Sundowner's Syndrome

Both my grandmothers were diagnosed with Alzheimer's disease. One of them died of it when I was a teen. Her health deteriorated quickly, I remember. She became comatose a little over two years after her diagnosis. Only with my other grandmother, who is in the sixth year of her diagnosis, I realized how difficult -and at times infuriating- it can be to take care of a dementia patient. 

Last summer, when I was her caregiver for the summer, I realized her situation was significantly worsening. As the daylight faded away, she would get confused and restless, and between her confusion and restlessness, some nights she would unlock the door to go out to the garden where in her healthier days, she used to either pull out the weeds or water the peppers and tomatoes, meanwhile calling names from the past for help; in others, she would make bread, kneading the imaginary dough on her bed. It was not possible to talk sense into her. As far as I was concerned, she was completely out of touch with reality. 

It's called sundowning. A clinical phenomenon characterized by the emergence or increment of neuropsychiatric symptoms in the late afternoon, evening, or at night, common among cognitively impaired, demented, or institutionalized elderly patients. 

The phenomenon does not have a clear definition or etiology. However, there are possible causes that can contribute to the outcome, such as tiredness, unmet needs (hunger, thirst), navigating a new environment, and noticing stress or frustration in those around them.

Approximately, one in five Alzheimer's patients suffers from sundowning, and it can worsen cognitive troubles the patient is already experiencing. 

However, there are things we can do to help manage sundowning. Discouraging daytime naps, avoiding caffeine, and other overly sugared food and drinks; keeping rooms well-lit so they can see more clearly and not get confused, leaving certain activities to earlier hours when they are more alert, and last but not least, building a routine, to reduce stress by letting them know what to expect.