Episodes of delusions, hallucinations, agitation, and increased dementia that intensify in the evening. clinicians do not fully understand the timing of sundowning episodes. Theories include correlations with hormonal cycles in the body, fluctuations in brain neurotransmitter levels that result from medication peaks and troughs, a “crash” letdown+ from the activities of the day, and the somewhat surrealistic images that can occur as a combination of artificial lighting and shadows as evening begins. As are other dimensions of neurodegenerative diseases, it is likely a combination of all of these factors. Sundowning is a particularly common manifestation in Alzheimer’s disease; its appearance in a person with Parkinson’s disease suggests that dementia is present.
Sundowning is stressful for caregivers because they know it is coming and they know it is unpredictable. Agitation reaches a peak when family members are also tired and ready to relax, and the resources they need to be innovative and supportive are often wearing thin by this time of the day. Sometimes the loved one responds to efforts to keep activities and the surroundings calm and quiet. other times, it seems that nothing family members try makes any difference. Sometimes changes in the anti-parkinson’s medication regimen improve the situation. Although in the person with Alzheimer’s disease antipsychotic medications are sometimes helpful, these drugs are a more limited option for the person with Parkinson’s because the risk of motor side effects or intensified symptoms of Parkinson’s is significant. Quetiapine, clozapine, and perhaps arip-iprazole are thought to be the best antipsychotics for people with Parkinson’s.
Establishing a predictable routine seems to be the most consistently helpful approach for managing sundowning. The routine should start while there is still plenty of daylight and should take place every day regardless of the day’s activities. This schedule can be confining for family members and the person’s response will continue to vary from day to day, but the sense of structure is useful to caregivers as well. other recommendations include making sure to turn on lights in the house before darkness sets in and having someone stay with the person during the transitional time between daylight and darkness. Most people who experience sundowning become calm again as night falls.
