From the Research
Sundowning is a behavioral syndrome that occurs in people with dementia, characterized by increased confusion, agitation, and other neuropsychiatric symptoms that typically begin in the late afternoon or evening and continue into the night, affecting approximately 1.6-66% of individuals with dementia, as reported in the most recent study 1. This phenomenon is not entirely understood, but contributing factors include fatigue, disrupted circadian rhythms, reduced lighting that creates shadows and visual misperceptions, and decreased sensory input. Some key points about sundowning include:
- The exact cause of sundowning is not fully understood, but it is thought to be related to the deterioration of brain regions that regulate circadian rhythms, particularly the suprachiasmatic nucleus in the hypothalamus, combined with sensory processing difficulties that become more pronounced with fatigue at day's end 1.
- Management strategies for sundowning include maintaining consistent daily routines, ensuring adequate exposure to bright light during daytime hours, limiting caffeine and sugar intake after lunch, creating a calm environment in the evening by reducing noise and stimulation, and using nightlights to reduce confusion from shadows.
- In some cases, medications may be considered, such as low-dose antipsychotics or melatonin, though these should be used cautiously due to potential side effects and interactions 1. The underlying mechanism of sundowning is complex and multifactorial, involving neurodegeneration, sleep disorders, and environmental factors, as discussed in the study 1. The most effective management approach for sundowning is a multidisciplinary one, incorporating behavioral and environmental interventions, as well as pharmacological approaches, as recommended in the most recent study 1.