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What Is Sundowning In Dementia

Tau: A Direct Driver Of Cognitive Decline

What Is Sundowning

In the study, Dr. Grinberg and the team analyzed the brains of 13 deceased people who had Alzheimers disease, as well as those of seven deceased individuals who had not experienced clinical neurodegeneration. The researchers obtained these samples from UCSFs Neurodegenerative Disease Brain Bank.

The team found that, in comparison with healthy brains, those affected by Alzheimers disease had a high level of tau across three regions that are key to staying awake, namely the locus coeruleus, the lateral hypothalamic area, and the tuberomammillary nucleus. Not only this, but these regions had actually lost 75% of their neurons.

Its remarkable because its not just a single brain nucleus thats degenerating, but the whole wakefulness-promoting network, notes the studys lead author, Jun Oh.

Crucially, this means that the brain has no way to compensate because all of these functionally related cell types are being destroyed at the same time, Oh explains.

For further clarification, the researchers went on to conduct a postmortem analysis of brain samples from seven people who had progressive supranuclear palsy and corticobasal disease. These are two forms of dementia that are characterized specifically by the overaccumulation of tau protein.

In these samples, the scientists did not find the same loss of neurons in areas connected with states of wakefulness, which suggests that this destructive loss may only occur in Alzheimers disease.

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Tips To Help Manage Symptoms Of Sundowning

  • Make notes about what happens before sundowning events and try to identify triggers.
  • Try to maintain a predictable routine for bedtime, waking, meals and activities.
  • Plan more activities and exposure to light during the day, such as walks, errands, or exercise.
  • Reduce stimulation in the evening, such as the TV, loud noises, clutter or too many people in the room. Make the early evening a quiet time of day.
  • Try to identify activities that are soothing to the person, such as listening to calming music, looking at photographs, or watching a favorite movie.
  • In a strange or unfamiliar environment, bring familiar items such as photographs to create a more familiar setting.
  • Close the curtains or blinds to minimize shadows. Keep the room well lit in the evening and leave a night light on at night.
  • Try to limit or avoid alcohol, caffeine, nicotine, or daytime naps to help with nighttime sleeping.

If a person experiencing sundowning becomes agitated, listen calmly to his or her concerns and frustrations. Try to distract and reassure them that everything is OK. Do not physically restrain.

How Can You Manage Sundowning

Despiteyour best efforts, you may not be able to fully deter the possibility ofsundowning. There can be triggers beyond your control. It is why it isimportant to learn how to cope with the symptoms and avoid worse casescenarios.

As a caregiver, you need to keep an eye on the signs of sundowning starting late in the noon. See if the patient seems more confused or agitated than usual. If Dementia patient is tirelessly pacing around or frequently yelling, take it as a sign and prepare to help them manage.

Your first priority should be theidentification of the cause. Look forpossibilities like missed meals, lack of nap or activity, excess or lack of sleep. Try to track back the schedule of thepatient throughout the day and see if there is a possible trigger. Thisapproach can help you think of the most effective coping strategy. Try tofulfill unmet needs and remove any reason to be upset or depressed.

Here are some tips to follow:

  • Try to reduce unwanted noises and clutter fromtheir room, but avoid complete silence
  • Create nerve-calming distractions such asplaying the favorite song of the patient or a movie they enjoy
  • Keep them away from depressive discussions and newschannels
  • Make sure they are only surrounded by peoplethey trust
  • Minimize shadows by closing the curtains butkeep the lights bright inside the room
  • Talk to them about familiar and enjoyableincidents from the past
  • Distract them without reminiscing activitiessuch as watching home videos or photos

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Sunrising And Dementia Behaviors At Other Times Of Day

Im not a doctor, but I have a theory about sunrise syndrome, because my mother does it. I think, because her brain has been able to run wild while shes sleeping, that when she awakens, opens her eyes and takes in her surroundings, she must determine what is real, what is new and what is a dream from the night before. She takes a little while to get her land legs, as I call it, and then she does better by about 10 a.m. Her mood is definitely different when she is sunrising compared to when she is sundowning. She experiences confusion over re-figuring out her world but without the irritation or perseverance she experiences in the evenings. EdithFrances

Sundown syndrome is a collection of behaviors that tend to happen later in the day, but they dont have to be isolated to that time. It can happen at any time of day. Definitely bring up sundowning behaviors to the doctor whenever they occur. There may be medication that can help reduce the severity of symptoms without making your loved one sleepy all the time. Make sure you are keeping a journal each day of what you see, hear and sense with your loved one, especially if something strikes you as new, different or super strange. The doctor is going to want to know how long something has been going on, what precedes the behavior, when it normally occurs, etc., and its too hard to remember the details correctly when you are up to your eyeballs in caregiving. sandwich42plus

Tips For Minimizing Sundowning Symptoms

Sundowning with Dementia and Effective Coping Strategies ...
  • Approach your loved one in a calm manner.Dont yell, raise your voice or touch them in an unexpected way. Reacting to their behaviors may unintentionally make matters worse.
  • Avoid rationalizing or arguing.Asking for explanations to statements or behaviors that dont make sense may escalate the situation. There is no reasoning with someone who has dementia.
  • Redirect to a non-stimulating location.Guide the person to an area away from noise, family activity and other distractions.
  • Validate their experience.If a dementia patient is feeling paranoid or experiencing delusions or hallucinations, meet them in their version of reality. Reassure them that everything is alright, and everyone is safe. This approach is called validation and is far more effective than using logic to reorient a loved one with dementia.
  • Provide comfort.Sometimes soothing or familiar music will help to calm and relax a person exhibiting anxious or restless behaviors. Provide a comfort object such as a familiar blanket, doll or turn on a favorite television show or movie as a distraction.
  • Sundowning syndrome can be exhausting for both the dementia patient and their caregiver. Don’t hesitate to ask for help. Whether provided by a family member, private duty nurse or home care provider, regular respite is necessary for a caregiver to be able to provide the best quality of care.

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    Ways To Manage Sundowning

    Sundowning, or sundown syndrome, is a form of confusion that may occur in elderly patients including those with various types of dementia, such as Alzheimer’s disease. It is characterized as the confusion that begins late in the day and often carries into the night. The cause of sundowning is unknown, but factors that may contribute to it include:

    • Fatigue
    • Low lighting and increased shadows combined with low vision
    • An upset in circadian rhythm our internal, biological clock causing disturbed sleep patterns
    • Confusion in regards to dreams and reality
    • Moving to a new environment or hospitalization

    While sundowning is most common among people with dementia, it can also affect people without dementia when they are coping with the aftermath of anesthesia or other medical issues.

    Sundowning And Care At Home

    Alzheimers and dementia can be difficult conditions to live with, not just for your loved one but also for the extended family. Thats why more and more people are turning to live-in carers to help with loved ones who are in the late stages of dementia. Employing a highly experienced and compassionate caregiver can be a relief to families who are struggling to cope with the demands of the disease, and the peace and calm that a skilled carer can bring to a household are beneficial for everyone.

    Live-in carers can provide a range of dementia care services, from simple companion care to the specific demands of dementia. They remain calm under pressure and can cope with emergency situations, making them a great option for families who are concerned about residential care for their loved ones.

    They can provide genuine support throughout the day and night, which can make a significant difference for families who are finding things challenging. The cost of live-in care in the UK with Elder starts at £1095 per week.

    Even if you think that you are coping well with your loved one, a period of live-in respite care can be helpful for anyone dealing with the particular demands of sundowning, allowing you to return from a short break or holiday refreshed and ready to face the challenges ahead.

    Getting funding from your local authority

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    Encourage Activities Before Late Afternoon/early Evening

    Although the exact cause is still unknown, the National Institute on Aging brings up the possibility that changes in brain function due to Alzheimers disease, contributes to Sun Downs Syndrome. Sundowning can also impact our biological clockscausing confusion and agitation, and interfering with sleep-wake cycles.

    Because Sun Downs Syndrome happens in the late afternoon, its important your loved one maintains a routine during daylight hours.

    Are Medications Used For Sundown Syndrome

    What is Sundowning?

    There is limited information about the effectiveness of medication in easing sundowning symptoms. In some cases, especially when symptoms are associated with depression or sleeping disorders, medication may be helpful. However, be sure to discuss possible side effects with your loved ones doctor. Some medicines may increase the chance of dizziness, falls, and confusion, according to the National Institute on Aging.

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    How To Deal With Sundowning

    Watching a loved one becoming irritated, upset, hyperactive or demonstrate other behavioural problems can be distressing, but its important to remember that they are not in control of their actions. There are also lots of things you can try to minimise sundowning symptoms. Every person with dementia is unique, and it may take a while to find out what works best for your loved one. Keeping a detailed diary of your loved ones behaviour can be a useful way of identifying triggers and managing symptoms.

    Maintain a positive routine

    The most important thing to do is to ensure that your loved one has a routine tailored around sundowning behaviour to eliminate it as far as possible. To this end, it is helpful to draw up a timetable or schedule, ensuring that busy activities and outings are arranged for the morning when your loved one is feeling at their best. Once you have a routine in place, its essential to stick to it.

    During the afternoon, try to engage your loved one in calming activities that dont require too much thought. The aim is to undertake simple and engaging activities at this time, ones that arent too stimulating. Make sure that any clutter is tidied away, as this can cause aggravation later in the day.

    Stay calm

    Raising your voice or becoming angry will only worsen the situation, so try to remain calm, no matter what the provocation. Speak in clear sentences, dont try to rationalise with them and keep reassuring them that everything is ok.

    Other Sleep Issues In People With Dementia

    Sundowning is a phenomenon in which individuals with dementia experience increased agitation later in the day and in the evening. The symptoms of sundowning include confusion, anxiety, wandering, and yelling. Sundowning can contribute to insomnia and other sleep problems when these behaviors continue into the night. Possible causes of sundowning include the circadian rhythm changes that occur in dementia, as well as fatigue, depression, and pain.

    People with dementia may also talk, yell, or cry out at night if they cannot sleep. Some dementia patients have a tendency to wander away from their homes, which can be especially dangerous at night. In dementia patients with REM sleep behavior disorder, shouting, grabbing, jumping, and other behaviors are related to dream enactment during sleep.

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    What Causes Sundowning In Dementia

    4.1/5Sundowning can cause aSundowningdementiacause

    âIt’s usually a few hours.â Sundowning symptoms peak during the middle stages of the disease and, in a cruel irony, ease as the disease gets worse. Paul’s symptoms disappeared after about 18 months, around the time his ability to speak started to decline.

    Likewise, what stage of dementia does Sundowning occur? Behaviour changesThis is often referred to as ‘sundowning‘. This pattern may continue for several months and often happens in the middle and later stages of dementia. Sundowning may be caused by: disturbance to the 24-hour ‘body clock’ that tells our bodies when to sleep, caused by the physical changes to the brain.

    Consequently, what triggers Sundowning?

    Possible CausesOne possibility is that Alzheimer’s-related brain changes can affect a person’s âbiological clock,â leading to confused sleep-wake cycles. This may result in agitation and other sundowning behaviors. Other possible causes of sundowning include: Being overly tired.

    Is Sundowning always associated with dementia?

    Most commonly associated with Alzheimer’s disease, but also found in those with other forms of dementia, the term “sundowning” was coined due to the timing of the patient’s confusion. Sundowning seems to occur more frequently during the middle stages of Alzheimer’s disease and mixed dementia.

    Tips For Managing Sundowning As It Happens

    Sundowning with Dementia and Effective Coping Strategies ...
    • Use distraction techniques: go into a different room, make a drink, have a snack, turn some music on, or go out for a walk
    • Ask the person what is the matter. Listen carefully to the response and if possible, see if you can deal with the source of their distress
    • Talk in a slow, soothing way
    • Hold the persons hand or sit close to them and stroke their arm.

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    At Sundown The Demons Get Riled Up

    Many people enjoy the sunset. Sunsets are picturesque, and they usher in the beginning of evening after a day of labor. Families congregate in the early evening around dinner, chatting and sharing in their daytime activities. For the most part, we look forward to sunsets that transition us from our relatively hectic daytime goings-on to unwinding with family, dinner and subdued pastimes or hobbies, before eventually relaxing into sleep.

    It is naturally not so for those who experience sundown syndrome. For them, sunsets and the evening hours can be associated with heightened dread and scorching anxiety, as opposed to the calm and relief many of us feel.

    Sundowning syndrome throughout the day

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    Hell For Caregivers Of Sundowning Individuals

    Thats when Linda began to tear-up. Its like at precisely that time of day, the devil gets into her, and she starts acting up in quite terrifying ways.

    When I asked her to expand on that, she said, She all of a sudden becomes agitated and argumentative -even combative. She says crazy things like some bad people are coming after her, and she starts pacing back and forth throughout the living room.

    It gets worse, she continued. The nighttime routine is absolute hell for whoever is caring for her. She yells out curse words incessantly and lashes out, and no one can get any sleep for she will be restless and ranting about people of some fifty years ago.

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    What Can You Do To Prevent Sundown Syndrome

    Watching a loved one suffer fromsuch severe symptoms can be painful. Coping with it isnt easy for the patientor for the caregivers. Therefore, it is best to avoid the situation in thefirst place. Here are a few things you can try to prevent sundown syndrome.

    • Increase daytimeexposure to natural light. Sit outside with the patient and enjoy the sunlight.This can reset their biological clock to a great extent.
    • Make sure the patient indulges in some form ofphysical activity throughout the day.
    • Encourage short daytime naps at fix hours everyday. Try not to disrupt that routine.
    • Do not serve caffeinated, carbonated, or sugarydrinks, especially late in the day.
    • Keep the patient away from alcohol orrecreational drugs.

    Keep an eye on the patientsfatigue level. Some activity is important to ensure a good night sleep, but toomuch of physical fatigue can be counterproductive. As a caregiver, you need to make sure the patients needs are fulfilled. Untimely or missed meals can makethe situation worse.

    Also, the need to socialize isequally important. Make sure the patient isnt bored or depressed. The feelingof loneliness can make them feel unsafe and vulnerable, which ultimatelytriggers sundowning.

    Clinical Approach To Sundowning

    Sundowning and Dementia Care

    Given the multiplicity of factors and determinants potentially involved in the emergence of sundowning, a multidimensional approach to this syndrome should be adopted. In particular, special attention should be devoted to the identification of potentially treatable/reversible underlying conditions in order to timely implement targeted interventions. As already proposed for other NPS, integrated, multistep approaches should be adopted in screening, identifying, and managing sundowning.

    It is noteworthy that, to date, no dedicated tools to screen/assess sundowning has been developed and validated. Moreover, in most of clinical tools commonly adopted in the daily practice to assess the severity of NPS , the temporal fluctuations of disturbances are poorly considered, so that indirect information about the eventual occurrence of sundowning could not be easily deduced. The adoption of standardized instruments to evaluate NPS may also introduce some biases, being the results, and scores potentially influenced by the personal characteristics of the interviewed caregiver and poorly reliable when such tools are administered by different raters. These aspects may have probably contributed to the poor attention so far devoted to this syndrome and might have potentially produced under-recognition of the phenomenon in the clinical setting .

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