Bridging Gaps in Sundown Syndrome Research: a Scoping Review and Roadmap for Future Multimodal Approaches

Sundown syndrome (SS), or sundowning, is a neuropsychiatric phenomenon marked by the worsening of symptoms in the late afternoon or evening, primarily in individuals with dementia. By systematically examining previous studies, this scoping review aims to (1) bridge traditional questionnaire-based assessment methods with advanced sensor-based tools and (2) propose a multimodal framework to guide future research in enhancing risk identification, diagnosis, monitoring, and treatment across key symptom categories.

We conducted a comprehensive review of Web of Science, PubMed, Medline, APA PsycInfo, and IEEE Xplore to identify studies on SS. Following established scoping review guidelines, 13 review papers and 41 empirical studies were selected and analyzed based on traditional questionnaire-based observation and/or sensor-based measurement methods.

We identified key limitations in traditional assessment methods and classified SS symptoms into five domains: psychomotor symptoms, cognitive and perceptual disturbances, mood and affective symptoms, psychosis, and disruptions in activities of daily living and instrumental activities of daily living. Building on these insights, we proposed a multimodal platform integrating sensor technologies to enhance risk identification, diagnosis, continuous monitoring, and treatment.

This study advances the understanding of SS by synthesizing prior research, refining symptom domains, and proposing a roadmap for future investigation and intervention. The integration of multimodal sensor technologies holds the potential to reduce caregiver burden, enhance patient care, and enable more effective management of SS and other behavioral disturbances in older adults.