Dr Kellyn Lee, CEO of The Dementia Care Hub, has highlighted a lesser-known dementia symptom called sundowning, which typically intensifies after midday. Speaking on TikTok, she explained that this pattern of increased confusion, anxiety, and agitation often occurs in the afternoon and early evening, and can include hallucinations or delusional thinking.
What is Sundowning?
Sundowning, also known as late-day confusion, is a symptom common in mid-to-late stage Alzheimer's disease and other dementias. According to care organisation Elder, it is one of the most challenging symptoms for carers, involving behaviours such as rocking, pacing, violent outbursts, wandering, yelling, crying, or closely following a caregiver. The exact cause is linked to brain changes affecting the internal body clock.
How Common is Dementia in the UK?
The Alzheimer's Society estimates that approximately 982,000 people in the UK are currently living with dementia, with many more undiagnosed. The actual figure is thought to be around 1 million. Dementia is not a disease itself but a collection of symptoms caused by brain damage from conditions like Alzheimer's.
Managing Sundowning
Dr Lee recommends keeping a diary to track when symptoms occur and what triggers them. In some cases, medications like lorazepam may be prescribed, but she cautions that these are highly addictive and GPs may be reluctant to prescribe them. She emphasises balancing addiction risk against the person's dementia.
Elder offers practical advice for managing sundowning: structure the day with stimulating activities in the morning, encourage light exercise and outdoor time, avoid long afternoon naps, serve the main meal at lunchtime, create a calming evening environment with early lighting, reduce clutter and noise, and limit caffeine after midday. During an episode, stay calm, speak clearly, avoid arguing, offer reassurance, and redirect attention gently.
Early Signs of Dementia
The NHS lists early signs including 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 gradually worsen, but dementia is not a normal part of ageing, so it is important to consult a GP if concerned.
