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What Is Sundowning in Dementia?

6 minute readLast updated February 6, 2024
fact checkedon February 6, 2024
Written by Melissa Bean, senior living writer
Reviewed by Erin Martinez, Ph.D.Dr. Erin Martinez is an associate professor of gerontology and director of the Center on Aging at Kansas State University, where she focuses on promoting optimal aging.
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Toward the end of the day, you may notice someone with dementia becoming noticeably more irritable, anxious, angry, and irrational. This change in behavior is called sundowning, also known as sundown syndrome. It’s not considered a separate disease or a type of dementia, but rather a set of mood and behavioral symptoms associated with dementia that begin in the afternoon or evening. Sundowning in dementia patients is relatively common, so it’s important to understand the causes of sundowning and ways to reduce or prevent sundown syndrome symptoms as a caregiver.

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What are the symptoms of sundown syndrome?

With dementia, confusion comes and goes. However, sundown syndrome is different than normal dementia symptoms that a person may experience. As a caregiver, you’re likely in tune with your loved one’s daily behaviors, and you’ll notice irregularities related to sundowning.

“It will be obvious. People who sundown experience restlessness, agitation, and aggression in later afternoon or early evening. They may wander, act out, or shout,” said Maureen Bradley, a senior new hire support specialist at A Place for Mom and a DHS student in Human Services at Walden University. “These behaviors are usually different, or at least more intense than any other part of the day.”

Some of the most common symptoms of sundown syndrome may include:

  • Rapid mood changes
  • Anxiety or fear
  • Agitation, restlessness, or pacing
  • Sadness
  • Anger
  • Stubbornness
  • Shadowing caregivers or others
  • Repeating questions and interrupting
  • Hallucinating
  • Hiding things
  • Feeling paranoid
  • Acting violently
  • Wandering[01]

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At what stage of dementia does sundowning usually begin?

Sundown syndrome typically begins in the mid to late stages of dementia and lasts through the end stage of dementia, but it can begin to present even earlier for some individuals.[02] Every situation is unique, though, meaning the progression of dementia and sundowning varies from person to person.

Why does sundowning occur in people with dementia?

The causes of sundowning are not necessarily straightforward. They may be unique to each person with dementia.

“There are a number of reasons that can trigger sundowning,” Bradley said. “Most of them have to do with the person not getting enough physical, psychological, and cognitive stimulation. Unmet needs are the key.”

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How can I support someone experiencing sundowning?

Because sundowning is unique to each person with dementia, there’s no single treatment or solution for sundowning that will make it go away for everyone who experiences it.

“When sundowning does occur, check to see if there is something physical going on that might be bothering the person with dementia,” Bradley said. “Do they need to use the bathroom? Are they in pain? Are they hungry or thirsty? Remember that people living with dementia are not as good as you or I at picking up on cues from their bodies, so we have to be detectives.”

In some cases, the environment or a person’s activity level may need a slight change.

“Look at the environment to see if adjustments can be made to light and noise. Put on some soothing music, offer a favorite snack, or go for a walk,” Bradley explained. “Truthfully, though, the best way to deal with sundowning is to prevent it.”

How can sundowning be prevented or reduced?

As a caregiver, there are steps you can take to help prevent or reduce sundowning in your loved one with dementia. These include the following ways, as suggested by Bradley:

  • Exercise. Plan to help your loved one do some sort of physical exercise each day at around the same time of day.
  • Exposure to natural sunlight. “Twenty to thirty minutes of sunlight a day helps people with dementia in terms of sundowning, as well as sleep schedules,” Bradley said.
  • Activity participation. Focus on those activities that support cognitive health and socialization.

The idea is to exercise one’s mind, body and spirit throughout the day,” Bradley said. “When this is done, sundowning symptoms tend to diminish or disappear entirely.”

As always, communicate with your loved one’s medical care team before starting a new exercise or activity regimen. Recommendations may vary based on your loved one’s unique health situation and medical history.

Sundowning and dementia: Coping and getting help

It’s important to remember that sundown syndrome isn’t something your loved one can control. They’re not purposely becoming agitated, angry, or afraid. Do your best to comfort them, but remember that you need support, too. Caregiver burnout is a real and serious risk.

Contact your loved one’s doctor if sundowning becomes frequent or difficult to manage or if you feel concerned. A doctor may be able to pinpoint additional triggers or offer different management techniques.

If you’d like to explore additional care options, such as memory care, for your family member or loved one, our Senior Living Advisors are available to help.

SHARE THE ARTICLE

  1. Canevelli M., Valletta, M., Trebbastoni, A., Sarli, G., D’Antonio, F., Tariciotti, L., de Lena, C., & Bruno, G. (2016). Sundowning in dementia: Clinical relevance, pathophysiological determinants, and therapeutic approachesFrontiers in Medicine.

  2. Alzheimer’s Society UK. (2021, September 30). Sundowning and dementia.

Meet the Author
Melissa Bean, senior living writer

Melissa Bean is a former veterans content specialist at A Place for Mom, where she crafted easy-to-understand articles about VA resources, senior care payment options, dementia caregiving, and more. Melissa pairs over a decade of writing experience with her time as a military spouse, during which she organized and led a multistate military family support group.

Edited by

Danny Szlauderbach

Reviewed by

Erin Martinez, Ph.D.

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