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Many Dementia or Alzheimer's sufferers get worse close to sunset; how to recognise this problem and suggestions for ways of minimising the symptoms
Sundown Syndrome is not a new phenomenon. Carers have noted that the symptoms of dementia or Alzheimer’s disease seem to get worse as the day progresses. Evening shift staff in care homes have reported that the degree of agitation and confusion amongst patients is notably higher after sunset, giving rise to the name Sundown Syndrome or Sundowning. The early signs of Sundown SyndromeThe earliest signs of the onset of this condition can be subtle and difficult to recognise for those new to Sundown Syndrome. These include paranoid delusions of being criticised or judged. For example, the sufferer may start to feel they are being watched and that their movements are known to neighbours. Hallucinations & ConfusionAs the condition progresses, they may become more confused, becoming more agitated towards the end of the day. At its worst, the sufferer may experience hallucinations - possibly caused by the effects of chemical imbalances in the brain affecting the centres that handle visual and auditory processing. The hallucinations can be very realistic, and sufferers may be convinced that they have had visitors or that people are shouting at them. Day-Night ConfusionAnother distressing symptom is confusion of the diurnal / nocturnal rhythms, i.e. not knowing whether it is night or day. The sufferer may decide to get up in the middle of the night in order to go for a walk. Such nocturnal wandering is one of the main reasons that is cited for sufferers being admitted into care homes. Causes of Sundown SyndromeThe medical community is divided on what causes Sundown Syndrome. Some believe that it is the cumulative effect of sensory stimulation during the day and others believe that it could be connected with fatigue or stress. Others suggest that it is hormonally related and another theory is that it is due to anxiety caused by reduced ability to see as well in the dark. Another piece of research suggests that it may be linked to disturbance in the day/night rhythms caused by altered patterns of sleep and wakefulness. They advise that using a full spectrum light bulb (e.g. 2000 lux) at a distance of approximately one metre from the sufferer first thing in the morning for half an hour can help to reset the body’s clock. Hydration is ImportantKeeping the body hydrated is very important. Many elderly people strictly control the amount that they drink because they don't want to have to get up in the night. Becoming dehydrated effects the brain and is more likely to bring on an attack of Sundown Syndrome. It is important to encourage the sufferer to have regular drinks throughout the day. Choice of drinks is important too. Water is best as it hydrates correctly, whereas fizzy drinks containing E numbers and artificial sweeteners may not have the desired effect. Care of Sundown SyndromeThe following are some suggestions that can help minimise the symptoms:
REFERENCESM. L. McGonigal-Kenney and D. Schutte. "Non-pharmacologic management of agitated behaviors in persons with Alzheimer disease and other chronic dementing illnesses." University of Iowa Gerontological Nursing Interventions Research Center, Research Dissemination Core, National Guideline Clearinghouse, 2004. Teicher MH et al. The phototherapy light vision: more than meets the eye. Am J Psychiatry 1995;1528,1197-202.
The copyright of the article Sundown Syndrome in the Elderly in Seniors' Health/Medicare is owned by Christine Fadhley. Permission to republish Sundown Syndrome in the Elderly in print or online must be granted by the author in writing.
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