A leading psychologist has drawn attention to a frequently overlooked symptom of dementia that typically intensifies in the later hours of the day, often leaving families confused and concerned.
What is Sundowning in Dementia?
Dr Kellyn Lee, the head of The Dementia Care Hub, has detailed a phenomenon known as 'sundowning'. This involves people living with dementia exhibiting increased anxiety, agitation, and confusion, particularly during the afternoon and evening. While it can occur at any time, Dr Lee notes a pronounced pattern of these episodes happening later in the day.
In a TikTok video from earlier this year, Dr Lee explained the signs to watch for. "This can happen at any time of day, but what we see a lot with people living with dementia is that it can happen in the afternoon," she said. "So, what I would be looking at is this would be, again, a symptom of anxiety and agitation and maybe increased confusion."
During sundowning episodes, individuals may become exceptionally distressed and can experience hallucinations or delusions. Their behaviour may appear more unpredictable and erratic as the day progresses.
Potential Triggers and Management Advice
The exact causes of sundowning are not completely understood, but the Alzheimer's Society clarifies it is not necessarily linked to the setting sun. Instead, it is likely driven by immediate, unmet needs or disruptions. Potential triggers include:
- Disrupted hormone levels or the person's internal 'body clock' due to brain damage.
- Side effects from prescribed medications.
- Sensory impairment, such as sight loss.
- Unmet physical needs like hunger, thirst, or pain.
- Overstimulation during the day or overtiredness.
- Lack of exposure to sunlight or social interaction.
- Underlying mood disorders, including anxiety and depression.
The Alzheimer's Society states, "Sundowning can happen at any stage of dementia but is more common during the middle stage and later stages." They advise carers to try and identify which specific problems might be affecting the person, as each may require a different approach.
Dr Lee recommends keeping a detailed log of symptoms, noting when they occur and what happens. This record can be invaluable for healthcare professionals. In terms of medication, she mentioned drugs like lorazepam could be used but emphasised they require caution. "Absolutely these drugs are drugs that need to be taken with caution because they are highly addictive," she said, adding that the risks must be balanced against the distress caused by sundowning in a person with dementia.
Recognising Broader Dementia Symptoms
While sundowning is a specific pattern of behaviour, other common early signs of dementia can include:
- Memory loss that affects daily life.
- Difficulty concentrating or following conversations.
- Struggling to complete familiar tasks.
- Confusion about time and place.
- Mood changes and finding the right words.
The NHS urges anyone experiencing these warning signs to seek medical advice. While there is currently no cure for dementia, treatments and medicines can help manage symptoms, especially for Alzheimer's disease, the most common form.
For further information and support, individuals are directed to the official NHS website and organisations like the Alzheimer's Society.
