Sundowning Syndrome
Sundowning Syndrome
Etiology and Treatment
12/3/2010
Anatomy & Physiology
sundowning syndrome: etiology and treatment
An escalation in disruptive behaviors in the late afternoon and early evening among institutionalized patients suffering from dementia and Alzheimer’s disease has been a recognized phenomenon for over 60 years (Bachman & Rabins, 2006). The timing of the onset of disruptive behaviors has led to calling this phenomenon sundowning, sundowning syndrome, and nocturnal delirium. Symptoms traditionally associated with sundowning include increased motor activity, confusion, yelling, aggression, wandering, agitation, and anxiety (Scarmeas, Brandt, Blacker, Albert, & Hadjigeorgiou, 2007). In spite of this long history, and a general consensus among clinician and medical textbooks that sundowning is real, there is still a substantial amount of controversy among researchers whether it’s more illusion than fact.
The controversy is due in part to the lack of a consensus definition for sundowning. (Cohen-Mansfield, 2007) cites three different definitions in order to highlight this lack of consensus: (1) “a syndrome of recurring confusion and increasing levels of agitation, which coincide with the onset of late afternoon and early evening”, (2) “the onset of exacerbation of delirium during the evening or night, with improvement or disappearance of delirium during the day”, and (3) “an exacerbation or appearance of symptoms indicating increased arousal or impairment in late afternoon, evening or at night among elderly, demented individuals” (p. 396). These definitions reveal some of the discrepancies that continue to plague this area of research, including whether to include nighttime episodes, which symptoms fit under sundowning, and whether dementia is a prerequisite. These conceptual differences manifest themselves in various ways as sundowning research progresses, thus prolonging the controversy . (Bachman, & Rabins, 2006)
In an attempt to create a
Etiology and Treatment
12/3/2010
Anatomy & Physiology
sundowning syndrome: etiology and treatment
An escalation in disruptive behaviors in the late afternoon and early evening among institutionalized patients suffering from dementia and Alzheimer’s disease has been a recognized phenomenon for over 60 years (Bachman & Rabins, 2006). The timing of the onset of disruptive behaviors has led to calling this phenomenon sundowning, sundowning syndrome, and nocturnal delirium. Symptoms traditionally associated with sundowning include increased motor activity, confusion, yelling, aggression, wandering, agitation, and anxiety (Scarmeas, Brandt, Blacker, Albert, & Hadjigeorgiou, 2007). In spite of this long history, and a general consensus among clinician and medical textbooks that sundowning is real, there is still a substantial amount of controversy among researchers whether it’s more illusion than fact.
The controversy is due in part to the lack of a consensus definition for sundowning. (Cohen-Mansfield, 2007) cites three different definitions in order to highlight this lack of consensus: (1) “a syndrome of recurring confusion and increasing levels of agitation, which coincide with the onset of late afternoon and early evening”, (2) “the onset of exacerbation of delirium during the evening or night, with improvement or disappearance of delirium during the day”, and (3) “an exacerbation or appearance of symptoms indicating increased arousal or impairment in late afternoon, evening or at night among elderly, demented individuals” (p. 396). These definitions reveal some of the discrepancies that continue to plague this area of research, including whether to include nighttime episodes, which symptoms fit under sundowning, and whether dementia is a prerequisite. These conceptual differences manifest themselves in various ways as sundowning research progresses, thus prolonging the controversy . (Bachman, & Rabins, 2006)
In an attempt to create a
References: Vance, D.E., & Cowan, R.N. (2004). Activity therapy as a vehicle for resetting the biological rhythm in adults with Alzheimer’s disease. Activities, Adaption & Aging, 28. Retrieved from http://www.informaworld.com/smpp/ftinterface~content=a903239629~fulltext=713 Scarmeas, N., Brandt, J., Blacker, D., Albert, M., & Hadjigeorgiou, G. (2007). Disruptive dehavior as a predictor in Alzheimer’s disease. Archives of Neurolgy, 64. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690610/ Sterniczuk, R., Dyck, R.H., LaFerla, F.M, & Antle, M.C. (2010). Characterization of the 3xtg-ad mouse model of alzheimer 's disease: part 1. Brain Research, 1348. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/20471965 Volicer, L., Harper, D.G., Manning, B.C., Goldstein, R., & Satlin, A. (2001). Sundowning and circadian rhythms in alzheimer 's disease. American Journal of Psychiatry, 158, 704-711. Cohen-Mansfield, J. (2007). Temporal patterns of agitation in dementia. American Journal of Psychiatry, 15, 395-405. Bachman, D., & Rabins, P. (2006). Sundowning and other temporally associated agitation states in dementia patients. Annual Review of Medicine, 57. Retrieved from http://cursa.ihmc.us/rid%3D1GM097FD0-1SFSKL8-1FVH/sundowning.pdf