Sundowning Syndrome and Alzheimer’s Disease

Late afternoons and early evenings mean the sun is starting to set and the world becoming darker. Have you noticed your loved one experiencing late-day confusion? This problem has been coined the term sundowning syndrome. Sundowning is a neurological phenomenon that affects older individuals. This syndrome is more prevalent in patients with Alzheimer’s: a neurodegenerative disease that causes mood swings, memory loss, behavioral issues, and disorientation. When it comes to Alzheimer’s, it is common for patients to experience forms of anxiety, confusion, and agitation. As this discomfort increases, it is possible for some individuals to experience forms of hallucinations and mental confusion.

It is common for Alzheimer’s patients to display changes in their mood, behavior, and personality.  There isn’t just one cause for this syndrome. In fact, it stems from a large group of contributors that trigger a person’s changes in behavior and demeanor. It is important to understand what causes sundowning and its symptoms. 


Causes:

  • Alzheimer's causes a disruption to the brain which directly affects the body's internal biological clock. This causes patients to get confused between night time vs the day time.

  • Exhaustion of the mind and body can add to the confusion a person feels. Unmet physical needs such as hunger, tiredness, and pain can worsen feelings of distress. 

  • Caregivers are a vital part of Alzheimer patients’ lives. When these caregivers aren’t present during the evening, it can cause an individual's anxiety to heighten.

  • Unfamiliar environments and situations can make a patient more disoriented.

  • Limited mobility and long periods of staying/sitting in one area. 

  • Sensory overload/deprivation: where there is too little or too much of a certain stimulus acting on the individual (e.g. bright lights, loud noises).

Signs:

There are numerous signs of sundowning an Alzheimer’s patient exhibits. The following list outlines them:

  • Pacing

  • Rocking in a chair

  • Wandering

  • Physical Violence 

  • Shadowing (when the individual follows their caregiver very closely, everywhere they go)

  • Crying

  • Insomnia

  • Yelling

How to reduce symptoms and cope: 

  • Setting a routine: Making sure that the patient has a set structure for their day is an important way to alleviate the confusion they experience during the later part of the day. Daily routines at specific times can introduce them to feelings of safety and familiarity. When unexpected events occur, it can pose a scary and stressful situation for some individuals. 

  • Alternative Therapy: Art, music, and light therapy utilize natural methods to help alleviate stress and calm heightened emotions. Forms of painting, dancing, listening to music, playing an instrument, and exposing yourself to light are some of these therapies in action. Exploring these avenues allows the patient to feel more in control of how they are feeling.

  • Calming Activities: Spend time with your loved one by delving into some of their favorite, calming activities. Listen to music, garden, read a book, or play a card game to help them take their mind off of uncomfortable thoughts and feelings.


Every case of sundowning syndrome can present itself differently. An accumulation of environmental triggers and internal changes directly impact the way an Alzheimer's patient experiences their afternoons and evenings. It is vital to be gentle and make your loved one feel safe and heard.

Amrutha Banda