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Alzheimer's Disease

Sundowner as a Specific Symptom of Alzheimer's Disease

01/21/2005

Question:

My mother has been told she has a condition of Alzheimer Disease called "Sundowner". It was explained to us this disease only starts to affect her during the evening hours. I noticed it starts around 4-5:00 pm. What do we need to know and what can we do to help her? How does this progress in time?

Answer:

"Sundowning" is a term used to describe a pattern of restlessness, confusion, disorientation, and other behavioral problems such as anxiety, agitation, or delusions in persons with Alzheimer's disease (AD) that usually begin in the late afternoon and early evening hours and become progressively worse through the evening hours, or as the "sun goes down", hence the term "sundowning".   Sundowning is not a disease.  Your mother always has AD, but you may only notice obvious symptoms and behavioral changes during this time.  Sundowning is very common in the moderate to severe stages of AD.  We are not sure what causes sundowning but it may be related to disrupted circadian rhythms, fatigue from the day, sensory changes due to decreased light, shadows, and a change in activity related to preparing dinner, etc.

There are several approaches to coping with this.  One is to realize it is just a part of the disease and "ride it out" during this bad time of the day.  Remaining calm and making sure there is adequate light and quiet in the environment may help.  A short afternoon nap or quiet time may be helpful as well.  Attempting to prevent stimulus "overload" is important.  It may be helpful to think about how we all feel toward the end of the day, and how this is magnified in persons with AD.  There are also medication approaches if the symptoms become too severe to handle, and your mother's physician's input will be essential at this time.  

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Response by:

Paula K Ogrocki, PhD Paula K Ogrocki, PhD
Assistant Professor of Neurology
School of Medicine
Case Western Reserve University