Dr Kellyn Lee, CEO of The Dementia Care Hub, has highlighted a lesser-known dementia symptom called 'sundowning,' which typically worsens in the afternoon and early evening. This condition affects an estimated 982,000 people in the UK, with the Alzheimer's Society suggesting the true figure is around 1 million due to undiagnosed cases.
What Is Sundowning?
Sundowning, also known as late-day confusion, is characterized by increased confusion, agitation, and distress during the late afternoon and evening. Dr Lee explained in a TikTok video: 'This can happen at any time of day, but what we see a lot with people living with dementia is that it can happen in the afternoon. So, what I would be looking at is this would be, again, a symptom of anxiety and agitation and maybe increased confusion.'
Symptoms and Impact
According to care organization Elder, sundowning can be one of the most challenging symptoms for caregivers. Common manifestations include rocking in chairs, pacing, violent outbursts, wandering, yelling, crying, and following caregivers closely. People experiencing sundowning may also suffer from anxiety, fear, restlessness, sadness, confusion, and paranoia. Dr Lee noted that hallucinations and delusional thinking can also occur.
Management Strategies
Dr Lee advises keeping a log of symptoms and timing to identify patterns. She mentioned that medications like lorazepam may be used but cautioned: 'Absolutely these drugs are drugs that need to be taken with caution because they are highly addictive. So, some GPs may not want to prescribe them. However, I think we really need to balance the risk of addiction compared to the fact the person has dementia.'
Elder recommends practical steps for managing sundowning: structure the day carefully, plan stimulating activities for the morning, encourage light exercise and outdoor time, avoid long afternoon naps, offer the main meal at lunchtime, create a calming evening environment, turn lights on before dusk, close curtains early, minimize clutter, lower noise levels, and keep the temperature comfortable. During an episode, caregivers should stay calm, speak clearly, avoid arguing, offer reassurance, and redirect attention gently.
Dementia Overview
The NHS explains that dementia is not a disease itself but a collection of symptoms resulting from brain damage caused by conditions like Alzheimer's. Early signs include memory loss, difficulty concentrating, trouble with familiar tasks, struggling to follow conversations, confusion about time and place, and mood changes. These symptoms may be mild and worsen gradually, termed mild cognitive impairment (MCI). The NHS advises consulting a GP if memory problems or other symptoms arise, as dementia is not a normal part of ageing.
