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Assessment and Management of "Sundowning" Phenomena
1Department of Psychiatry and Beharioral Sciences, Department of Veterans Affairs Health Care System, Palo Alto, California, USA
Seminars in Clinical Neuropsychiatry
|April 1, 1997
Summary
Sundowning, characterized by confusion and agitation in Alzheimer
Area of Science:
- Gerontology
- Neuroscience
- Psychiatry
Background:
- Sundowning, a pattern of increased confusion and agitation in Alzheimer's disease (AD) patients during late afternoon and evening, affects approximately 25% of individuals.
- The phenomenon lacks standardized assessment methods, hindering clinical trials and precise prevalence studies.
- Existing research links caregiver-reported sundowning behaviors to early bedtime, sedative-hypnotic use, and greater cognitive impairment.
Purpose of the Study:
- To review current research on the prevalence and characteristics of sundowning in Alzheimer's disease (AD) patients.
- To explore potential contributing factors and management strategies for sundowning and associated sleep disturbances.
- To highlight the need for standardized assessment tools and further research into sleep and circadian rhythm changes in dementia progression.
Main Methods:
- Review of recent research on the prevalence of abnormal behaviors in AD patients at different times of day.
- Analysis of caregiver reports correlating confusion and disruptive behavior with specific factors.
- Consideration of existing evidence on sleep quality in AD patients and the effects of psychotropic medications.
Main Results:
- Caregiver reports indicate associations between sundowning, early bedtime, sedative-hypnotic use, and more severe cognitive impairment.
- Poor sleep quality is common in AD patients, suggesting potential benefits from behavioral insomnia treatments.
- Psychotropic medications may negatively impact sleep and daytime cognition, necessitating careful management.
Conclusions:
- Improved assessment of sundowning is crucial for advancing research and clinical care.
- Behavioral interventions for insomnia may be applicable to AD patients experiencing sleep disturbances.
- Longitudinal studies on sleep and circadian rhythms in dementia progression are needed to optimize treatment strategies for behavioral and sleep disturbances.