Table of ContentsView AllTable of ContentsSymptomsDementia and SundowningDementia StagesFactors Worsening ItReducing SundowningTips for Caregivers
Table of ContentsView All
View All
Table of Contents
Symptoms
Dementia and Sundowning
Dementia Stages
Factors Worsening It
Reducing Sundowning
Tips for Caregivers
Sundowning—also known as sundowner’s syndrome—occurs when dementia symptoms like confusion, agitation, distress, and confusion occur or worsen in the later afternoon or evening.While anyone with dementia can exhibit sundowning, it’s most often seen in the middle or late stages of the condition.
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What Does Sundowning in Dementia Feel and Look Like?
Research shows that neurodegenerative disorders, like dementia, affect the circadian rhythm (yourbody’s biological clock). Disruptions in the sleep-wake cycle can also affect emotional processing and aggression. Researchers believe this relationship contributes to sundowner’s syndrome.
Sundowning episodes can vary from case to case, lasting anywhere from a few minutes to several hours, sometimes continuing through the night. Someone experiencing an episode may feel:
Some people with dementia experience daily attacks, while for others, sundowning may be more sporadic. However, once episodes start, they’re likely to recur.
Signs of Sundowning in Others
It’s essential to recognize thesymptomsof sundowning when caring for or living with someone with dementia. Typical signs associated with sundowning include:
What Stage of Dementia Is Sundowning?
Though it can arise in the early stages, sundowning is typically a sign that the dementia is more advanced; sundowning in early dementia is rare. As such, this issue generally arises once other symptoms, such as confusion and memory lapses, are more pronounced.
Since fatigue triggers sundowning, this condition is more common and severe in people with dementia who are more independent and active, primarily occurring in those with moderate-stage dementia. People in later stages of dementia tend to be less active, and sundowning is rarer and less severe in this population.
Dementia Stages: What to Expect
Dementia is aprogressive conditionthat gradually worsens over time. Clinically, healthcare providers break dementia into seven stages, as follows:
These stages are categorized as “early,” “moderate,” or “severe” dementia, as described below.
Early Dementia
Early dementia comprises stages 1 through 3. Healthcare providers can see evidence of cognitive decline in imaging in the earliest stages, but people in these stages show mild or no symptoms. The earliest signs are memory lapses that may be mistaken for age-related memory decline.As dementia progresses, it leads to more pronounced memory and cognitive problems andmild cognitive impairment.
Signs in someone with early-stage dementia may include:
Moderate Dementia
Stages 4 and 5—moderate and moderately severe cognitive decline—make up moderate dementia. In moderate dementia, people start to need assistance with daily living. Symptoms become more severe as the damage spreads to parts of the brain involving consciousness, language, memory, senses, and perception. Signs of this stage can include:
Severe Dementia
In stages 6 and 7, memory, cognition, and language deficits are so severe that someone with severe dementia can’t live independently. Over time, people lose the ability to talk, move, and respond to the outside environment. In thefinal stagesof Alzheimer’s disease or other progressive brain diseases, people need help eating, dressing, and going to the bathroom.
Factors That Can Worsen Sundowning
Researchers are still working to understand what triggers sundowning. They believe it arises due to a combination of factors, including changes in brain structure and function and problems with the circadian rhythm. Several health factors can trigger or worsen sundowning, including:
Methods to Reduce Sundowning
There’s no cure for dementia, but there are ways tomanage sundowningand other symptoms. Support your loved one in adopting lifestyle habits to reduce the chance of episodes and try methods to manage irritation and aggression. Steps you can take include:
How to Manage Sundowning: Tips for Caregivers
There’s no doubt that dementia can be challenging, not only for the person with the condition but also for the caregiver. Caring for someone who is experiencing sundowning means coping with symptoms like aggressiveness and irritation while providing support and comfort. In doing so, thinking about communication, environment, activities, and safety is essential.
Communication
If someone is irritable, angry, or displaying other symptoms, try to be patient and avoid displaying frustration. Methods to promote good communication with someone with dementia include:
Environment
Activities
Certain activities or objects can help someone with dementia as they experience symptoms, changing their focus. Here’s what you can try:
Safety
As a caregiver for someone with dementia and sundowning, it’s essential to consider safety, which can involve:
Summary
Sundowning occurs when dementia symptoms like confusion and irritability worsen in the late afternoon or evening. Dementia progresses through stages of severity, and sundowning is most prevalent in the moderate stages of the condition. Sleep disruptions, noisy or chaotic environments, and insufficient natural light are among the factors that worsen sundowning. Make lifestyle adjustments to address these factors to help prevent episodes and manage symptoms.
9 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Canevelli M, Valletta M, Trebbastoni A, et al.Sundowning in dementia: clinical relevance, pathophysiological determinants, and therapeutic approaches.Front Med (Lausanne). 2016;3:73. doi:10.3389/fmed.2016.00073Todd WD.Potential pathways for circadian dysfunction and sundowning-related behavioral aggression in Alzheimer’s disease and related dementias.Front Neurosci.2020;14:910. doi:10.3389/fnins.2020.00910.Valletta M, Canevelli M, Blasi MT, Bruno G.Sundowning in patients with dementia: prevalence and clinical features.J Neurolog Sci. 2021;429:119004. doi:10.1016/j.jns.2021.119004Guu TW, Aarsland D, Ffytche D.Light, sleep-wake rhythm, and behavioural and psychological symptoms of dementia in care home patients: revisiting the sundowning syndrome.Int J Geriatr Psychiatry.2022;37(5):10.1002/gps.5712. doi:10.1002/gps.5712Shih YH, Pai MC, Lin HS, Sung PS, Wang JJ.Effects of walking on sundown syndrome in community-dwelling people with Alzheimer’s disease.Int J Older People Nurs. 2020;15(2):e12292. doi:10.1111/opn.12292Sheppard O, Coleman M.Alzheimer’s disease: etiology, neuropathology and pathogenesis. In: Huang X, editor.Alzheimer’s Disease: Drug Discovery[Internet].Brisbane (AU): Exon Publications; 2020. doi:10.36255/exonpublications.alzheimersdisease.2020.ch1Therriault J, Zimmer ER, Benedet AL, Pascoal TA, Gauthier S, Rosa-Neto P.Staging of Alzheimer’s disease: past, present, and future perspectives.Trends Mol Med. 2022;28(9):726–741. doi:10.1016/j.molmed.2022.05.008National Institute on Aging.Alzheimer’s disease fact sheet.National Institute on Aging.Coping with agitation, aggression, and sundowning in Alzheimer’s.
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Canevelli M, Valletta M, Trebbastoni A, et al.Sundowning in dementia: clinical relevance, pathophysiological determinants, and therapeutic approaches.Front Med (Lausanne). 2016;3:73. doi:10.3389/fmed.2016.00073Todd WD.Potential pathways for circadian dysfunction and sundowning-related behavioral aggression in Alzheimer’s disease and related dementias.Front Neurosci.2020;14:910. doi:10.3389/fnins.2020.00910.Valletta M, Canevelli M, Blasi MT, Bruno G.Sundowning in patients with dementia: prevalence and clinical features.J Neurolog Sci. 2021;429:119004. doi:10.1016/j.jns.2021.119004Guu TW, Aarsland D, Ffytche D.Light, sleep-wake rhythm, and behavioural and psychological symptoms of dementia in care home patients: revisiting the sundowning syndrome.Int J Geriatr Psychiatry.2022;37(5):10.1002/gps.5712. doi:10.1002/gps.5712Shih YH, Pai MC, Lin HS, Sung PS, Wang JJ.Effects of walking on sundown syndrome in community-dwelling people with Alzheimer’s disease.Int J Older People Nurs. 2020;15(2):e12292. doi:10.1111/opn.12292Sheppard O, Coleman M.Alzheimer’s disease: etiology, neuropathology and pathogenesis. In: Huang X, editor.Alzheimer’s Disease: Drug Discovery[Internet].Brisbane (AU): Exon Publications; 2020. doi:10.36255/exonpublications.alzheimersdisease.2020.ch1Therriault J, Zimmer ER, Benedet AL, Pascoal TA, Gauthier S, Rosa-Neto P.Staging of Alzheimer’s disease: past, present, and future perspectives.Trends Mol Med. 2022;28(9):726–741. doi:10.1016/j.molmed.2022.05.008National Institute on Aging.Alzheimer’s disease fact sheet.National Institute on Aging.Coping with agitation, aggression, and sundowning in Alzheimer’s.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Canevelli M, Valletta M, Trebbastoni A, et al.Sundowning in dementia: clinical relevance, pathophysiological determinants, and therapeutic approaches.Front Med (Lausanne). 2016;3:73. doi:10.3389/fmed.2016.00073Todd WD.Potential pathways for circadian dysfunction and sundowning-related behavioral aggression in Alzheimer’s disease and related dementias.Front Neurosci.2020;14:910. doi:10.3389/fnins.2020.00910.Valletta M, Canevelli M, Blasi MT, Bruno G.Sundowning in patients with dementia: prevalence and clinical features.J Neurolog Sci. 2021;429:119004. doi:10.1016/j.jns.2021.119004Guu TW, Aarsland D, Ffytche D.Light, sleep-wake rhythm, and behavioural and psychological symptoms of dementia in care home patients: revisiting the sundowning syndrome.Int J Geriatr Psychiatry.2022;37(5):10.1002/gps.5712. doi:10.1002/gps.5712Shih YH, Pai MC, Lin HS, Sung PS, Wang JJ.Effects of walking on sundown syndrome in community-dwelling people with Alzheimer’s disease.Int J Older People Nurs. 2020;15(2):e12292. doi:10.1111/opn.12292Sheppard O, Coleman M.Alzheimer’s disease: etiology, neuropathology and pathogenesis. In: Huang X, editor.Alzheimer’s Disease: Drug Discovery[Internet].Brisbane (AU): Exon Publications; 2020. doi:10.36255/exonpublications.alzheimersdisease.2020.ch1Therriault J, Zimmer ER, Benedet AL, Pascoal TA, Gauthier S, Rosa-Neto P.Staging of Alzheimer’s disease: past, present, and future perspectives.Trends Mol Med. 2022;28(9):726–741. doi:10.1016/j.molmed.2022.05.008National Institute on Aging.Alzheimer’s disease fact sheet.National Institute on Aging.Coping with agitation, aggression, and sundowning in Alzheimer’s.
Canevelli M, Valletta M, Trebbastoni A, et al.Sundowning in dementia: clinical relevance, pathophysiological determinants, and therapeutic approaches.Front Med (Lausanne). 2016;3:73. doi:10.3389/fmed.2016.00073
Todd WD.Potential pathways for circadian dysfunction and sundowning-related behavioral aggression in Alzheimer’s disease and related dementias.Front Neurosci.2020;14:910. doi:10.3389/fnins.2020.00910.
Valletta M, Canevelli M, Blasi MT, Bruno G.Sundowning in patients with dementia: prevalence and clinical features.J Neurolog Sci. 2021;429:119004. doi:10.1016/j.jns.2021.119004
Guu TW, Aarsland D, Ffytche D.Light, sleep-wake rhythm, and behavioural and psychological symptoms of dementia in care home patients: revisiting the sundowning syndrome.Int J Geriatr Psychiatry.2022;37(5):10.1002/gps.5712. doi:10.1002/gps.5712
Shih YH, Pai MC, Lin HS, Sung PS, Wang JJ.Effects of walking on sundown syndrome in community-dwelling people with Alzheimer’s disease.Int J Older People Nurs. 2020;15(2):e12292. doi:10.1111/opn.12292
Sheppard O, Coleman M.Alzheimer’s disease: etiology, neuropathology and pathogenesis. In: Huang X, editor.Alzheimer’s Disease: Drug Discovery[Internet].Brisbane (AU): Exon Publications; 2020. doi:10.36255/exonpublications.alzheimersdisease.2020.ch1
Therriault J, Zimmer ER, Benedet AL, Pascoal TA, Gauthier S, Rosa-Neto P.Staging of Alzheimer’s disease: past, present, and future perspectives.Trends Mol Med. 2022;28(9):726–741. doi:10.1016/j.molmed.2022.05.008
National Institute on Aging.Alzheimer’s disease fact sheet.
National Institute on Aging.Coping with agitation, aggression, and sundowning in Alzheimer’s.
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