Sundowning describes an increase in agitation, confusion or irritability that sets in towards the end of the day as the light starts to fade and gets worse during the evening and night.

Experienced by as many as 1 in 5 people living with Alzheimer’s Disease, it is most common in the mid to later stages of the disease, and although particularly associated with Alzheimer’s it also affects people living with other forms of dementia as well.

Coming as it does at the end of the day or middle of the night when carers are already tired and less able to cope with the inevitable frustration and interruption to sleep, it is often cited by loved ones as one of the most upsetting and troubling effects of dementia.​

Medics are unsure about the causes of sundowning but most agree that fading light in the evening and darkness at night are the main triggers.

Signs of sundowning to watch out for

Confusion

Irritability

Agitation

Distress

Disorientation

Becoming demanding or suspicious

Hearing or Seeing things that aren’t there

Yelling or Pacing

Factors that might contribute to sundowning behaviour

Less light and more shadows in the house can lead to confusion and fear.

An upset to the ‘internal body clock’, resulting from the disease’s damage to the brain, can cause a biological mix-up between night and day.

Disorientation resulting from an inability to distinguish between dreams and reality.

Reduced need for sleep and disturbance in sleep patterns common in older age.

Reaction to unintended body language from a carer as frustration and tiredness kick in at the end of a long and busy day of caregiving.

Discomfort (caused by thirst, hunger, pain), depression or boredom could all make the symptoms worse.

Coping strategies for dealing with sundowning behaviour

* First and foremost seek help…

In exactly the same way that airlines instruct those looking after others to put on their own oxygen mask before attending to others, carers need to look after their own needs first. If you are emotionally drained and physically exhausted, you won’t be in the best position to stay calm and collected under pressure.

All carers need help, either from other family members or a home care provider to give you a little respite. Take a nap if possible during the day, and try to keep in touch with friends and/or a support group to keep your spirits up.

* Talk to your doctor.

It is important to rule out physical ailments (such as urinary tract infections, sleep apnea, incontinence etc) that could be contributing to sleep problems, and then discuss possible ways forward to help your loved one.

*Try to work out the particular triggersthat prompt the agitation and confusion, and attempt to alleviate them.

Ways to help

Here are our some tried and tested coping strategies that can really help…

ALZHEIMER’S disease and diabetes are so closely related that drugs used to control blood sugar levels could also slow the progression of dementia, according to new research.

Many Alzheimer’s patients also have Type-2 diabetes and until now scientists believed mental decline could only come after the development of the metabolic disorder.

However, experts at Aberdeen University have now proven that the degenerative brain disease can also lead to diabetes in the first study of its kind.

Lead researcher Professor Mirela Delibegovic

The team, led by professors Bettina Platt and Mirela Delibegovic found the conditions are so closely related that medicines currently used to regulate glucose levels in people with diabetes may also alleviate the symptoms and progression of Alzheimer’s.

Exploring the links between Diabetes and Alzheimer's

The groundbreaking work at Aberdeen began four years ago when the experts discussed aspects of their specialities, with Platt leading an Alzheimer’s research team and Delibegovic heading work on diabetes.

The group developed a new model of Alzheimer’s disease and found that increased levels of a gene involved in the production of toxic proteins in the brain not only led to dementia-like symptoms, but also to the development of diabetic complications.

Platt said: “Around 80 per cent of people with Alzheimer’s disease also have some form of diabetes or disturbed glucose metabolism. This is hugely relevant as Alzheimer’s is in the vast majority of cases not inherited, and lifestyle factors and co-morbidities must therefore be to blame.

“Until now, we always assumed that obese people get Type-2 diabetes and then are more likely to get dementia. We now show that actually it also works the other way around. Additionally, it was previously believed that diabetes starts in the periphery – the pancreas and liver – often due to consumption of an unhealthy diet, but here we show that dysregulation in the brain can equally lead to development of very severe diabetes, so again showing that diabetes doesn’t necessarily have to start with your body getting fat, it can start with changes in the brain.”

She went on: “This study provides a new therapeutic angle into Alzheimer’s disease and we now think that some of the compounds that are used for obesity and diabetic deregulation might potentially be beneficial for Alzheimer’s patients as well.

“The good news is that there are a number of new drugs available right now which we are testing to see if they would reverse both Alzheimer’s and diabetes symptoms.

“We will also be able to study whether new treatments developed for Alzheimer’s can improve both, the diabetic and cognitive symptoms.”

The research is published in the journal Diabetologia and the team is now working with brain tissue banks and a pharmaceutical firm to take its findings forward.

However, Platt cautioned that they are unlikely to find a universal treatment for patients.

She said: “It’s unlikely to be effective for everybody. It’s quite a diverse group of patients, it’s a complex problem. We need to look at this much more holistically. Researchers need to come together. Our understanding of what the causes are is still very fragmented. We must understand much better why one person can have healthy ageing and the other one not.”