July 8th, 2011 at 9:00 am
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Study reveals sundowning with Alzheimer’s likely has a biological basis

by Carol Bursack

Sundowning is a syndrome in which elders–particularly those with Alzheimer’s–tend to display high levels of activity, anxiety and agitation, sometimes accompanied by delirium, near the end of the day. Sundowning has confused, frustrated and even frightened caregivers over the years.

Working toward understanding sundowning

A new study conducted at Ohio State University could shed some light into the problems associated with sundowning. Says study co-author Randy Nelson, professor of neuroscience and psychology at Ohio State:

Some people have argued that sundowning could be explained just by a buildup of frustration of older people who couldn’t communicate their needs over the course of the day, or by other factors. But our findings suggest there is a real phenomenon going on here that has a biological basis.

Unlike previous studies that have used observation of human’s with Alzheimer’s, this study used genetically altered mice so changes in the brains of the mice could be observed and studied. Nelson continues:

Findings in aged mice showed greater expression of a certain enzyme–acetylcholinesterase–before sleep than earlier in the day. High levels of this enzyme are associated with anxiety and agitation.

The study, which was published in late June 2011 in the online Early Edition of the Proceedings of the National Academy of Sciences, is one of many steps needed to finding solutions to sundowning.

Four ways for caregivers to cope with sundowning

The Alzheimer’s Association suggests that caregivers take the following steps to deal proactively with sundowning.

  1. Plan more active days. A person who rests most of the day is likely to be awake at night. Discourage afternoon napping and plan activities, such as taking a walk, throughout the day.
  2. Monitor diet. Restrict sweets and caffeine consumption to the morning hours. Serve dinner early, and offer only a light meal before bedtime.
  3. Seek medical advice. Physical ailments, such as bladder or incontinence problems, could be making it difficult to sleep. Your doctor may also be able to prescribe medication to help the elder relax at night.
  4. Change sleeping arrangements. Allow the person to sleep in a different bedroom, in a favorite chair or wherever it’s most comfortable. Also, keep the room partially lit to reduce agitation that occurs when surroundings are dark or unfamiliar.

Other tips caregivers find successful include distracting the person with a favorite DVD, playing soft music to sooth agitation, providing warm milk, a hot water bottle or other physical comforts. In addition, you may also find it beneficial to reassure the individual using a soft voice and comforting body language. If the caregiver’s body language shows frustration, the situation will only escalate, so caregivers need to be aware of subtleties.

It is nice to know sundowning doesn’t last forever. The average person with Alzheimer’s generally shows this behavior during mid-stages of the disease, and then the behavior slowly subsides. Meanwhile, caregivers may want to get some relief by changing shifts with other family members or hired caregivers, when possible.

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