Sundowning Syndrome: Etiology and Treatment

An escalation in disruptive behaviors in the late afternoon and early evening among institutionalized patients suffering from dementia and Alzheimer's disease has been a recognized phenomenon for over 60 years (Bachman & Rabins, 2006). The timing of the onset of disruptive behaviors has led to calling this phenomenon sundowning, sundowning syndrome, and nocturnal delirium. Symptoms traditionally associated with sundowning include increased motor activity, confusion, yelling, aggression, wandering, agitation, and anxiety (Scarmeas et al., 2007). In spite of this long history, and a general consensus among clinicians and medical textbooks that sundowning is real, there is still a substantial amount of controversy among researchers whether it's more illusion than fact.

The controversy is due in part to the lack of a consensus definition for sundowning. Cohen-Mansfield (2007) cites three different definitions in order to highlight this lack of consensus: (1) "a syndrome of recurring confusion and...
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