Nahm’s study of terminal lucidity: 83 patients who regained clarity shortly before death

Step 1

Before 2009 · The question

Nineteenth-century physicians wrote about patients who said goodbye with a clear mind

For nineteenth-century physicians, it was something familiar. Asylum doctors wrote about it many times. Some patients who had been confused for years began thinking clearly again as their death approached. They remembered their lives, recognized their loved ones, and said goodbye.

In the twentieth century, medical journals almost stopped talking about it. Cases kept appearing, but mostly in books and magazines outside medicine.

No one had gathered these cases to see what they had in common.

Step 2

2009 · The authors

A German biologist and a Virginia psychiatrist give it a name: terminal lucidity

Michael Nahm is a biologist from Freiburg, in Germany. He had spent years researching how trees work. He was also interested in unsolved questions about the mind. In 2009, he published a review of cases of mentally ill patients who regained clarity before death. He did so in a journal specializing in near-death experiences.

That same year, Nahm and the psychiatrist Bruce Greyson published a short article in a psychiatry journal. In it, they gave the phenomenon the name terminal lucidity. They defined it as the unexpected return of mental clarity and memory shortly before death.

Three years later, with two other researchers, they expanded the collection of cases.

Step 3

2010 and 2011 · How it was done · As the study tells it

They gather 83 cases published over 250 years, most of them by healthcare professionals

The four authors searched books and journals from the past 250 years. They found 83 cases of terminal lucidity, published by 55 different authors. Most of these authors were professionals working in healthcare. Of these cases, 54 described how the illness had progressed, and among them there were 22 women and 32 men.

They also found 18 physicians or caregivers who said they had seen terminal lucidity but gave no details. Apart from the 83, they added recent cases that some people had told them about directly.

The authors point out the limits of this collection. In the nineteenth-century cases, the diagnoses were outdated, imprecise, or missing. Some cases, especially those published outside medicine, may have been embellished in the telling. And in some, the improvement may have coincided with death by chance.

The cases came from very different illnesses.

Step 4

Nineteenth and twentieth centuries · The cases · As the study tells it

There are cases with tumors, strokes, meningitis, dementia, and schizophrenia

The study arranges the cases by illness. These are some of the ones it describes.

• A brain abscess, in 1822. A 17-year-old boy had been in the hospital for 18 days. He was in constant pain, he was vomiting, and he was losing his memory. On day 19, he suddenly got up, said nothing hurt anymore, and said he planned to leave the hospital the next day. He died a quarter of an hour later. The autopsy found two pockets of pus the size of a hen’s egg in the front part of his brain.
• Two strokes, in a 91-year-old woman. The second stroke had left her unable to move or speak. One day, her daughter heard her exclaim something. The woman sat up in bed, raised her arms, and said her late husband’s name in a clear voice. Then she fell back and died.
• Alzheimer’s, in an 81-year-old woman in Iceland. She hadn’t recognized her family or spoken for a year. One day she sat up, looked at her son, and told him she was going to recite a verse for him. In a clear voice, she recited the first stanza of a psalm by an Icelandic poet. Her son wrote it down on the spot. Afterward she became unresponsive again, and she died a month later.
• A cancer that had spread to the brain. A young man had lung cancer that had reached his brain. According to a 2007 article in Time magazine, a scan showed that he had little brain tissue left. A nurse and his wife said that, an hour before he died, he woke up and talked with his family for about five minutes.
• Schizophrenia. In 1975, two physicians described three patients who had been hospitalized for 11, 20, and 27 years. Shortly before they died, all three were almost normal.

The cases with an autopsy all date from the nineteenth century. The recent cases come from what relatives, nurses, or magazines reported.

What remained unknown was whether this happens often or very rarely.

Step 5

1844 and 2008 · How often · As the study tells it

They find only two figures, one from an 1844 book about an asylum and one from a nursing home in 2008

The authors looked for how often terminal lucidity happens. They found only two figures.

The first comes from an 1844 book that reviewed the figures from a British asylum. There, 139 patients died between 1796 and 1841. Of these, 13 in 100 died in a considerably better mental state than they had been in before.

The second is from 2008. An English team asked the nurses and care assistants at a nursing home. Seven in ten said they had seen terminal lucidity in the previous five years. These were patients with dementia or confusion who regained clarity a few days before they died.

The two figures measure different things. The first counts patients. The second counts caregivers who saw it at least once.

Of all the cases, there is one that is cited more than any other.

Step 6

March 1, 1922 · Germany · As told by the director and the physician of her institution

A woman who had never spoken sang for half an hour before she died, according to the director and the physician of her institution

Anna Katharina Ehmer, known as Käthe, lived at Hephata, a residential institution for people with mental disabilities in central Germany. She had arrived there at the age of six. She died there on March 1, 1922, at 26.

The Protestant pastor Friedrich Happich ran the part of the institution where Käthe lived. According to him, Käthe had had a very severe disability since birth and had never said a single word. The institution’s physician, Wilhelm Wittneben, wrote that she had had meningitis many times and that it had badly damaged her brain. She also had tuberculosis, and one of her legs had been amputated because of it.

Both men said that, before she died, Käthe sang farewell songs for half an hour, with clear words. Then she died peacefully. According to Happich, the physician said he couldn’t explain it.

In 2014, Nahm and Greyson studied how the case had been told. The institution’s register of deaths confirms Käthe’s dates. The physician first spoke about the case in 1926, without giving Käthe’s name. The first full account dates from 1930, eight years after her death. The two witnesses told it at least five times, in almost the same words.

No autopsy was done. According to Happich, in a 1934 text, the physician said an autopsy could show that Käthe’s brain didn’t allow her to think. Both men used the case to oppose the Nazis’ killing of the mentally ill. They were, however, in favor of sterilizing them.

Nahm and Greyson write that today it is hard to say with certainty whether the case is authentic. The neuroscientist who writes online as Neuroskeptic analyzed it in 2014. Neuroskeptic points out that the physician never explained what damage Käthe had in her brain or how he knew. Neuroskeptic adds that, if Käthe didn’t speak, that doesn’t prove she was unable to speak. And Neuroskeptic notes that singing uses different parts of the brain from those used for speaking.

With all these cases, the authors drew their conclusions.

Step 7

2012 · The conclusion · As the study tells it

The authors think some cases are hard to explain with what is known about the brain

According to the authors, some cases pose difficulties for the explanations currently given of how the brain produces the mind. These are mainly the cases in which a tumor, a stroke, or Alzheimer’s had destroyed part of the brain. They write that, during terminal lucidity, memory and thinking might work in a way different from that of the normal brain.

At the same time, they think it isn’t yet possible to know why it happens. There may not be a single cause. As early as 1826, a physician distinguished two forms of lucidity before death. In one, the patient’s confusion fades little by little as the body weakens. In the other, clarity arrives suddenly, just before death.

The authors themselves propose a possible explanation in the brain. A patient who loses a lot of weight at the end of life might also lose some brain volume. That would lower the pressure that a tumor or a lesion creates inside the skull, and the brain might work again for a while. They also cite studies suggesting that some of the damage of Alzheimer’s might be reversible. They don’t know whether that is enough to explain a complete recovery.

They call for more research. They think terminal lucidity can teach us how memory and thinking work at the end of life. And they think knowing about it would help physicians and families be prepared if they see it.

In the following years, other teams began to study it.

Step 8

2019 to 2025 · What came next

Caregivers describe lucidity close to death, and the video study also finds it months earlier

In 2018, the US National Institute on Aging brought together a group of experts. Among them were Greyson and the psychologist Alexander Batthyány, from a university in Budapest. Nahm co-authored the article that came out of that meeting. It was published in 2019. The article called the lucidity that occurs in people with dementia paradoxical lucidity. It is called paradoxical because it happens in people who, because of their dementia, were thought to be no longer able to communicate.

The two terms are used for similar things, and experts don’t agree on where the difference lies. For Nahm, terminal lucidity is the kind that happens shortly before death, with any illness. Paradoxical lucidity is the kind that happens in advanced dementia, even when death is still months away.

In 2021, Batthyány and Greyson published an online survey of caregivers who had seen an episode in the previous 12 months. They gathered 124 cases of people with dementia. In almost 80 in 100, the caregivers said the patient spoke clearly and almost normally. And in 94 in 100 cases, the patient died within the following week.

In 2025, a University of Wisconsin team filmed 19 people with very advanced dementia for months. There were 9 lucid moments in 3 of them. They happened between 9 days and 20 months before their death. We cover this in the Gilmore-Bykovskyi study.

The survey and the video study don’t entirely contradict each other. The survey only collected cases that caregivers remembered, and the farewell at the bedside may be what people remember most. The authors themselves urge caution in linking these episodes to imminent death. The video study didn’t depend on memory, and it didn’t find that lucidity clustered close to death.

There is still something no one has done.

Step 9

2023 · What is missing

In about 600 cases, no one has measured the brain while the patient was lucid

In 2023, Batthyány wrote a letter to a journal specializing in near-death experiences. He estimated that there were already about 600 documented cases of terminal lucidity. And he wrote that in none of them had brain activity been measured during the episode. A review of 30 studies published in 2024 doesn’t include any such measurement either.

In that letter, Batthyány was correcting a 2023 book by Raymond Moody and Paul Perry. The book said terminal lucidity sometimes happens in people who are brain-dead, with no activity in the brain. Batthyány replied that no such case is known. All the patients in the known cases were alive, they were breathing, and their brains worked well enough to keep them alive. In 2024, Nahm agreed with him on that point.

The question from the beginning remains: what is known about patients who become lucid again before death? Let’s look at what is known and what isn’t.