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Understanding the Concept of Sundowning in Alzheimer's Disease

There are many identifying symptoms of Alzheimer's that are cognitive or behavioral but one aspect of the disease that is of a particular hallmark of Alzheimer's is that of s"undowning". Sundowning is a term used to describe the phenomenon in which the individual becomes confused and agitated during the late afternoon and into the early evening hours. There are some theories of why this phenomenon occurs one of which has to do with the decline in light.

It is the approach of darkness that seems to trigger the sundowning to occur. When darkness approaches the individual will become increasingly agitated and confused. The individual is also greatly fatigued and easily over stimulated.

Sundowning is perhaps the single most difficult part of Alzheimer's for others to understand because the behavior is often so bizarre that it confuses family members and friends. Communication can be difficult and safety measure must be in place because of the confused state and agitation that is likely to occur.

There are many things that can be done to minimize the intensity of the symptoms experienced by the patient. Factors that trigger symptoms tend to be low lighting, a noisy environment, fatigue and increasing shadows. To make things easier on the patient as these hours approach each day try to keep the patient in a calm and quiet environment that is well lit. It also helps to make sure that the individual has had the opportunity to rest or nap during the day so as not to be fatigued as the evening draws close.

Symptoms that the patient may exhibit during sundowning include:

· Fatigue

· Visual Hallucinations

· Agitation

· Confusion

· May easily become frightened of strangers (real or imaginary)

· Become disoriented

· Exhibit Paranoia

It is vital that anyone who cares for someone with Alzheimer's understand the concept of sundowning. It is important to understand that the individual has a disease and that the symptoms are characteristic of the disease and they are not to be punished or ill-treated because of their aggression or other behavior that may look on outward appearances to be threatening of others. The Alzheimer's patient must be monitored and kept safe especially from wandering during these hours when sundowning is likely to occur. Caregivers, family members and friends should be instructed as to what the symptoms are and how to address them when they occur. The environment should be set up to protect the individual from harm such as providing adequate lighting, maintaining a quiet environment as much as possible and to remove all possible hazards for when the individual becomes confused.

If the concept of sundowning is not explained to respite workers, unfortunate incidents can happen so remember to educate all staff, respite helpers and family members or others living in the same home with the patient of the aspects of sundowning as well as other symptoms of Alzheimer's disease.