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Disorientation and confusion underpin most of the other sundowning symptoms and behaviors. As the day is ending, people may start to be uncertain and confused about what’s going on in their environment.
“For example, if their family is preparing dinner, the patient might be thinking, ‘What are these people doing?’ They don’t understand the activity around preparing the meal,” Diaz said. They may also feel that they are in the wrong place.
Because of this, they may become agitated and restless. “They might pace around or rock in the chair, things like that, where there’s visibility, an inability to relax,” Krowel said.
The person may become anxious, irritable, upset or aggressive. They may also have difficulty falling asleep or staying asleep, Diaz said. “Relatives may say they observe the patient wandering at night, because they’re not sleeping at night and reversing the day with the night.”
Symptoms “present differently from patient to patient, because there is more than one form of dementia,” Diaz noted. Visual or auditory hallucinations are more common in those with Lewy body Dementia, for example.
It’s important to learn to tell sundowning apart from delirium, though, as symptoms can appear similar.
Delirium may mean the person is going through a condition that is critical and in some cases, life-threatening, so being able to identify its root cause is essential. “Disorientation in delirium [may mean] the patient is in a critical condition. It could be a bad infection, sepsis, a severe and sudden spike in blood pressure, very high blood sugar, or a manifestation of stroke in patients who are older,” Diaz said.
The main way to distinguish between delirium and sundowning is by remembering that the latter typically occurs around the time the sun is setting or at a specific time of day, whereas delirium occurs abruptly at any time of the day, Diaz explained.
“For the most part, once you find out what is causing the delirium, and treat it or get it under control, the delirium will subside,” he noted. Sundowning tends to recur, though there are ways to ease its symptoms when it does.
If you suspect your loved one is experiencing delirium, Krowel advised seeing your primary care physician or going to emergency care, “depending on how severe the symptoms are at the time.”
What can worsen sundowning?
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