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Sundowning: Why does my parent’s confusion get worse as the sun goes down?

Many patients suffering from Alzheimer’s Disease (AD) and other forms of dementia experience a condition called Sundowning.  People may seem to be acting “normally” all day but become confused, paranoid, and even aggressive in the late afternoon or evening. This can make caring for patients with dementia more difficult. Sundowning may be the first hint of early cognitive impairment and should prompt a visit to the doctor. Sundowning is one of the most common behavioral disruptions in dementia and can be one of the main reasons for institutionalization. Further, associated with this confusion is an increased risk of wandering, which worsens as the degree of cognitive impairment becomes more severe.  

 

Factors that make sundowning worse are fatigue, spending the day in an unfamiliar place, low lighting, time changes, hunger, thirst, boredom, depression, or an infection such a urinary tract infection. Sundowning is also seasonal because of its association with the amount of sunlight, which is why it becomes more severe in the fall and winter. There are changes in the area of the brain which releases melatonin in response to sunlight.  These alterations can affect sleep as well.

 

Besides management with medications such as anti-depressants and anti-psychotics, there are other changes you make to help the situation.  For example, identifying triggers (such as turning on the news!) or hunger (giving an afternoon snacks) can help.  If the patient is in a new environment such as assisted living, surrounding the person with familiar items such as picture frames of family members and blankets and pillows from home.

 

If someone you love seems to be suffering from signs of confusion, mood changes, aggression and wandering at night, BeCareLink can help to screen them for early signs of cognitive impairment remotely from home with gamelike activities on a mobile phone.  Early detection is more important than ever before because of the new medications that can prevent progression and reduce the severity of dementia.

 

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