight the possibility of a network-level return of cognitive
function. This may provide novel insights into the underlying neurobiology and delineate future therapeutic
possibilities. While, there is no definition of PL, and no systematic studies have assessed the epidemiology,
neurologic underpinnings, and phenomenology of PL in dementia, however, lucidity and/or consciousness with
phenomenological similarities to PL have been described during other brain states which are also not expected
to support lucidity. This includes severe cerebral ischemia in cardiac arrest (CA) (at times referred to as near-
death experiences [NDE]). Some data suggests these lucid death related episodes may correlate with surges in
electrocortical activity, which may in turn provide mechanistic insights and biological plausibility for PL in severe
dementia. We have pioneered research into NDE’s and found a similar phenomenology to PL in severe
dementia. Our team has conducted largescale multisite studies, including a current 20-site study of NDE’s in
1500 CA subjects with real-time biomarkers of electrocortical activity using electroencephalography (EEG). We
are proposing to test the hypothesis that patients with advanced end stage dementia with an estimated life
expectancy 7 days can be successfully identified and recruited into a study exploring episodes of PL at the end
of life. Furthermore, we hypothesize that the use of symptom diaries and video, audio and EEG monitoring will
be feasible and deemed not sufficiently intrusive to prevent its use for patients or their families at the end of life
in a larger prospective study.Through a multidisciplinary team, including the Visiting Nurse Service of New York’s
(VNSNY) hospice services we aim to systematically study the phenomenology, characteristics, and
electrocortical biomarkers of PL in dementia and create a measurement scale.The R21 phase aims are 1) To
obtain necessary and sufficient data to determine the safety and feasibility of using symptom diaries and real-
time video EEG monitoring for a future study of PL in advanced dementia 2) To obtain necessary and sufficient
data to design a prospective cohort study of PL in advanced dementia and its underlying cerebral electrocortical
biomarkers The R33 phase aims are to 3) Conduct a mixed methods prospective study of PL during end stage
advanced dementia 4) Create a definition and measurement scale for PL in advanced dementia and to 5) Explore
the potential ele...

## Key facts

- **NIH application ID:** 10095286
- **Project number:** 1R21AG069850-01
- **Recipient organization:** NEW YORK UNIVERSITY SCHOOL OF MEDICINE
- **Principal Investigator:** Sam Parnia
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $428,229
- **Award type:** 1
- **Project period:** 2020-09-30 → 2023-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10095286

## Citation

> US National Institutes of Health, RePORTER application 10095286, Paradoxical lucidity in severe end stage dementia: a mixed methods prospective study (1R21AG069850-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10095286. Licensed CC0.

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