A psychologist has shed light on a frequently overlooked dementia symptom that tends to become particularly noticeable during afternoon hours, potentially causing significant distress for both patients and their loved ones.
Understanding the 'Sundowning' Phenomenon
Dr Kellyn Lee, CEO of The Dementia Care Hub and Visiting Academic at the University of Portsmouth, has explained this complex symptom through her educational content. "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 noted in a recent presentation.
The phenomenon, commonly referred to as 'sundowning', describes increased unpredictable behaviour in dementia patients that typically emerges after midday and continues into the evening hours. During this period, individuals may experience heightened anxiety, agitation, and confusion that can be challenging for caregivers to manage effectively.
What Triggers Sundowning Episodes?
Although the precise causes remain incompletely understood, medical experts emphasise that sundowning is not necessarily linked to sunset itself. Instead, it often relates to unmet physical or emotional needs at that particular moment. The Alzheimer's Society identifies several potential contributing factors:
- Mood disorders including anxiety and depression
- Physical discomfort such as hunger, pain or other bodily needs
- Disturbed hormone levels and circadian rhythms
- Side effects from prescribed medications
- Sensory impairments including vision loss
- Disruption to the body's internal clock caused by brain changes
- Overstimulation during daytime hours
- Fatigue and overtiredness
- Insufficient exposure to natural sunlight
- Lack of meaningful social interaction
"Sundowning can happen at any stage of dementia but is more common during the middle stage and later stages," explains additional guidance from the Alzheimer's Society.
Practical Management Strategies
For caregivers concerned about sundowning episodes, Dr Lee recommends systematic observation and documentation. "What I would be looking at doing is noting down when this is happening and what's happening," she advises. This careful tracking can help identify patterns and potential triggers that might otherwise go unnoticed.
The Alzheimer's Society suggests considering whether daytime events might have affected the individual's state. When agitation appears, they recommend calming techniques such as distraction through discussion of favourite memories or enjoyable topics.
Medical Intervention Considerations
In some cases, medical intervention may be considered. "There are tablets that can be used, such as lorazepam," Dr Lee acknowledges, while emphasising the need for caution. "Absolutely these drugs need to be taken with caution because they are highly addictive. Some GPs may not want to prescribe them."
She adds an important perspective: "I think we really need to balance the risk of addiction compared to the fact the person has dementia," highlighting the complex decisions families and medical professionals must make regarding treatment approaches.
The Broader Context of Dementia in the UK
Dementia serves as an umbrella term encompassing various conditions including Alzheimer's disease, all characterised by progressive decline in brain function. Current NHS statistics reveal that over 944,000 people throughout the United Kingdom are living with dementia today.
While symptoms vary depending on the specific type of dementia, early indicators often include:
- Noticeable mood changes and emotional shifts
- Difficulty concentrating on tasks or conversations
- Challenges performing familiar daily activities
- Memory lapses that affect daily life
- Struggling to follow conversations or find appropriate words
- Confusion regarding time, place, or situation
NHS guidance clarifies: "These symptoms are often mild and may get worse only very gradually. It's often termed 'mild cognitive impairment' (MCI) as the symptoms are not severe enough to be diagnosed as dementia."
The health service emphasises that dementia is not a natural part of ageing, making early consultation with a GP crucial when memory problems or other concerning symptoms emerge. "You might not notice these symptoms if you have them, and family and friends may not notice or take them seriously for some time," the guidance notes, while adding that some people with MCI will eventually develop dementia, though others may remain stable.
