People with Alzheimer’s disease are commonly affected by a
phenomenon known as “sundowning” or “sundown syndrome” – when symptoms such as
restlessness, agitation, disorientation, aggression, anxiety
become worse in the afternoon.
As a caregiver, it’s important to understand why this occurs
and how best to deal with the phenomenon.
What is sundowning?
Sundowning is most commonly associated with Alzheimer's, but
also occurs in people with mixed dementia (where characteristics of both
Alzheimer’s disease and vascular dementia are present) and Parkinson’s disease.
Sundowning is always cause for concern: it is a common cause
of institutionalisation of older dementia patients and often predicts faster cognitive
decline in Alzheimer's patients.
People who experience sundown syndrome typically experience
behavioural problems in the late afternoon, evening or at night, hence the
Apart from the symptoms mentioned above, the affected person
may also experience mood swings, an abnormally demanding attitude,
suspiciousness, and visual and auditory
Sundowning is one of the many effects of dementia that
experts do not yet fully understand.
However, many experts believe that dementia may cause damage
to the body’s internal clock (the so-called “circadian rhythm”). The result is
a change in behaviour and mood as the evening draws closer.
A variety of treatment options have been found to help keep
the symptoms associated with sundowning in check.
therapy (regular exposure to bright light, including the sun)
• Melatonin supplementation (a
hormone made by the pineal gland in the brain, which helps control sleep and
• Acetylcholinesterase inhibitor
drugs (it’s believed that the “cholinergic” pathways in the brain are
compromised by Alzheimer’s disease)
• N-methyl-d-aspartate receptor
antagonists (this group of drugs work by regulating the activity of a chemical
messenger involved in memory and learning)
Change in behaviour discussion
It’s important to always discuss a change in behaviour with
the patient’s attending doctor, who will be able to check whether there’s a
physical cause. Sometimes changing the dosage or the time that medication is given
can help relieve symptoms.
In her book Care of Alzheimer’s Patients: A Manual for
Nursing Home Staff, Lisa Gwyther also offers the following tips:
• If fatigue
is making the sundowning worse, an early afternoon rest might help. Keep the
person active in the morning and encourage a rest after lunch.
• Early evening activities that are
familiar from an earlier time in the person’s life may be helpful. Closing the
curtains, a pre-dinner drink or assisting with preparing dinner or setting the
table may be helpful.
• Don’t physically restrain the
person. Let them pace where they’re safe. A walk outdoors can help reduce
restlessness.Visit www.fightdementia.org.au for more of Gwyther’s tips.
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