Sundowning, Alzheimer's Disease and Dementia

What is Sundowning?
People with Alzheimer's disease and many other forms of dementia are often at their best early in the day. As the day progresses, however, a patient's memory and ability to carry out tasks can deteriorate. "Sundowning" is the term used to describe the increased confusion and agitation that occurs later in the day and evening and sometimes into the night.

Sundowning is more common in the moderate to severe stages of Alzheimer's. There is evidence that Alzheimer's disease damages or disrupts the parts of the brain that control the circadian rhythms, the body clock and the sleep-wake cycle.


Sundowning is Exhausting for Caregivers and People with Dementia

A difficult thing about sundowning is that toward the end of the day both the person with Alzheimer's and his or her caregiver are tired and not always at their best.
But if you know that sundowning is a feature of dementia then it can be less frustrating.


Signs and Symptoms of Sundowning

Sundowning occurs in the later part of the day and in the evening. Behavior can include the following:

Increased agitation

Increased anxiety

Increased confusion

Restlessness

Less cooperative

More argumentative

It is important that you do not misinterpret the above behaviors. It may be that people with Alzheimer's disease are behaving the way they are because of other things. Are you being more demanding? Are you making unrealistic demands? Are they suffering from other physical discomforts (noise, continence problems, medications, illness, pain) rather than sundowning?



Strategies to Minimize or Prevent Sundowning


Make sure sundowning is not the result of physical illness or medication.

Caregivers need to be flexible in their approach and in their expectations.

Avoid caffeine drinks in the afternoon and evening.

Have non-glare lighting.

Be soothing and try to be undemanding. Try to make the person with Alzheimer's feel safe and secure.

Make sure the person's physical needs are met, i.e. that they are not hungry, thirsty, or constipated.

Avoid too many naps during the day.

Soothing music may help relax them.

Provide stimulating activities in the day without exhausting the person.

Remember that a person with Alzheimer's does not have control over their behavior.

Sundowning strategies do not always work the first time, or even the second or third time. You have to find out what suits each individual to minimize the problematic behaviors of sundowning. Keeping a diary of different strategies and their results over time can help you isolate some important key features. Medical intervention or medication may be required if things do become too difficult.

Posted from reference by Ms Hendi Lingiah, Clinical Psychologist, France

Source : http://alzheimers.about.com/



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