Alzheimer’s patients may experience greater confusion and agitation once sun goes down

Some patients of Alzheimer’s disease or other forms of dementia may experience greater confusion or agitation daily, once night falls.

This phenomenon, affecting about 20 per cent of Alzheimer’s and dementia patients, is called sundowning or sundown syndrome. It usually manifests at the moderate stage of Alzheimer’s and gets better as the disease progresses.

As the sun goes down, Alzheimer’s patients with sundown syndrome may experience a worsening of the following symptoms:

1. Confusion
2. Disorientation
3. Forgetfulness
4. Anxiety
5. Restlessness
6. Agitation
7. Aggression
8. Mood swings

“Alzheimer’s patients with sundown syndrome may experience these symptoms in the late afternoon, early evening or at night,” explains Adjunct Associate Professor Shahul Hameed, Senior Consultant from the Department of Neurology at National Neuroscience Institute (NNI)​, a member of the SingHealth​ group. “They may have trouble sleeping at night, and may wander about in the house, or pace up and down and get aggressive because they can’t sleep.”

Causes and risk factors for sundowning

The causes of sundowning are not known though research points to an impairment of the brain cells that control the body’s circadian rhythm or internal clock. Factors such as severe constipation, a poor diet, excessive medication, pain, infection and a noisy environment have been found to increase the risk for sundowning.

How to manage sundowning at home

The severity of the symptoms of sundown syndrome can be reduced with the following dietary and lifestyle changes:

1. Avoid caffeine and sugar in the afternoon and evening
2. Have an early dinner
3. Avoid snacking late in the evening
4. Avoid daytime naps
5. Get some daily outdoor physical exercise
6. Get some daily exposure to sunlight
7. Remain involved in different activities during the day
8. Maintain a quiet sleeping environment and keep a night light on

Can a healthy diet and exercise prevent Alzheimer’s and dementia?

There is no proven way to prevent Alzheimer’s or dementia. However, a healthy lifestyle that includes a balanced diet with plenty of fruits, vegetables and fibre, and sufficient physical exercise may play a significant role in maintaining mental health.

Social interaction and intellectual stimulation are also important factors that can help preserve mental function in older years.

See page 1 for symptoms of mild, moderate and severe Alzheimer's disease.

See page 2 to learn about the causes of Alzheimer's and how the condition is diagnosed and treated.

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