How does the last stage of senile dementia proceed?

Vascular dementia disease

It is not difficult to understand that the disease vascular dementia is caused by persistent damage to the large and small vessels of the brain. This is due to impaired blood supply to the cortical-subcortical structures of the brain. The disease significantly affects a person's cognitive function. It destroys his social and professional skills, does not allow the patient to work normally and communicate with people around him. Many patients have impaired motor function and, over time, significantly lose self-care skills.

This disease most often affects elderly people over 65 years of age. But science knows of cases where vascular dementia was diagnosed in younger people. In addition to the main cause of the disease indicated above, it can also be caused by other factors, such as diseases and injuries of the brain and its tissues.

In this regard, experts identify such forms of this disease as:

1. With an acute onset, which begins soon after serious damage to the brain and its blood vessels.
2. The multi-infarction form develops some time after damage to the large and medium vessels of the brain.
3. The subcortical form is a progressive dementia caused by persistent lesions of the small vessels of the brain.
4. A combined form that appears with serious damage to the cortex and subcortical structures of the brain.

Diagnostics

Dementia of the vascular type is diagnosed in the presence of clinical data, characteristic anamnestic or neuroimaging signs of cerebrovascular disease: previous stroke or cases of subclinical local cerebral ischemia.

It is also important to have a cause-and-effect relationship and a relationship in time between brain damage of vascular etiology and the development of cognitive impairment. The very presence of dyscirculatory disorders according to neuroimaging, as well as the presence of neurological disorders - hemiparesis, speech and swallowing disorders, walking and urination disorders, are mandatory.

It is necessary to differentiate between Alzheimer's disease and vascular dementia.

Once the syndrome of dementia is identified, it should be syndromicly distinguished from depression, moderate or even mild cognitive impairment and delirium. To diagnose depression, various questionnaires and tests should be used (clock drawing test, HADS anxiety and depression scale, Montreal Mental Status Scale, MMSE test, etc.).

The distinction between vascular dementia and dementia due to Alzheimer's disease is often difficult. If in Alzheimer's disease the deterioration can occur slowly and constantly, then in the case of vascular dementia the deterioration occurs suddenly (for example, after stroke) and proceeds in stages.

When the vascular component predominates, the following signs are common: focal neurological symptoms (rigidity, hemiparesis, bradykinesia, bulbar disorders), neuropsychological disorders depending on the location of the cerebral infarction (aphasia, lack of sensory sensitivity, apraxia), gait disturbances (with Parkinson-like or ataxic movements), urinary disorders with urinary incontinence and urgency.

In addition to a thorough neurological examination and targeted laboratory tests, MRI or MSCT is necessary to identify infarcts and white matter lesions.

It must be remembered that quite often the same patient exhibits both signs of vascular dyscirculation and symptoms of Alzheimer's disease. Modern research indicates that the chronic dyscirculatory process is a risk factor for the development of Alzheimer's disease and plays a pathogenetic role in the neurodegenerative process, based on this, the vast majority of cases of dementia are mixed in their pathogenesis - vascular-degenerative.

Symptoms of vascular dementia

Since this disease primarily affects a person's psyche and his ability to maintain social and professional functions, the main symptoms of vascular dementia usually indicate a violation of this function. Such patients may laugh or cry for no reason, as well as show other emotions that are inappropriate to the place and circumstances. They may have all sorts of speech disorders. People begin to speak unclearly and, often, in a very nasal voice. Many words and letters may be replaced by others or may sound incomprehensible to others. Patients are often practically devoid of facial expressions and active expression of emotions. Their true mood sometimes becomes incomprehensible to others.

A manifestation of this disease can also be an unclear and unsteady gait, due to which patients become susceptible to falls and injuries even when walking on a flat surface. With dementia, hand tremors are often observed, and habitual physical actions become slow and unclear. Patients may experience involuntary movements of the lips, eyes, arms or legs. In addition, this diagnosis is often characterized by a violation of pelvic functions, one of the common manifestations of which is involuntary urination.

Some other signs may also indicate dementia. But at the same time, many of them are uncharacteristic and can be symptoms of many different mental and other diseases.

Symptoms of late stage dementia

There are many diseases and causes that can lead to dementia. They affect the general condition of patients and the appearance of clinical signs. The following symptoms are characteristic of different types of dementia:

• memory impairment;
• speech problems;
• thinking disorders;
• disorientation in space;
• change in character;
• difficulty performing daily tasks;
• apathetic attitude towards the environment.

The development of the disease is divided into mild, moderate and severe stages. The duration of the transition from one stage to another depends on timely treatment, the cause of the pathology, the general condition of the patient and his individual characteristics. The initial stage can progress to the final stage over a period of more than 10 years, and sometimes the process takes less than 1 year. The intensity of manifestations and characteristics of symptoms depend on the patient’s age, level of intelligence, moral and physical health, level of social activity, quality of life, nutrition, living conditions, genetic predisposition and other factors.

Stages of vascular dementia

Psychiatrists usually distinguish three stages of vascular dementia:

• Early, which can be almost invisible to others. At this stage, patients have only slightly impaired social and professional skills. In addition, they forget certain events, but do not suffer significant memory loss. Patients may have unstable mood and increased anxiety.
• Average. At this stage, there is significant impairment of memory and social skills. People are practically unable to practice their profession, and their communication with others is significantly hampered. At the same time, patients may not even recognize their relatives and well-known people. They often get lost even close to home and forget where their things and objects are. Many people are practically unable to take care of themselves. Their need for service and assistance from third parties is growing rapidly.
• Late - the person is almost completely dependent on outside help. He is almost unable to navigate space and communicate in society. Such patients cannot take care of themselves and do not recognize their relatives and friends. Their speech often becomes incoherent and incomprehensible. People suffering from this stage of vascular dementia experience visual and other hallucinations. The patient's personality and character completely changes according to the principle of degradation. He hardly takes care of himself and does not strive to maintain personal hygiene. Despite the fact that most people at this stage of the disease have significant impairments in motor and physical activity, many of them leave home and begin to wander. Such people often become victims of traffic accidents and other accidents.

Treatment of dementia in old age

The treatment regimen for senile dementia is influenced by comorbidities. It is no secret that old people have many pathologies.

Drug correction is aimed primarily at the etiopathogenesis and mechanisms of disease development. It is especially important to pay attention to cognitive problems during therapy. If additional research confirms the diagnosis of Alzheimer's, the prescription of centralized cholinesterase neurotransmitter inhibitors is justified. The patient is also advised to take “Amiridin” (from 10 to 40 mg 1 time per day), “Tacrine” (4 times a day, 10 mg), “Exelon” (1.5 mg, if in solution - 0.75 ml) and a course of Donepezil (for 6 weeks, 5-10 mg per day).

According to some data, the use of medications will help slow down the development of the disease and prevent dementia in old age:

• estrogenic hormones;
• non-steroidal anti-inflammatory blockers of COX 1 and 2;
• vitamin E;
• “Selegilina” (10 mg per day, preferably taken before lunch and divide the dose into two doses);
• “Cognitive” (10 mg in the morning);
• "Yumexa" (in two doses of 10 mg).

In elderly dementia of vascular origin, medications that have a positive effect on areas of possible risk are important. This:

• antihypertensive drugs (Berlipril, Lisinopril, Vazar);
• disaggregants (“Magnikor”, “Cardisave”);
• anticoagulants "Clopidogrel", "Tugina" (according to indications).

If the disease is accompanied by anxiety and insomnia, antipsychotics and benzodiazepines (Haloperidol, Chlorprothixene) are prescribed in small doses. For depressive conditions, an elderly patient is prescribed antidepressants.

In some cases, in order to improve cognitive-behavioral abilities, regular exercise is practiced to train memory processes and attentiveness. However, straining your memory is useful only when cognitive impairment is not too severe.

It is important that the elderly patient is supported by family and loved ones. Due to impaired perception, anxiety and confusion in older dementia patients manifests itself in unusual conditions. Therefore, you should avoid trips and trips - they can lead to severe disorientation. The home environment, on the contrary, has a beneficial effect on an elderly person.

At the very beginning of the disease, when men and women are still able to work, they should not overwork. You need to try to maintain a work routine and fully relax. Elderly patients should be monitored as there is a risk that they will confuse medications or dosages.

Nutrition is especially important in senile dementia. An elderly patient should eat well, eat a lot of nuts, fresh foods containing vitamins and fatty acids. The patient, even the elderly, needs light loads. Normotimics (lithium salts) and nootropics (“Gamalon”, no more than 900 mg; “Lucidril”, no more than 900 mg; “Piroditol”, “Nootropil”) have a good effect on the body.

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Diagnosis of vascular dementia

Diagnosing this disease at an early stage is quite difficult. Indeed, at this moment, its symptoms can be almost invisible. There are also cases when the diagnosis of vascular dementia is complicated by the fact that the disease disguises itself as other diseases. However, most people who get sick usually do not realize that they are sick. Therefore, the concern for establishing this diagnosis in most cases falls on the shoulders of the patient’s relatives, who must promptly notice changes in his behavior and usual way of life.

When a disease is suspected, diagnosis most often begins with a visit to a general practitioner, who must rule out the presence of other diseases and refer the person for examination by a neurologist and psychiatrist. In this case, a neurologist, using special studies, determines the condition of the brain and its cortex, as well as blood vessels. It is very important at this stage to correctly identify vascular changes typical of dementia. Also taken into account are the external manifestations of the disease, expressed in changes in behavior, social functions, disruption of professional activities, speech, motor activity and other skills and functions.

A psychiatrist can confirm the presence of dementia based on research and analysis of behavioral disorders. Despite the negative attitude towards such specialists that has developed over the years in Russian society, contacting them in this case should be immediate in order to avoid even more unpleasant consequences.

Alcoholic dementia

This type appears due to the long-term (over 15–20 years) influence of toxic substances on the brain. In addition to the direct effects of alcohol, the development of pathology is indirectly affected by vascular disorders and endotoxins in alcoholic liver damage.

In most patients at the third stage of alcoholism, when the personality has degraded, atrophic changes in the brain are noticeable, in the form of dilated cerebral ventricles and furrows in the cerebral cortex.

Clinical symptoms of alcoholic dementia are expressed in a diffuse decrease in intelligence. Due to personality degradation, the patient’s memory, attention, and ability to think abstractly deteriorate. Emotional hardening occurs, social ties are destroyed, thinking becomes primitive, and all value guidelines disappear.

At this advanced stage of alcoholism, it is difficult to motivate a person to engage in treatment. But if the patient completely abstains from alcohol for 6–12 months, then the symptoms gradually decrease. In addition, according to research, organic defects are smoothed out.

Diagnosis of vascular dementia

The diagnosis of vascular dementia can be made by a psychiatrist or neurologist based on research and examination of the patient. Also, the stage of the disease can be identified and its treatment can be selected, aimed at reducing negative manifestations and reducing progression.

This diagnosis often becomes the cause of disability and incapacity in old age. Such patients require constant care in many cases. If it is impossible to provide it to relatives and friends, caregivers may be appointed by specialists from social authorities. In addition, many people with this disease are placed for long-term treatment in psychiatric clinics.

Alzheimer's disease

Alzheimer's disease is characterized by a selective or lacunar type of dementia. This is an atrophic senile type of dementia, the symptoms of which appear before the age of 60. The majority of cases are observed between the ages of 65 and 75 years. Alzheimer's disease can be inherited. Risks are reduced if you study music and foreign languages ​​from early childhood.

This type of senile dementia can develop for the following reasons:

• getting injured;
• state of oxygen starvation of the brain;
• neurotoxin poisoning.

The disease develops as a result of a biochemical disorder of glucose metabolism, which leads to the formation of plaques consisting of poorly soluble protein. These plaques, deposited in the brain, contribute to degenerative changes in nerve cells. As a result, lesions form in the cerebral cortex, which can lead to total dementia.

How quickly does dementia progress in old age? At the onset of Alzheimer's disease, memory is impaired. The elderly man is slightly absent-minded and a little forgetful, which does not attract attention at first.

The environment begins to notice changes when a person constantly forgets even recently occurring events. Although the elderly patient remembers much earlier episodes from her life very well. But later they disappear too. A patient with Alzheimer's syndrome cannot recall necessary information at the right time.

The newly received information is practically not absorbed. Elderly people have impaired spatial and temporal orientation. They often start asking questions about what day of the week, date, month, year it is. The course of the disease worsens, and the person ceases to understand where he is and does not recognize himself in the mirror. In addition, visual and hearing disturbances appear, and tactile sensitivity is impaired. Older patients cease to correctly perceive acquaintances, relatives, and home environment. In the later stages of dementia, older people cannot adequately identify their own identity.

The practical sphere of activity is gradually degrading. The process begins with the loss of complex professional skills and ends with the complete disappearance of self-service skills.

At the very beginning of the development of the disease, the elderly person is animated and fussy. Then his fussiness turns into reflexive monotonous movements. Speech is gradually reduced.

Emotionally, an Alzheimer's patient develops egocentrism, dissatisfaction with himself and his inability to overcome difficulties in professional activities and studies.

First, the elderly patient realizes that abnormal abnormalities are occurring and tries to take action. As the disease progresses, the level of self-criticism decreases. At the same time, the circle of interests of an older person narrows significantly, his judgments become more primitive. Literally before our eyes, the elderly patient degrades emotionally, turning into a very distrustful, touchy and, finally, indifferent person.

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Stages of development of vascular dementia

This disease is characterized by stage-by-stage development. In most cases it develops relatively slowly. The disease may progress over several years. But sometimes doctors are faced with a fairly rapid development of the disease. But regardless of this, it is always possible to trace three stages of the development of vascular dementia.

1. Mild, in which the signs of the disease are almost invisible. At this stage, patients remember worse important events, the names of their family and friends, planned activities and other events.
2. Moderate. At this stage, the manifestations of the disease become more noticeable, but most often only the patient’s relatives and friends can see them. After all, these signs are incomprehensible to most people around, since the patient has mild memory loss, loss of professional skills, decreased social function and other problems that can often be attributed to character traits.
3. Heavy. At this stage, the manifestations of the disease are very noticeable even to people unfamiliar with the disease and non-specialists. The patient needs constant assistance from third parties. He practically cannot navigate even in the home space familiar to him; there are serious deviations in behavior, disturbances in speech, memory, gait, and much more.

Despite the presence of obvious signs of dementia, diagnosis can only be made by a doctor on the basis of special studies indicating changes in brain tissue and blood vessels characteristic of this disease. After all, many of these symptoms can also be a manifestation of other diseases or mental conditions. Since this diagnosis is most common in older people over 65 years of age, these patients should be tested for its presence. But there are cases when this disease is diagnosed in younger people.

Life expectancy forecast for dementia

One of the determining factors of how long patients live when pathology develops is the type of dementia.

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The types of pathology differ in local characteristics and are determined by which part of the brain is affected. The main ones include:

• dementia due to Alzheimer's disease;
• with Parkinson's disease;
• against the background of Huntington's disease;
• dementia with Lewy bodies;
• vascular;
• frontal dementia.

Each type has its own symptoms and a specific course of therapy. Life expectancy forecasts also differ.

Often, dementia is an senile or senile disease, but sometimes the breakdown of mental functions also occurs at a young age.

In different people, the disease occurs with different intensity, which is explained by the influence of individual indicators:

• the patient’s initial level of intellectual abilities;
• state of physical and moral health (the presence of somatic diseases plays an especially important role);
• level of social activity, living conditions (living together with close relatives or alone), the presence or absence of trusting relationships with loved ones;
• quality of nutrition, lifestyle;
• genetic inheritance.

How many years can you live with Alzheimer's dementia?

This type of disease relates mainly to the elderly; people from 65 to 85 years of age are most susceptible to it.

The peculiarity of the pathology is this: the earlier the symptoms appear, the more intensely they will develop.

Typically, late-onset forms are tolerated more easily and progress poorly.

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If dementia occurs in a person under 65 years of age in good physical shape, it is difficult to correct the condition and stop the disease. Life expectancy is on average 5 to 7 years

.
If there are chronic health problems, a person can fade away within 1 year. With late development, symptoms are expressed weaker and less intense. The patient is able to live from 5 to 15 years
.

In the moderate or severe stages of dementia, life expectancy is significantly reduced. In such cases, there is a high risk of loss of balance and falling, and for older people they are fraught with hip fractures. It is not always possible to operate on a patient; often the person remains bedridden for a long time. Against the background of this condition, bedsores, thromboses form, and the blood becomes infected. With such serious complications, death can occur in a matter of weeks.

The average life expectancy for Alzheimer's disease is from 2 to 9 years

.

Prognosis for Parkinson's disease

Dementia often occurs as a result of this disease. It is not as intense and aggressive as with Alzheimer's disease, but the consequences are no less serious. In the later stages, the patient loses his skills, the ability to think, he is no longer able to cope without outside help even with the slightest difficulties.

A person with a similar diagnosis lives from 1 to 4 years.

When the above symptoms are combined, a person is constantly in a depressed state, which leads to chronic depression and lack of desire to live. The most optimistic prognosis in this case is 5 years, with proper treatment, the patient staying in a comfortable environment, in caring hands and without stress.

Life expectancy with dementia due to Huntington's disease

The disease is genetic, characterized by periodic mental disorders and the patient’s lack of ability to self-control.

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When dementia joins these symptoms, exacerbations of the pathology become more frequent. The disease manifests itself moderately and not so rapidly, but it invariably shortens life expectancy.

The prognosis for people with this diagnosis is from 4-5 to a maximum of 15 years, provided there are no acute mental disorders and proper treatment.

In such cases, appropriate drug therapy can suppress the signs of dementia and provide the patient with about 3 years of almost full life.

How long can you live with dementia with Lewy bodies?

This is a special type of pathology, which is characterized by a constant increase in the blood of the mentioned bodies. range of 50-65 years are most susceptible to it.

. In the early stages of dementia in older people, symptoms appear only in the form of infrequent mental disorders.

Until the age of 70, the disease develops moderately, but with the onset of this age the situation worsens. Mental disorders are becoming global, people are losing memory and attentiveness. This condition persists for 2-3 years, after which the deterioration of the condition recurs. By the age of 75-76, the pathology develops to a severe degree and quickly ends in death.

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The life expectancy forecast from the moment the disease is diagnosed is 4-15 years.

Prognosis for vascular dementia

People over 65 years of age are most susceptible to developing pathology. Dementia often develops against the background of a stroke or other problems with the blood vessels of the brain.

How long a person lives depends on the type of stroke he suffered. With dementia after an ischemic stroke, life lasts from 5 to 7 years

, against the background of hemorrhagic dementia, dementia can progress to a severe stage in just 1 year. The prognosis depends on the degree of wear and tear of the blood vessels, the quality of nutrition, and the physical health of the patient.

Life expectancy with frontal lobe dementia

The disease occurs in younger people - between the ages of 40 and 50 years. This is due to significant hormonal changes in the body during this period.

In the first stages, the disease manifests itself in a person’s unusually aggressive behavior; later, he is overcome by dissatisfaction with himself, and absurd and illogical conclusions arise. As frontal frontal dementia (or Pick's disease) develops, the patient experiences difficulty communicating, speaking, and expressing emotions.

Depending on what led to the formation of the pathology and at what age the first symptoms appeared, life expectancy varies from 3 to 15 years.

If the disease develops rapidly, then the inability to self-control is added to the listed symptoms, memory decreases, and behavior goes beyond the limits of adequacy.

Drugs for the treatment of vascular dementia

When treating this disease, medications for concomitant diseases must be prescribed. Blood thinners, such as ThromboAce, are also often prescribed. Patients are prescribed vasoactive drugs, such as vinpocetine and the like, aimed at dilating the blood vessels of the brain and heart. In addition, other drugs that affect the state of the nervous system, brain, heart and blood vessels may be prescribed.

Drugs for the treatment of vascular dementia must necessarily include nootropics. Medicines from this group support and improve brain structures. Taking medications such as piracetam or Cerebrolysin may slightly increase brain activity. They are also sometimes able to slightly improve and prevent memory, spatial orientation and other social functions from rapidly deteriorating. In some cases, such treatment can maintain some professional and intellectual functions at a completely stable level for a long time, which allows patients not only to be almost full members of society and take care of themselves, but even to work in some simple jobs. True, this is possible only in the initial stages of the disease in the absence of its significant manifestations.

Doctors treating vascular dementia must also prescribe medications that relieve dangerous symptoms and manifestations of the disease. Most often, patients are prescribed treatment for depression, unreasonable aggression and insomnia. It is important to remember that such medications have many side effects. Therefore, their use should be strictly controlled by specialists based on tests and other studies, as well as an assessment of the patient’s general condition.

Senile dementia with Lewy bodies

This type refers to atrophic, degenerative processes, during which intracellular inclusions (Lewy bodies) are formed in the brain. What are the causes of this phenomenon and what are the mechanisms of its development, specialists do not know. Doctors note the important role of hereditary factors in the progression of pathology. This type of elderly dementia accounts for 15–20% of the total mass of senile disorders of the central nervous system.

Many symptoms of this type of pathology are similar to the manifestations of dementia described above. The most characteristic indicator is fluctuation, which consists of sudden disruptions in intellectual and mental activity. Doctors consider these deviations to be partially reversible.

With small forms of fluctuations, elderly patients experience a temporary inability to concentrate on anything specific (subject, object, task, as well as the process of solving it). If an elderly patient has large forms of fluctuation, he does not recognize objects, close people, and is not able to navigate the area.

Another distinctive characteristic of this type of dementia is auditory, visual, and sometimes taste and tactile hallucinations.

In addition, autonomic disorders are observed during the disease process:

• hypotension of the orthostatic type, in which an elderly patient’s blood pressure sharply decreases when changing body position;
• fainting, arrhythmia;
• disorders in the gastrointestinal tract, increased constipation, urination problems, etc.

Treatment of senile dementia with Lewy bodies is similar to that of Alzheimer's disease. If there are signs of confusion in an elderly patient, acetylcholinesterase inhibitors and sometimes atypical antipsychotics are prescribed.

What is dementia?

Dementia is an acquired dementia, a decline in mental functions associated with damage to the brain. The process is irreversible, and it usually begins with mild symptoms, for example, forgetfulness. Gradually, the stages of dementia increase: further deterioration of memory, attention, perception, and consciousness occurs; a person loses motivation, the ability to analyze, control his emotions, his behavior may become unacceptable.

The causes of dementia in young people are the presence of provoking factors, such as drug addiction or alcoholism. However, although not directly caused by the aging of the body, it is still a disease of older people. The most common causes of dementia are vascular sclerosis, which can lead to atrophy of parts of the brain. Symptoms vary as different groups of brain cells are affected. The rate of development of the disease is individual and depends both on the type of human nervous system and on other factors. Women are twice as likely to be affected by the disease: this is due to more pronounced nervous and psychosomatic processes in the fairer sex.

A disorder that is recognized at its inception stage is easier to correct. The environment plays a significant role: among loving relatives and friends, older people tolerate the disease more easily.

How can you identify dementia in a loved one yourself?

The Dementia.ru resource recommends politely asking a person to draw a very ordinary dial with the exact hours indicated on blank paper.

The patient is told: “Please draw a round clock with numbers on the dial. The hands show the time at fifteen minutes to two.”

The patient must draw a round dial from memory so that the numbers and arrows are in their places. When you deviate from the reference clock pattern, you can understand the degree of cognitive impairment.

An elderly person with dementia needs special care. He requires a lot of attention and communication skills, which are professionally mastered by the staff of the Vita nursing home for dementia patients. Each new client is under medical supervision by a psychologist, and work is carried out to prevent the disease.

Signs of dementia before death

At the last stage, the patient no longer shows vital activity. He is indifferent to the events of the world around him. This condition indicates impending death. Dementia before death combines the symptoms listed below.

Long sleep

It is almost impossible to wake up a person in such a state - a long-term suspended animation develops. Sleepiness takes up most of the day and night.

Lack of appetite

The patient loses his appetite due to the decline of vital functions. If he regains consciousness, he refuses to eat.

Hallucinations and delusions

Changes in the perception of the outside world in the form of hallucinations and delusions are a classic manifestation of dementia in the terminal stage. The person is completely disoriented, does not understand where, what and why is happening.

Changing body temperature

The decline in the functioning of the body is also reflected in body temperature. As a rule, it is underestimated. Poor blood circulation results in cold extremities.

Changes in heart rate and constriction of pupils

Interruptions in the functioning of the heart are possible, which is expressed in arrhythmia: bradycardia or tachycardia. In addition, there is a constriction of the pupils.

Features of the excretory system

There is a lack of stool, difficult excretion of dark-colored urine with a specific odor due to impaired kidney function.

Impaired consciousness

Consciousness may be impaired. The patient sleeps for a long time. When he comes to his senses, it is not possible to establish contact with him as before.

Agony

The stage of dementia before death inevitably ends in agony. Agony is one of the periods of a terminal state preceding the onset of clinical death. At this time, the functions of the higher parts of the central nervous system, which were not involved in life, are turned on.

Sometimes patients gain clear, short-term consciousness before death. The agony lasts from several minutes to an hour and is accompanied by muscle cramps, restoration of heart rate and breathing.