A scoping review of episodes of lucidity in people living with dementia near the end of life: the potential role of speech-language pathology in research and practice.

Abstract

Purpose: There is existing and emerging evidence showing that people living with dementia may experience episodes of lucidity (EL) near the end of life. ELs involve a transient recovery of function that was presumably lost, often manifesting as a return of communication functions, demonstration of increased awareness of surroundings, and/or a return of daily living abilities. Given the centrality of communication to most definitions of EL, this scoping review seeks to assess the existing body of knowledge, describe the disciplines involved in research of EL, and formulate recommendations for SLPs working with people living with dementia near the end-of-life. Ultimately, we aim to guide future research and stimulate the development of clinical strategies for speech-language pathologists engaging in end-of-life care for this population.

Method: We conducted a systematic literature search and scoping review across five major databases using relevant terms such as "dementia," "end-of-life," and "lucidity," covering all records up to May 2023. Quantitative, qualitative, and mixed methods studies [focused on lucid episodes at end of life] were included.

Results: Of 5,780 articles that were independently screened for inclusion by two independent reviewers, 10 met criteria and were synthesized using narrative methods. Data extraction and quality assessment were independently performed by these reviewers. Among the selected studies, three were case reports, while the remaining seven employed qualitative assessments based on caregiver or informant reports. The majority of studies featured contributions from disciplines such as nursing, medicine, and psychology. All definitions and reports of lucidity involved aspects of verbal and nonverbal communication by the individuals living with dementia.

Conclusions: The scoping review of lucid episodes in people with severe dementia near the end of life represents a valuable synthesis of evidence at a time when research on this understudied phenomenon is growing. There is growing interest in unraveling the neurobiological and behavioral aspects of lucidity in dementia, with the ultimate aim of enhancing care for older adults. Given the fundamental role of communication in the definition of lucidity, speech-language pathologists are well-positioned to participate in this research and care continuum.