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Neuroscientists typically assume that human mental functions are generated by the brain and that its structural elements, including the different cell layers and tissues that form the neocortex, play specific roles in this complex process. Different functional units are thought to complement one another to create an integrated self-awareness or episodic memory. Still, findings that pertain to brain dysplasia and brain lesions indicate that in some individuals there is a considerable discrepancy between the cerebral structures and cognitive functioning. This seems to question the seemingly well-defined role of these brain structures. This article provides a review of such remarkable cases. It contains overviews of noteworthy aspects of hydrocephalus, hemihydranencephaly, hemispherectomy, and certain abilities of “savants.” We add considerations on memory processing, comment on the assumed role of neural plasticity in these contexts, and highlight the importance of taking such anomalies into account when formulating encompassing models of brain functioning.
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The unexpected return of mental clarity and memory shortly before death in patients suffering from severe psychiatric and neurologic disorders, which we have called "terminal lucidity", has been reported in the medical literature over the past 250 years, but has received little attention. We review a range of terminal lucidity cases in order to encourage investigation of the mechanisms involved and possible insights into both the neuroscience of memory and cognition at the end of life and treatment of terminal illness. These examples include case reports of patients suffering from brain abscesses, tumors, strokes, meningitis, dementia or Alzheimer's disease, schizophrenia, and affective disorders. Several of these accounts suggest that during terminal lucidity, memory and cognitive abilities may function by neurologic processes different from those of the normal brain. We expect that significant contributions to better understanding the processes involved in memory and cognition processing might be gained through in-depth studies of terminal lucidity. Studying terminal lucidity might also facilitate the development of novel therapies. In addition, increased awareness of unusual end-of-life experiences could help physicians, caregivers, and bereaved family members be prepared for encountering such experiences, and help those individuals cope with them.
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The sporadic occurrence of unusually enhanced mental clarity before death has been documented over time and cultures, and reported in patients with and without neurodegenerative diseases, psychiatric disorders, and other neurocognitive deficits, as well as those with nonterminal and terminal conditions. Using a purposive sampling method via existing professional networks, clinical presentations of terminal lucidity in pediatric populations, as witnessed by pediatric oncologists and medical personnel, were solicited. We document clinical presentations suggestive of terminal lucidity in children, which were compiled by their attending physician at two large tertiary pediatric hospitals. Unanticipated and unexplained changes in mental clarity, verbal communication, and/or physical capability in the days and hours before the death of the pediatric patients were observed. Each patient's medical condition should not have allowed for such changes. The phenomenon known as terminal lucidity provides a conceptual framework for these deviations, although more systematic documentation and clinical research is required before definitive conclusions can be drawn.
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Unexpected cognitive lucidity and communication in patients with severe dementias, especially around the time of death, have been observed and reported anecdotally. Here, we review what is known about this phenomenon, related phenomena that provide insight into potential mechanisms, ethical implications, and methodologic considerations for systematic investigation. We conclude that paradoxical lucidity, if systematically confirmed, challenges current assumptions and highlights the possibility of network-level return of cognitive function in cases of severe dementias, which can provide insight into both underlying neurobiology and future therapeutic possibilities.
Erkunden
Team
- Nahm (6)
Eintragsart
Sprache
- Englisch (3)
Thema
- Adolescent (1)
- Adult (1)
- Aged (1)
- Aged, 80 and over (1)
- Alzheimer Disease (1)
- Alzheimer's disease (1)
- Brain Diseases (1)
- Child (1)
- Child, Preschool (1)
- Cognition (3)
- Communication (1)
- Consciousness (1)
- Dementia (1)
- Documentation (1)
- End-of-life care (1)
- Female (1)
- Humans (3)
- Lucidity (1)
- Male (1)
- Mental Disorders (1)
- Middle Aged (1)
- Mood Disorders (1)
- Neoplasms (1)
- Recovery (1)
- Schizophrenic Psychology (1)
- Terminally Ill (1)
- Young Adult (1)