Sundowning (dementia)
Encyclopedia
In medicine
, sundowning, also known as sundown syndrome, is a syndrome
involving the occurrence or increase of one or more abnormal behaviors in a circadian rhythm
. Sundowning typically occurs during the late afternoon, evening, and night, hence the name. It occurs in persons with certain forms of dementia
and psychosis
, such as seen in Alzheimer's disease
. Although not widely surveyed, sundowning has been estimated to occur in 45% of persons diagnosed with Alzheimer's disease.
A person who is sundowning may exhibit mood swings, become abnormally demanding, suspicious, upset or disoriented, and see or hear things that are not there in the late afternoon and evening. After wandering
, sundowning is the second most common type of disruptive behavior in institutionalized persons with dementia. Sundowning often co-occurs with wandering, and the combination of these two syndromes is an important contributing factor to an emergency situation: elopement
at night.
The cause of sundowning is unknown, but may be related to disturbed circadian rhythm
. Contributing factors may include medication
s that can cause agitation or confusion, and sleep disorder
s.
medication such as haloperidol
, risperidone
, or olanzapine
. However, these have significant side effects.
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
, sundowning, also known as sundown syndrome, is a syndrome
Syndrome
In medicine and psychology, a syndrome is the association of several clinically recognizable features, signs , symptoms , phenomena or characteristics that often occur together, so that the presence of one or more features alerts the physician to the possible presence of the others...
involving the occurrence or increase of one or more abnormal behaviors in a circadian rhythm
Circadian rhythm
A circadian rhythm, popularly referred to as body clock, is an endogenously driven , roughly 24-hour cycle in biochemical, physiological, or behavioural processes. Circadian rhythms have been widely observed in plants, animals, fungi and cyanobacteria...
. Sundowning typically occurs during the late afternoon, evening, and night, hence the name. It occurs in persons with certain forms of dementia
Dementia
Dementia is a serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging...
and psychosis
Psychosis
Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...
, such as seen in Alzheimer's disease
Alzheimer's disease
Alzheimer's disease also known in medical literature as Alzheimer disease is the most common form of dementia. There is no cure for the disease, which worsens as it progresses, and eventually leads to death...
. Although not widely surveyed, sundowning has been estimated to occur in 45% of persons diagnosed with Alzheimer's disease.
A person who is sundowning may exhibit mood swings, become abnormally demanding, suspicious, upset or disoriented, and see or hear things that are not there in the late afternoon and evening. After wandering
Wandering (dementia)
Wandering, in persons with dementia, is a common behavior that can cause great risk for the person, and is often the major priority for caregivers. It is estimated to be the most common form disruption from people with dementia within institutions. Although it occurs in several types of...
, sundowning is the second most common type of disruptive behavior in institutionalized persons with dementia. Sundowning often co-occurs with wandering, and the combination of these two syndromes is an important contributing factor to an emergency situation: elopement
Wandering (dementia)
Wandering, in persons with dementia, is a common behavior that can cause great risk for the person, and is often the major priority for caregivers. It is estimated to be the most common form disruption from people with dementia within institutions. Although it occurs in several types of...
at night.
The cause of sundowning is unknown, but may be related to disturbed circadian rhythm
Circadian rhythm
A circadian rhythm, popularly referred to as body clock, is an endogenously driven , roughly 24-hour cycle in biochemical, physiological, or behavioural processes. Circadian rhythms have been widely observed in plants, animals, fungi and cyanobacteria...
. Contributing factors may include medication
Medication
A pharmaceutical drug, also referred to as medicine, medication or medicament, can be loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease.- Classification :...
s that can cause agitation or confusion, and sleep disorder
Sleep disorder
A sleep disorder, or somnipathy, is a medical disorder of the sleep patterns of a person or animal. Some sleep disorders are serious enough to interfere with normal physical, mental and emotional functioning...
s.
Prognosis
In persons with early Alzheimer's disease, the presence of sundowning has been associated with faster decline in cognitive functions.Treatment
Behavioral disturbance is often treated with antipsychoticAntipsychotic
An antipsychotic is a tranquilizing psychiatric medication primarily used to manage psychosis , particularly in schizophrenia and bipolar disorder. A first generation of antipsychotics, known as typical antipsychotics, was discovered in the 1950s...
medication such as haloperidol
Haloperidol
Haloperidol is a typical antipsychotic. It is in the butyrophenone class of antipsychotic medications and has pharmacological effects similar to the phenothiazines....
, risperidone
Risperidone
Risperidone is a second generation or atypical antipsychotic, sold under the trade name . It is used to treat schizophrenia , schizoaffective disorder, the mixed and manic states associated with bipolar disorder, and irritability in people with autism...
, or olanzapine
Olanzapine
Olanzapine is an atypical antipsychotic, approved by the FDA for the treatment of schizophrenia and bipolar disorder...
. However, these have significant side effects.