Many people experience mood and energy shifts as the day winds down. Fatigue, irritability, or simply wanting quiet time are normal responses to daily life. However, in individuals with dementia, a distinct pattern known as “sundowning” emerges – a worsening of symptoms like agitation, anxiety, or confusion specifically during late afternoon and evening hours.
Understanding sundowning is critical, especially as families spend more time together during the holidays, when changes in behavior may become more noticeable. This phenomenon isn’t a disease itself, but rather a symptom of underlying cognitive decline.
What is Sundowning?
Sundowning refers to behavior changes in people with dementia that occur at a specific time of day. It’s most often seen in those diagnosed with Alzheimer’s or other forms of dementia, though it can sometimes appear before a formal diagnosis. Doctors don’t fully understand the cause, but it may involve hormonal shifts, brain deterioration, circadian rhythm disruption, or environmental factors.
Symptoms vary but can include:
- Increased anxiety and agitation
- Pacing or restlessness
- Disorientation and confusion
- Hallucinations or delusions
- Trouble sleeping
Sundowning can sometimes manifest as physical or verbal outbursts, such as frustration over meal preferences or forgetting recent conversations. Individuals may also exhibit increased clinginess to loved ones, seeking reassurance, or become profoundly confused about their surroundings.
Is Sundowning an Early Dementia Sign?
While sundowning typically appears after a dementia diagnosis, it can also be an early indicator of mental decline. Brain changes associated with dementia can disrupt normal cognitive function, leading to sundowning behaviors even before other symptoms are apparent.
However, it’s essential to avoid jumping to conclusions. Sundowning isn’t exclusive to dementia; older adults experiencing illness or delirium can exhibit similar symptoms. Fatigue alone is different from sundowning; fatigue can be relieved by rest, whereas sundowning involves persistent confusion and disorientation.
Distinguishing Sundowning from Normal Aging
Normal fatigue comes and goes, often resolving with rest. Sundowning, however, is consistent in timing and includes cognitive impairment. Someone experiencing sundowning may not recognize loved ones, forget recent events, or exhibit impaired judgment, even after resting.
Managing Sundowning
If you suspect a loved one is experiencing sundowning, establishing a consistent daily routine is crucial. This includes regular mealtimes, predictable activities, and exposure to natural light during the day. Minimize evening stimulation – loud noises, bright screens, large gatherings – and address physical needs like hunger or discomfort.
The most important step is to consult a doctor immediately. They can evaluate potential underlying causes, including dementia, medication side effects, or environmental triggers. Early diagnosis and management are key to improving quality of life.
Recognizing sundowning is not about panic, but about proactive care. If you see these behaviors emerge, seek professional assessment to ensure appropriate support and treatment.
