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Dementia Sundowning - A Pattern Of Deterioration

Aug 17, 2007
People with various forms of dementia including Alzheimer's disease are often found to be at their emotional best at earlier points in the day. Caretakers often report that as the day progresses the patient's memory and emotional well-being deteriorate, this is often referred to as "sundowning".

Some of the symptoms of sundowning are an increase in the agitation levels of the patient as well as the loss of abilities to comprehend, perform certain tasks and other functions that the patient may have had little to no difficulty with earlier in the day. Confusion and anger are also common reactions by patients that can realize in the earlier stages of dementia and Alzheimer's that something is amiss but they can't quite put their finger on exactly what. Inability to sleep and restlessness are also common with sundowning.

Sundowning can occur in any level of dementia or Alzheimer's and seems to be more severe in the moderate stages of these conditions. There is some scientific evidence to support the theory that Alzheimer's causes severe damage to the parts of the brain that control the internal clock of body and the normal urges to sleep when tired and awake when rested are forever set off balance.

Sundowning can make both the caregiver and patient wear down as anyone caring for a patient with dementia or Alzheimer's can attest to. It is exhausting and neither the patient nor the caregiver may be at their emotional best at the end of the day. It's human nature to lose your patience and it is also human nature to be frustrated with a patient that it is difficult to reason with due to both their condition and their increased agitation.

Caregivers can benefit greatly from just taking a little time for themselves, especially if they have someone in their care that is experiencing sundowning on a regular basis. Just having a friend or someone responsible that is willing to act as a caregiver for a couple of hours while the regular caregiver has a meal in a restaurant or catches a movie will make a world of difference and in many cases, many dementia and Alzheimer's patients also react favorably to someone new to talk to or be with for a short time.

Knowing the basics of sundowning can make caring for a dementia or Alzheimer's patient that is experiencing this frustrating symptom a lot easier to deal with if you know the basics of the syndrome and what to look for. Also, if you have a patient that is experiencing sundowning, scheduling outings early in the day may be a big part of eliminating a lot of the frustration. If the patient has some of the classic symptoms of sundowning such as agitation, confusion and becoming argumentative, you can avoid a lot of confrontations by not taking them out after the early afternoon.

Also, rule out other causes of suddenly acting out or severe agitation. Make sure that your patient isn't having issues with any kind of discomfort, bothered by noises or lights or having pain. Sometimes dementia and Alzheimer's sufferers have difficulty vocalizing their physical discomfort and may act out instead.

Don't assume because you have a patient that paces, cries and is angry at night that he or she is experiencing the effects of sundowning. On the contrary, these outbursts may be due to a very real physical problem that is causing discomfort in some form to the patient. Make sure and you address physical comforts before you assign a label of sundowning to the behavior of your patient.

Lighting can also be an issue with some patients. Try softening the lighting and you might just see a similar softening in their moods. Also, soft music makes many dementia and Alzheimer's patients feel safer and more secure. Also, many patients "feed" off the emotional states of others and if lose your composure after a frustrating day, the patient may mirror your frustration and it will increase their agitation directed right back at you.

It's a good rule of thumb to take a deep breath and remember that patients with dementia and Alzheimer's do not have control over their conditions or their emotions for the greater part of the time. Each patient will need to be dealt with in a different way to handle their sundowning, as each patient will need to be addressed in different ways. Keeping a journal of outbursts, sundowning symptoms and the ways they were successfully handled is a great way to see what methods work and what does not.

Caring for a patient with dementia or Alzheimer's can be a frustrating, rewarding and enriching experience. Knowing some of the nuances that may be experienced in caring for a patient will make the process a lot easier for everyone involved.
About the Author
Andi Michaels writes regularly for Alzheimers And Dementia where you can read many more articles on dementia and Alzheimers symptoms and much more.
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