There are several reasons why you might feel off in the late afternoon and evening. Perhaps you’re mentally drained after socializing all day, or your brain is exhausted from hours of work. If you woke up early, you might simply prefer to wrap yourself in a blanket and watch Netflix rather than engage with others—any of these are valid reasons to feel irritable during this time. However, in individuals with dementia, which encompasses various conditions related to mental decline such as Alzheimer’s, there is a phenomenon called “sundowning” where symptoms, like agitation and anxiety, intensify later in the day and evening.
As we enter the holiday season, you may be spending more time with older loved ones than usual. It’s important for adults to have a better understanding of how sundowning manifests and what it could indicate for the cognitive well-being of their loved ones. For more information, we reached out to two healthcare providers specializing in older adults.
Meet the experts: Shannel Kassis Elhelou, PsyD, is a fellow in geropsychology and neuropsychology at the Brain Wellness and Lifestyle Programs at Providence Saint John’s Health Center in Santa Monica, California. Fred Kobylarz, MD, is the co-director of the Center for Healthy Aging at Rutgers Robert Wood Johnson Medical School.
“Sundowning” refers to behavioral changes in individuals with dementia that occur at a specific time of day. Also known as “sundowner’s syndrome,” sundowning comprises symptoms or behaviors observed in some individuals with Alzheimer’s disease and dementia, as outlined by the Alzheimer’s Association.
“This usually occurs as the dementia advances,” explains Fred Kobylarz, MD, co-director of the Center for Healthy Aging at Rutgers Robert Wood Johnson Medical School. “It is a symptom of dementia rather than a disease.” Unfortunately, the cause of sundowning remains unknown. It is believed that sundowning in dementia patients may result from a combination of hormonal changes, brain deterioration or damage, environmental factors, disruption of circadian rhythms, among other factors.
Symptoms of sundowning can vary among individuals but may include anxiety, agitation, pacing, disorientation, hallucinations, and sleep disturbances. Sundowning typically manifests in the late afternoon and evening in individuals with dementia, notes Shannel Kassis Elhelou, PsyD. However, Dr. Kobylarz mentions that it can begin as early as 1 p.m. for some individuals.
Distinguishing between a normal end-of-day fatigue and sundowning is crucial. Apart from the aforementioned symptoms, sundowning may involve verbal or physical outbursts, according to Elhelou. Individuals may exhibit frustration if meals don’t meet their expectations or struggle to find items. Some may seek increased closeness with loved ones for reassurance.
Confusion is another common feature of sundowning. “They may not recall conversations or meals from earlier in the day,” Dr. Kobyl
As the sun dips below the horizon, a peculiar transformation can occur in individuals living with dementia. Dr. Kobylarz explains, “You can see [the person with dementia] change at a certain time of the day and almost become another person.” This phenomenon, known as sundowning, raises questions about its connection to early signs of dementia. While often observed post-diagnosis, sundowning can also serve as a precursor to mental decline. “There are changes taking place in the brain,” Dr. Kobylarz elucidates, shedding light on the complex nature of dementia onset and progression.
The line between sundowning and typical aging blurs as fatigue sets in during the evening hours. Dr. Kobylarz distinguishes sundowning by stating, “Fatigue can occur at all times of the day. Sundowning is truly confusion.” Unlike mere tiredness that can be alleviated by a nap, sundowning presents persistent cognitive challenges. Elhelou emphasizes the consistency in sundowning patterns, often marked by disorientation and impaired judgment, setting it apart from regular fatigue.
Recognizing the distinctive features of sundowning is crucial in caring for individuals experiencing this phenomenon. Establishing a structured routine and understanding the individual’s optimal time of day are key components in managing sundowning, according to Dr. Kobylarz. While navigating the complexities of sundowning can be daunting, Elhelou recommends creating a serene environment and adhering to a predictable schedule to minimize confusion and fatigue. Encouraging exposure to natural light and engaging in daytime activities can support healthy sleep patterns, contributing to a more stable routine for those affected by sundowning.
Moreover, it is essential to address physical needs and avoid overstimulation in the evening to ensure a sense of security for individuals experiencing sundowning. Elhelou underscores the importance of monitoring and discussing any changes with a healthcare provider promptly. Seeking medical advice can help identify underlying causes such as dementia, medication effects, or environmental factors, guiding effective strategies to manage behavioral shifts associated with sundowning.
While sundowning is commonly linked to dementia, Elhelou stresses that its occurrence is not exclusive to individuals with dementia. Older adults, especially when unwell or experiencing delirium, may exhibit similar symptoms. Therefore, vigilance and proactive communication with healthcare providers are vital in addressing sundowning-related concerns.
In the realm of aging and cognitive health, the nuances of sundowning shed light on the intricate interplay between mental faculties and external stimuli. By understanding the unique characteristics of sundowning and adopting tailored management strategies, caregivers and healthcare professionals can navigate this phenomenon with empathy and precision, enhancing the quality of life for those affected.
In essence, the enigma of sundowning serves as a poignant reminder of the multifaceted nature of dementia and cognitive changes in aging individuals. By unraveling the complexities of sundowning through compassionate care and informed interventions, we pave the way for
