Sundown syndrome linked to middle-stage dementia

Q. What is sundown syndrome and who does it affect?

Sundown syndrome, which is also called sundowning, is a symptom that affects people with dementia. Those with the syndrome become confused and anxious as the sun sets. People with sundowning often have trouble sleeping.

The cause of the syndrome isn’t known yet. Some research suggests that sundowning may be related to changes to the brain’s circadian pacemaker. That’s a cluster of nerve cells that keeps the body on a 24-hour clock.

A recent animal study done at Ohio State University indicated that sundowning in humans may have a biological cause.

“Some people have argued that sundowning could be explained just by a buildup of frustration of older people who couldn’t communicate their needs over the course of the day, or by other factors,” said Randy Nelson, coauthor of the study and professor of neuroscience and psychology at Ohio State. “But our findings suggest there is a real phenomenon going on here that has a biological basis.”

The study found that, when compared to middle-aged mice, aged mice showed significantly more anxiety in the hours before they went to sleep. In these aged mice, the researchers found changes in parts of their brain associated with attention, emotions, and arousal, all of which could be associated with the behavior seen in sundowning.

About one in five people with dementia experiences sundowning. Dementia is not a specific disease. It’s an overall term that describes a wide range of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person’s ability to perform everyday activities. Alzheimer’s disease accounts for 60 to 80 percent of dementia cases. Sundowning usually is at its worst in the middle stages of Alzheimer’s. Its effects lessen as the disease progresses.

Here are some tips to reduce the severity of sundowning:

• Maintain a schedule. Breaks in routine create stress, which exacerbates sundowning.

• Make the evening a calm time. Soft music is helpful. Stay with simple activities that aren’t challenging.

• Keeping the home brightly lit in the afternoon and evening may help reduce the symptoms of sundowning. According to studies published in Clinical Geriatrics, people who were exposed to more light late in the day showed less agitation.

• Sundowning syndrome creates sleep problems, so keeping those with dementia busy during the day can help them get to sleep at night. Discourage afternoon napping. Encourage hobbies and exercise, such as walking.

• Large meals - especially those that include caffeine and alcohol - can increase agitation and may keep sundowners up at night. They should enjoy these foods during lunch instead of dinner. Limit evening intake to a light snack that is filling, but won’t interfere with rest.

• Seniors who experience sundowning in a hospital or assisted living facility need comforting through the familiar objects of their everyday life. Surround them with important items from home such as framed photos.

• Each person has different triggers for sundowning. Keep a journal of activities, environment, and behavior to identify triggers. Once the triggers are known, it’s easier to avoid situations that promote agitation and confusion.

• Keep a night light on to reduce agitation that occurs when surroundings are dark or unfamiliar.

• The person’s sleeping area should be kept at a comfortable temperature.