People with Alzheimer’s Disease or related dementia often have behavior problems in the late afternoon and evening. They may become demanding, suspicious, upset or disoriented.

They may perceive things differently than an ordinary person would. The non-ordinary perception may frighten them. Or, they may pace or wander around the house when others are sleeping.

While experts are unsure how or why this behavior occurs, they suspect that the problem of late afternoon confusion, which is sometimes called “sundowning,” may be due to these factors:

• The person with Alzheimer’s cannot see well in dim light and becomes confused.
• The impaired person may have a hormone imbalance or a disturbance in his/her “biological clock.”
• The person with Alzheimer’s tires at the end of the day and is less able to cope with stress.
• The person is involved in activities all day long and grows restless if there’s nothing to do in the late afternoon or evening. He or she may have been overstimulated and cannot “wind down” without assistance.
• The caregiver communicates fatigue and stress to the person with Alzheimer’s and the person becomes anxious.

Try these ways to lessen the behaviors of “sundowning”:

• Make afternoon and evening hours less hectic. Schedule appointments, trips, and activities, such as baths or showers, early in the day.
• Help the person use up extra energy through exercise. For the person who tends to pace or wander in the evening, you may want to arrange at least one or two brisk walks during the day. Pacing and wandering may be anxiety. Talking to him or her may help.
• Control the person’s diet. Reduce foods and beverages with caffeine (chocolate, coffee, tea, and soda) or restrict them to the morning hours to reduce agitation and sleeplessness. An early dinner or late afternoon snack may also help. Offer liquids often.
• You may want to reduce the level of noise from radios, televisions or stereos all day. Control the number of people who visit in the evening hours, or confine noisier family activities to another area of the house.
• Noise, loud TVs, the clatter of dishes may all irritate and fatigue someone with Alzheimer’s disease.
• Make it easy for the person to use the bathroom. Consider a bedside urinal or commode. Encourage the person to use the bathroom before going to bed.
• Keep rooms adequately lit. Good lighting may reduce the person’s confusion. A nightlight may prevent the person from becoming agitated in unfamiliar surroundings.
• Reassure and comfort the person. Tell the person experiencing sundowning what time it is and what’s going on in the house. Let the person know you’re there and will remain there, and then try to involve the person in a meaningful activity such as setting the table, folding towels, doing dishes, or sweeping the floor.
• Avoid arguing or asking for explanations. The person may not know what’s wrong or be able to tell you if he does. Keep in mind that the person with Alzheimer’s has no control over annoying, repetitive behavior. Confusion and restlessness occur because the brain can no longer sort out cues in the environment.

“Sundowning” is often accompanied by “Shadowing,” where the person with Alzheimer’s follows or mimics the caregiver, or talks, interrupts, and ask questions repeatedly. At times, the person may become upset if the caregiver wants to be alone. While shadowing and other forms of agitation vary from person to person, you may be able to manage the behavior by following these steps:

• Examine factors that trigger agitation. Consider these questions:
  
  
  • How long does the behavior last?
  • At what time of day does it occur?
  • Is the behavior triggered by certain people or surroundings?
  • What seems to calm the impaired person?
  • Once you develop answers to these questions, you may be able to avoid the situations that brings about agitation and introduces activities that help calm the person with Alzheimer’s.
  • Protect your privacy. You may want to install a childproof doorknob on the bathroom door or use a timer and reassure the person by saying, “I’ll be back when the timer goes off.”


• Try to keep the person occupied. Find simple, repetitious activities to occupy the person even if you could do them better on your own. Possibilities include folding the wash, dusting, stacking papers or magazines, stuffing envelopes, or winding a ball of yarn. Or provide the Alzheimer’s patient with headphones for listening to calming music.


• Consider “gum therapy” or “cereal therapy.” If the person with Alzheimer’s is able to chew and swallow easily, you may want to give him/or her sugarless gum. Or consider providing the person with a nonbreakable bowl of high-fiber, low-sugar cereal. By having something to snack on, the person may be less inclined to talk or ask questions.


• Rely on the ideas of support groups. Caregivers are always discovering new ways to deal with behaviors such as shadowing and are happy to share them.

A better understanding of the feelings of the person with Alzheimer’s disease, such as fear, frustration, and anger, may help you accept the resulting behaviors. Providing reassurance and helping your loved one respond to his/her changing environment can help you manage the person’s behavior.

One of the best places to seek additional help is the Alzheimer’s Association.