Paradoxical Lucidity in Severe End-Stage Dementia

NYU Langone Health520 enrolled

Overview

Cognitive decline in dementia is considered irreversible, however episodes of paradoxical lucidity (PL) in severe dementia suggest other mechanisms may be in play. Beyond anecdotal reports of transient PL events occurring in patients predominantly in late-stage dementia and typically lasting anywhere from a few minutes to several hours, little is known about PL. The study team proposes to develop and conduct a mixed methods prospective study of PL during end stage advanced dementia, creating a definition and measurement scale for PL in advanced dementia, and identifying the potential electro cortical biomarkers of PL in advanced dementia. This study will be divided in two phases: Phase I and Phase II. During Phase I, the study team will collect sufficient and necessary data through an online survey and focus groups as well as assess the safety and feasibility of using symptom diaries (also known as daily trackers or journals) and real-time video EEG monitoring (vEEG). After preliminary review of the study procedures, the PI will decide whether to move onto the Phase II. The second phase will aim to expand the study population and refine study methods as well as create a definition and measurement scale for PL in advances dementia.

Study Type

OBSERVATIONAL

Enrollment

520

Conditions

Dementia

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age \> 18 years * Advanced (severe) dementia diagnosed using the Global Deterioration Scale (GDS) with a score of 7 or the Palliative Performance Scale (PPS) with a score of less than 30% * Accepted for hospice care based on the Medicare eligibility guidelines * No longer being provided with nutrition or fluids * Anuria (dry diaper) or less than 200cc urine (almost dry diaper) in any 24-hour period Exclusion Criteria: * Cognitive or functional impairment due to a diagnosis other than dementia * Dementia with a GDS score \<7 (mild, moderate, moderately severe dementia). Please refer to rationale outlined for inclusion criteria 2.

Outcomes

Primary Outcomes

Phase I and II - Number of self-reports of patient distress/discomfort in relation to symptom diary use and recording of potential episodes of paradoxical lucidity (PL) using mobile devices

Time frame: up to Day 7

Phase I - Number of self-reports of informants' distress or discomfort due to the presence of the video EEG device.

Time frame: up to Day 7

Phase I - Number of families who express interest in the study and contact the research team

Time frame: up to Day 7

Phase I - Number of successful informed consents obtained from family members/legally authorized health care proxies

Time frame: up to Day 7

Phase I - Number of days taken for patients to die after being identified by hospice staff with a life expectancy </= 7 days

Time frame: up to Day 7

Phase I - Number of diary reports completed and returned to research staff

Time frame: up to Day 7

Phase I - Time taken to establish video EEG monitoring in homes or nursing homes

Time frame: up to Day 7

Phase I - Total number of instances in which video EEG monitoring was successfully initiated

Time frame: up to Day 7

Phase I - Average number of days for which video EEG monitoring was completed

Time frame: up to Day 7

Secondary Outcomes

Phase II - Change in average number of changes in EEG rhythm

Time frame: Baseline, up to Day 7

Phase II - Average number of changes in EEG rhythm during PL

Time frame: Baseline, up to Day 7

Paradoxical Lucidity in Severe End-Stage Dementia

Overview

Conditions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes

Central Contacts