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A Caregivers' Challenge: Dealing with "Sundowning" in Alzheimer's Disease

What is Sundowning?

"Sundowning" or "Sundown Syndrome" is a phenomenon well known to many of the estimated 2.4 to 3.1 million caregivers to persons with Alzheimer's disease in the U.S. Sundowning refers to the changes in behavior and mood that often occur in the late afternoon or evening in people with Alzheimer's disease and similar conditions that alter brain function. These changes in mood and behavior can be particularly challenging for caregivers and loved ones.

Symptoms associated with sundowning include:

  • aggression,
  • agitation,
  • delusions,
  • hallucinations,
  • paranoia,
  • increased disorientation, and
  • wandering.

Sometimes sundowning occurs together with "shadowing," in which the person mimics or follows the caregiver, sometimes asking repetitive questions.

It's not clear why these troubling behaviors occur most commonly at night and in late afternoon. The circadian rhythm and hormonal factors may predispose to the late-day agitation and restlessness in some people. Other possible reasons for might be reduced vision due to lower light levels, tiredness after a full day, boredom and the absence of planned activities at night, insomnia, or stress and anxiety of the caregiver that is communicated to or perceived by the patient.

Last Reviewed 9/11/2017

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