I recall one of the first times Mom experienced Sundowning Syndrome in my presence. She began asking me where her mother was. While this took me aback, I answered as truthfully as possible, which only led to her becoming upset. Later, there were phone calls, which could also be determined as Sundowning, in which she would demand her mother’s phone number. She had tried her old number and found it wasn’t any good any longer - so she would phone my brother or me for the information.
One of her friends had also phoned me as she had seen it happening. As Mom declined at home the syndrome became more prevalent. I had to begin asking whether or not this was symptomatic of Alzheimer’s and Dementia? or was it simply caused by age?
No one truly knows the actual reason for the phenomenon. It affects 1 in 4 Alzheimer’s patients, and it also affects many who are not succumbing to dementia. This has left the medical community with a puzzle. However, what they do know is that there is such a thing and it seems to begin around 6 pm nightly.
What is Sundowning?
Sundowning is represented by late-afternoon, early evening changes in the person. This is exhibited by:
- Agitation
- Restlessness
- Irritability
- Confusion
- Disorientation
- Being Demanding (more so in cases like Mom)
- Suspiciousness
It may also include:
- Yelling
- Pacing
Hearing/Seeing Things (Delusions or Hallucinations)- Mood Swings
- Ataxia (the lack of control during voluntary movements, such as walking or picking up objects. A sign of an underlying condition, Ataxia can affect movement, speech, eye movement, and swallowing) A Caregiver's Guide to Sundown Syndrome
Also, some of these symptoms may not necessarily be caused by Sundowning, but rather “manifestations of dementia, delirium, Parkinson's disease, and sleep disturbances. Sundown Syndrome in Persons with Dementia: An Update
There are theories that either pronounced age, later age hormonal fluctuations, or the root causes of the dementia have toyed with the person’s circadian clock. This is the organic clock that allows the body to coordinate biological activities in the day-night cycle. But, then again, this isn’t well-documented and is only a theory, as are most causes at this time.
What they also have determined, though, is that light stimulation begins to decrease at a certain point in the day which can trigger confusion with the loss of light and growth of shadows.
Some of the triggers that have been noticed are:
- Fatigue
- Depression
- Boredom
- Pain
- Hunger/Thirst
- Low Lighting
- Shadows
- Disruption of the body’s internal clock
- Difficulty separating reality from dreams
- Confusion Surrounding Increased Activity
- Confusion Surrounding Changes
The last two on the list may have more effect on those who have caregivers in a facility or home, where the staff changes occur later in the day.
Patients may begin following staff, have troubles with redirection, become agitated, and wandering.
There have been studies in which there has been promise by giving the patients melatonin, but then further exploration denied those conclusions.
According to the National Institutes of Health and Aging, the following are acceptable interventions to use in preventing and controlling the syndrome:
- Light Therapy
- Aromatherapy
- Music Therapy
- Caregiver Education
- Multisensory Stimulation
- Simulated Presence Therapy
- Following Sleep Hygiene Routine
- Structured Daily Routine with Strict Adherence
- Physical Exercise
There seems to be no real effect in using any drug therapy at this time.
So, This is my little synopsis of the syndrome. I’m hoping you learnt something along the way!
No comments:
Post a Comment