Ever wonder why someone with Alzheimer’s Disease (AD) or another type of dementia seems to have more trouble with conversation or performing tasks in the evening compared to earlier in the day? Or, have you noticed that in the late afternoon or evening that a person living with AD or dementia (PLwD) may seem to hallucinate, be agitated or argumentative when earlier that same day they were calm and cooperative? It’s referred to as “sundowning”.
Sundowning is a common occurrence with people living with Alzheimer’s and other types of dementia. It is a syndrome characterized by a person becoming more confused at the end of the day, hence the term “sundown”. They are notably more agitated and can often become aggressive, combative, hallucinate or become delusional. The exact cause is not well understood, but it is often triggered by fatigue, reduced vision due to poor or low lighting and can be provoked by lack of activity/boredom.
It is always a challenging time of the day not only for PLwD but perhaps more so for the family and caregiver. Unfortunately, there is no completely effective treatment for sundowning but there are some tips for managing it.
Maintain a well-lit area. Consider closing curtains/blinds. This can help reduce hallucination triggers.
Plan most outing events such as appointments earlier in the day. Ideally late morning/early afternoon.
Establish a routine and whenever possible do not stray from it. Those with any form of dementia strive in a structured and predictable environment.
Consider having music on in the background. This can have a calming effect.
Make sure it is a type of music that is enjoyed by the person with dementia.
If sundowning is becoming a concerning issue, there are medications that help with this syndrome; however, they do not come without risk. You need to have a conversation about these risks with the prescriber.
Remember this, not every person with AD or dementia will experience sundowning. It may be occasional, daily or even not at all. If someone previously has not been sundowning and now begins to, or if there is a sudden change from what is their “norm”, you must consider that there may be something else going on.
Things to consider:
Could they possibly have an infection? Just because there is no cough or fever does not mean that there is not some infectious process happening. The most common type of infection to consider is a urinary tract infection (UTI). Unlike the typical symptoms experienced in our younger years, most notably lower abdominal cramping, increased frequency of urination and burning with urination, the only hint that you may get that there is an infection is a change in mental status. This means that regardless of their usual state, they are notably more confused. They may hallucinate when previously they did not. They may be combative when they never were prior to that time. They may have unintelligible speech when previously you could easily understand what they were saying.
Has there been a significant recent change in their life? Perhaps a new caregiver or a new routine. Maybe a new residence or alteration in the appearance of where they reside, like a remodel. Were they just in an environment with overstimulation like a party or event?
Has there been any recent medication adjustments? New medications, recently deleted medications or dose adjustments? The slightest change can make a significant change in how someone responds.
Although sudden change can occur with natural disease progression, more often it is provoked by something else. Always investigate before assuming it is natural disease progression.