Understanding Sundowning: An Early Indicator of Dementia and What You Should Know

Have you ever noticed that by late afternoon or evening, your mood just isn’t the best? Maybe after a busy day of work or social events, your brain feels drained and you just want to relax and disconnect. It’s totally normal to feel a little irritable or exhausted at the end of a long day. Many of us simply prefer curled up on the couch watching Netflix rather than dealing with more social interaction after a tiring day.

But for some individuals, especially older adults, feeling unsettled or agitated at the end of the day might be more than just tiredness. This could be a warning sign of something deeper called 'sundowning,' which is linked to dementia-related illnesses like Alzheimer’s disease. So, as you spend more time with your older family members during busy seasons like the holidays, understanding what sundowning looks like and what it means can make a big difference.

Sundowning refers to a set of behaviors and mood shifts that happen primarily during late afternoon or evening in people who have dementia. You might hear it called 'sundowner’s syndrome,' but it’s not a condition on its own — rather, it’s a symptom that appears as dementia advances. Experts aren’t completely sure why sundowning happens, but it’s thought to be caused by a mix of factors like changes in brain chemistry, damage to certain brain areas, disruptions to natural body clocks, and environmental triggers.

Typical signs of sundowning include feelings of anxiety, increased agitation, pacing restlessly, confusion about their surroundings, hallucinations, and difficulties falling or staying asleep. For those caring for someone with dementia, these symptoms often become more noticeable as the afternoon transitions into evening, though in some cases, symptoms may begin as early as midday. Recognizing these signs is crucial to helping someone who may be struggling with this challenging syndrome.

It can be tricky to differentiate between ordinary end-of-day tiredness and sundowning, especially if you’re unfamiliar with the condition. Sundowning doesn’t just make someone feel worn out; it can lead to intense emotional and behavioral changes. People might become unusually irritable or agitated, have outbursts of anger or frustration, or seem more confused than usual. For example, someone might get upset if dinner isn’t what they expected or become frustrated trying to locate misplaced items.

Sometimes, individuals experiencing sundowning seek more physical closeness or reassurance from loved ones, staying close or following them around the room. In other situations, they may become disoriented, forgetting conversations from earlier, the meals they’ve just eaten, or even not recognizing their home or family members caring for them. It's almost like they become a different person during these periods, which can be both confusing and heartbreaking to witness.

While sundowning often happens after a dementia diagnosis, it can also be an early sign that cognitive decline is beginning. As the brain starts to change and deteriorate, symptoms might appear even before dementia is officially diagnosed. If you notice these late-day mood and behavior changes, it’s worth paying close attention and discussing them with a healthcare professional.

That said, it’s important to remember that sundowning symptoms aren’t exclusively caused by dementia. Similar behaviors can sometimes be seen in older adults who don’t have dementia but may be experiencing other health issues such as illness or delirium. So, if someone you care about shows signs of sundowning, it doesn’t necessarily mean they have dementia, but it should definitely prompt a check-in with their doctor for proper assessment and guidance.

Feeling off or tired as the day winds down is something most people experience, especially during busy and stressful times. However, sundowning is different because it includes confusion and cognitive difficulties, not just fatigue. While a tired person might feel like taking a short nap to recharge, someone experiencing sundowning might be wide awake, restless, and confused instead. These symptoms tend to happen consistently around the same part of the day and don’t simply disappear with rest.

Helping a loved one manage sundowning requires patience and understanding of their unique daily rhythm. Establishing a consistent routine can help reduce confusion and make days more predictable. Encouraging activities and exposure to natural light during daylight supports healthier sleep patterns. In the evenings, keeping the environment calm by minimizing loud noises, bright screens, and large gatherings can ease symptoms. Also, regularly checking and addressing physical needs like hunger, thirst, or discomfort helps the person stay more comfortable and secure.

If you notice signs of sundowning, it’s very important to bring these observations to the family doctor or specialist. They can investigate possible causes, including dementia progression or side effects from medications, and recommend effective strategies tailored to your loved one’s needs. Remember, while sundowning is challenging to manage, with proper care and support, you can help your loved one experience more comfort and calm during difficult times.