Sundowning is not a disease itself but a collection of neurological and behavioral changes that typically occur in the late afternoon and evening, particularly in individuals with Alzheimer's and other forms of dementia. It's a manifestation of the brain's reduced ability to cope with environmental changes and internal biological clocks. The signs of sundowning can be subtle at first, but they often progress and become more pronounced over time.
One of the most common indicators is a notable increase in dementia agitation. While a person with dementia might be calm and agreeable during the day, they may become visibly irritable, upset, or even aggressive as evening approaches. This agitation can manifest as pacing, yelling, hitting, or a general refusal to cooperate. It's important to remember that this behavior is not a choice; it's a symptom of their distress and confusion.
Beyond agitation, there are a host of other sundown syndrome behaviors to watch for. Individuals may begin to wander, seemingly with no purpose, as if searching for something they cannot define. They might try to leave the house, insisting they need to go "home" even if they are already there. This is often linked to a deep-seated feeling of being lost or disoriented. In some cases, the person may develop paranoid or delusional thoughts, accusing caregivers or family members of stealing their belongings or harming them.
Another key symptom is heightened restlessness. A person who was content to sit earlier in the day may now be unable to sit still. They might pace back and forth, rummage through drawers, or continuously try to get up from their chair. This restlessness often coincides with an inability to sleep, leading to a reversed sleep-wake cycle that can be exhausting for both the individual and their caregiver.
Perhaps one of the most heartbreaking aspects of sundowning is the rise of anxiety in the evening. The fading light and the increased shadows can be disorienting and frightening. The individual may become clingy, repeatedly asking questions, or expressing fears they cannot articulate. They might call out for a parent or a long-gone spouse, feeling an intense sense of loss and loneliness as the day ends. This heightened anxiety can also trigger repetitive actions or verbalizations, such as repeating a phrase or humming a tune over and over.
The symptoms of sundowning can also include:
Confusion and Disorientation: As the day darkens, a person with dementia may have even more difficulty recognizing people or places, and they may be unable to recall recent events.
Shadowing: The person may follow a caregiver from room to room, like a shadow, unable to be left alone without becoming distressed.
Increased Screaming or Crying: Some individuals may express their distress through nonverbal sounds, such as crying, moaning, or screaming.
Identifying these sundowning symptoms is crucial for developing a tailored care plan. It allows dementia caregivers to anticipate the difficult period and implement strategies before the symptoms peak. By recognizing the patterns, you can adjust the daily routine, create a calming environment, and try to address the underlying triggers. While sundowning can be a formidable challenge, a proactive and knowledgeable approach can make a significant difference in the quality of life for both the person with dementia and those who love and care for them. If you have further questions about sundowning, please reach out your local Interim HealthCare office.