Sundowning is an oddly cute expression used to describe a difficult phase of Alzheimer’s disease.
For about 20 percent of Alzheimer’s patients, there is a point in the day, often late afternoon to early evening, when their symptoms become more acute. “People may be confused about where they are or what’s happening to them. They may become more resistive, angry, belligerent,” says Dr. Joel Sadavoy, Director and Founder of the CARERS program at Mount Sinai Hospital in Toronto.
Overall agitation intensifies; and sometimes even docile people become violent. “From my experience, it’s impossible to know how long it will last, but it is time limited,” says Dr. Sadavoy. “It’s usually a few hours.”
Sundowning symptoms peak during the middle stages of the disease and, in a cruel irony, ease as the disease gets worse. Paul’s symptoms disappeared after about 18 months, around the time his ability to speak started to decline.
The most accurate way to talk about sundowning is that we don’t really know what’s happening.
When it comes to what causes sundowning, we don’t have answers, but we do have theories.
• Dementia attacks the part of the brain that controls our circadian rhythm, the internal clock. That means the systems that keep us sleeping at night and active during the day are compromised.
• Darkness reduces sensory stimulation. That means your charge is getting less input from her environment—fewer sounds, fewer visual clues to what’s happening around her. That can cause disorientation and intense frustration. Sundowning is her way of trying to cope.
• Shadows in dim light can add to disorientation and confusion, causing people to imagine they are seeing things that aren’t there. What they are conjuring could cause them to become agitated, angry or scared.
• By the end of the day, people with sundowner’s syndrome may be overly tired, physically or emotionally.
In the end though, “The most accurate way to talk about sundowning is that we don’t really know what’s happening,” says Dr. Sadavoy.
About the author