Can sundowning syndrome improve over time?

From the Guidelines

Sundowner's syndrome can improve over time with appropriate management strategies, as disease manifestations may ameliorate over time in many patients. When considering the management of sundowner's syndrome, it is essential to prioritize strategies that address the underlying causes of the condition, such as disruptions in the body's circadian rhythm, neurological changes, and increased fatigue. Some key considerations for managing sundowner's syndrome include:

• Establishing regular routines to provide a sense of structure and stability
• Ensuring adequate lighting to minimize shadows and reduce confusion
• Limiting caffeine and sugar intake in the afternoon to prevent exacerbating symptoms
• Creating a calm environment before sunset to reduce agitation and behavioral changes
• Addressing underlying causes like pain, hunger, or need for toileting to reduce symptoms While medications like low-dose antipsychotics or melatonin may be prescribed in some cases, they should be used cautiously due to potential side effects, as noted in general medical practice 1. It is crucial to individualize treatment according to the patient's needs and how much the symptoms impact their quality of life, as well as to regularly reassess and adjust management strategies as needed, in line with the principles of personalized care 1. By taking a comprehensive and tailored approach to managing sundowner's syndrome, many individuals can experience improvement in their symptoms over time.

From the Research

Sundowners Improvement Over Time

• The available evidence does not provide a clear answer to whether sundowners can improve over time 2, 3, 4, 5, 6.
• Studies suggest that sundowning is a complex phenomenon associated with various factors, including impaired circadian rhythmicity, environmental and social factors, and impaired cognition 2, 3, 4.
• Treatment options, such as bright light therapy, melatonin, acetylcholinesterase inhibitors, and behavioral modifications, have been found to be helpful in ameliorating the neuropsychiatric symptoms associated with sundowning 2, 4, 6.
• However, there is a lack of randomized controlled trials specifically investigating the effectiveness of pharmacological and non-pharmacological strategies in managing sundowning 3, 5.
• Further research is needed to develop a clinically operational definition of sundown syndrome and to investigate its etiology, risk factors, and effective treatment options 2, 3, 4.

Factors Influencing Sundowners

• Neurodegeneration, sleep disorders, circadian rhythm, and mood disorders are thought to contribute to the development of sundowning syndrome 4.
• Environmental and social factors, such as restriction of daytime sleep, exposure to bright lights, and mild activity schedules, may also play a role in managing sundowning behavior 6.
• The use of sedatives and other pharmacological approaches may be effective but is often associated with severe side effects 4, 5.
• Behavioral interventions, although more efficacious, require intense involvement of caregivers 4.

Treatment and Management

• A variety of treatment options are available, including pharmacological and non-pharmacological approaches 2, 4, 6.
• Bright light therapy, melatonin, and acetylcholinesterase inhibitors have been found to be helpful in managing sundowning symptoms 2, 4.
• Behavioral modifications, such as restriction of daytime sleep and exposure to bright lights, may also be effective in reducing sundowning behavior 6.
• Further research is needed to develop effective treatment strategies and to improve patient outcomes 2, 3, 4.