PROJECT SUMMARY Alzheimer’s disease and related dementias are typically thought of in terms of progressive cognitive decline, and relatively little is known about episodes of lucidity that occur among people with dementia. Paradoxical lucidity is defined as spontaneous, relevant communication or connectedness in a person with dementia. Few studies have focused on paradoxical lucid episodes, and little is known about what may cause paradoxical lucidity, how common lucid events are, and how lucidity impacts family caregivers of persons with dementia. The broad goal of this study is to define paradoxical lucidity, determine the prevalence and predictors of paradoxical lucidity, and assess the impact that lucidity has on family caregivers. Our proposal will establish a definition of paradoxical lucidity based on survey data and interviews with caregivers, as well as input from a panel of clinical experts in Alzheimer’s disease and related dementias. Next, we will administer an online survey to 8,000 dementia caregivers across three time periods (baseline, 6-months, and 12-months) to measure how frequently paradoxical lucidity occurs across time. We will analyze survey data to establish what may predict paradoxical lucidity and how paradoxical lucidity is linked to caregiver well-being. The results of this work will help inform clinical practice, build capacity for Alzheimer’s Disease education and advocacy, and build knowledge on an understudied aspect of dementia.

PROJECT NARRATIVE Alzheimer’s disease and related dementias (ADRD) are widely understood by progressive cognitive decline, yet relatively little is known about the incidence of paradoxical lucidity (PL) within ADRD, and the effect of PL on family caregivers. The proposed mixed-methods R21 will operationalize PL, while the R33 will administer a 3-wave longitudinal survey to 8,000 caregivers to assess prevalence and predictors of PL and link PL to caregiver outcomes. This work aligns with the mission of the NIA and will inform clinical practice around PL, increase the technical capacity of advocacy organizations to provide PL education, and establish a basis for epidemiological research on PL.