What Is Sundowning As It Relates To Alzheimer

One of the hallmark symptoms of Alzheimer’s disease is something called, “sundowning”. The term refers to a phenomenon that is unique to Alzheimer’s in which the individual afflicted with the disease exhibits confusion and becomes agitated during late afternoon and early evening. There have been several theories offered as to why this occurs and these theories along with experience help to give guidelines for managing “sundowning” in Alzheimer’s patients.

Approaching darkness and the presence of shadows is one reason that the patient with Alzheimer’s may become more agitated or confused. Another is that by the end of the day the individual is greatly fatigued and has a reduced ability to deal with stressful situations as they occur. Caregivers attempting to manage individuals with Alzheimer’s should pay close attention to late afternoons and early evening hours and make every effort to make the environment as calming, relaxing and as devoid of distractions as possible in an effort to minimize “sundowning”.

There are factors that may contribute to the intensity of the symptom “sundowning” including low lighting in the environment, distractions such as noise, the fact that shadows are increasing, and of course as mentioned already the individual is more likely to be more fatigued as the day wear into night. If the individual is in a care facility the changing of staff in the late afternoon and then again in the early evening hours can create more activity and noise that can add to the confusion and agitation experienced by Alzheimer patients.

Caregivers can help to minimize sundowning by encouraging the individual to have a mid-afternoon nap or at least to have some downtime that is spent in a quiet atmosphere. It is important to light all walkways, doorways and stairs with adequate lighting during late afternoons, early evening and into the night as well such as nightlights in bathrooms and along hallways.

Sundowning can be minimized if the patient is in an unfamiliar environment by bringing items that remain familiar to the patient such as photographs, a familiar bedding item, or small object that will remind them of home. Planning activities around these hours that will relax or entertain those with Alzheimer’s can also minimize sundowning.

The symptoms of “sundowning” can include visual hallucinations, agitation and confusion. The hallucinations included in sundowning are those that are not threatening or frightening such as seeing a stranger that others in the room cannot see. The symptoms of disorientation and agitation usually go hand-in-hand such as when a place that is familiar suddenly becomes strange and provokes fear or even hostility in the Alzheimer’s patient.

One unusual symptom of sundowning is that while they are in an episode, the individual may start to use curse words that those familiar with the individual have never heard them use before. This is called “cortical disinhibition”.

Paranoia is another element that may occur as part of sundowning.

It is not known yet, what causes sundowning to occur but some researchers suggest that perhaps the changing illumination in the later hours of the day somehow triggers the symptoms of sundowning.

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