Sundowning: Difference between revisions

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	In ], '''sundowning''', also known as '''sundown syndrome''', is a ] involving the occurrence or increase of one or more abnormal behaviors in a ].<ref name="Volicer2001"/> Sundowning typically occurs during the late afternoon, evening, and night, hence the name. It occurs in persons with certain forms of ] and ], such as seen in ]. Although not widely surveyed, sundowning is estimated to occur in 45% of persons diagnosed with Alzheimer's disease.<ref>{{cite journal \|author=Scarmeas N, Brandt J, Blacker D, ''et al.'' \|title=Disruptive behavior as a predictor in Alzheimer disease \|journal=Arch. Neurol. \|volume=64 \|issue=12 \|pages=1755–61 \|year=2007 \|month=December \|pmid=18071039 \|doi=10.1001/archneur.64.12.1755 \|url=}}</ref> A person who is sundowning may become abnormally demanding, suspicious, upset or disoriented, and see or hear things that are not there. After ], sundowning is the second most common type of disruptive behavior in institutionalized persons with dementia.<ref>{{cite book		In ], '''sundowning''', also known as '''sundown syndrome''', is a ] involving the occurrence or increase of one or more abnormal behaviors in a ].<ref name="Volicer2001"/> Sundowning typically occurs during the late afternoon, evening, and night, hence the name. It occurs in persons with certain forms of ] and ], such as seen in ]. Although not widely surveyed, sundowning is estimated to occur in 45% of persons diagnosed with Alzheimer's disease.<ref>{{cite journal \|author=Scarmeas N, Brandt J, Blacker D, ''et al.'' \|title=Disruptive behavior as a predictor in Alzheimer disease \|journal=Arch. Neurol. \|volume=64 \|issue=12 \|pages=1755–61 \|year=2007 \|month=December \|pmid=18071039 \|doi=10.1001/archneur.64.12.1755 \|url=}}</ref> A person who is sundowning may exhibit mood swings, become abnormally demanding, suspicious, upset or disoriented, and see or hear things that are not there in the late afternoon and evening. After ], sundowning is the second most common type of disruptive behavior in institutionalized persons with dementia.<ref>{{cite book
	\|author=U.S. Congress, Office of Technology Assessment		\|author=U.S. Congress, Office of Technology Assessment
	\|title=Special care units for people with Alzheimer's and other dementias: Consumer education, research, regulatory, and reimbursement issues.		\|title=Special care units for people with Alzheimer's and other dementias: Consumer education, research, regulatory, and reimbursement issues.

Revision as of 16:33, 17 May 2009

In medicine, sundowning, also known as sundown syndrome, is a syndrome involving the occurrence or increase of one or more abnormal behaviors in a circadian rhythm. Sundowning typically occurs during the late afternoon, evening, and night, hence the name. It occurs in persons with certain forms of dementia and psychosis, such as seen in Alzheimer's disease. Although not widely surveyed, sundowning is estimated to occur in 45% of persons diagnosed with Alzheimer's disease. A person who is sundowning may exhibit mood swings, become abnormally demanding, suspicious, upset or disoriented, and see or hear things that are not there in the late afternoon and evening. After wandering, sundowning is the second most common type of disruptive behavior in institutionalized persons with dementia. Sundowning often co-occurs with wandering, and the combination of these two syndromes is an important contributing factor to an emergency situation: elopement at night. The cause of sundowning is unknown, but may be related to disturbed circadian rhythm.

Cause

Although the cause of sundowning is unknown, proposed causes include sensory deprivation from lower light conditions in the evening, and fatigue. Alzheimer's disease alters the normal daily cycle of changes in body temperature, and sundowning appears to be related to delay of those changes that normally occur in the evening. Contributing factors may include medications that can cause agitation or confusion, and sleep disorders.

Prognosis

In persons with early Alzheimer's disease, the presence of sundowning has been associated with faster decline in cognitive functions.

Treatment

Behavioural disturbance is often treated with antipsychotic medication such as haloperidol, risperidone, or olanzapine. However, these have significant side effects.

External links

MayoClinic

References

^ Volicer L, Harper DG, Manning BC, Goldstein R, Satlin A (2001). "Sundowning and circadian rhythms in Alzheimer's disease". Am J Psychiatry. 158 (5): 704–11. doi:10.1176/appi.ajp.158.5.704. PMID 11329390. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
Scarmeas N, Brandt J, Blacker D; et al. (2007). "Disruptive behavior as a predictor in Alzheimer disease". Arch. Neurol. 64 (12): 1755–61. doi:10.1001/archneur.64.12.1755. PMID 18071039. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
U.S. Congress, Office of Technology Assessment (1992). Special care units for people with Alzheimer's and other dementias: Consumer education, research, regulatory, and reimbursement issues. Government Printing Office. {{cite book}}: Unknown parameter |address= ignored (|location= suggested) (help)
Satlin A, Volicer L, Stopa EG, Harper D (1995). "Circadian locomotor activity and core-body temperature rhythms in Alzheimer's disease". Neurobiol. Aging. 16 (5): 765–71. doi:10.1016/0197-4580(95)00059-N. PMID 8532109.{{cite journal}}: CS1 maint: multiple names: authors list (link)
Alzheimer’s Disease: Questions and Answers. Cleveland Clinic Regional Hospitals
Scarmeas N, Brandt J, Blacker D; et al. (2007). "Disruptive behavior as a predictor in Alzheimer disease". Arch. Neurol. 64 (12): 1755–61. doi:10.1001/archneur.64.12.1755. PMID 18071039. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)

Mental disorders (Classification)

Adult personality and behavior

Sexual	Ego-dystonic sexual orientation Paraphilia Fetishism Voyeurism Sexual anhedonia Sexual anorexia Sexual maturation disorder Sexual relationship disorder
Other	Factitious disorder Munchausen syndrome Fear of intimacy Gender dysphoria Intermittent explosive disorder Dermatillomania Kleptomania Pyromania Trichotillomania Personality disorder

Childhood and learning

Emotional and behavioral	ADHD Conduct disorder ODD Emotional and behavioral disorders Separation anxiety disorder Movement disorders Stereotypic Social functioning DAD RAD Selective mutism Speech Cluttering Stuttering Tic disorder Tourette syndrome
Intellectual disability	X-linked intellectual disability Lujan–Fryns syndrome
Psychological development (developmental disabilities)	Pervasive Specific

Mood (affective)
Bipolar Bipolar I Bipolar II Bipolar NOS Cyclothymia Depression Atypical depression Dysthymia Major depressive disorder Melancholic depression Seasonal affective disorder Mania

Neurological and symptomatic

Autism spectrum	Autism Asperger syndrome High-functioning autism PDD-NOS Savant syndrome
Dementia	AIDS dementia complex Alzheimer's disease Creutzfeldt–Jakob disease Frontotemporal dementia Huntington's disease Mild cognitive impairment Parkinson's disease Pick's disease Sundowning Vascular dementia Wandering
Other	Delirium Organic brain syndrome Post-concussion syndrome

Neurotic, stress-related and somatoform

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Adjustment disorder with depressed mood

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Dissociative

Somatic symptom

Physiological and physical behavior

Eating	Anorexia nervosa Bulimia nervosa Rumination syndrome Other specified feeding or eating disorder
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Postnatal	Postpartum depression Postpartum psychosis
Sexual desire	Hypersexuality Hypoactive sexual desire disorder

Psychoactive substances, substance abuse and substance-related
Drug overdose Intoxication Physical dependence Rebound effect Stimulant psychosis Substance dependence Withdrawal

Schizophrenia, schizotypal and delusional

Delusional	Delusional disorder Folie à deux
Psychosis and schizophrenia-like	Brief reactive psychosis Schizoaffective disorder Schizophreniform disorder
Schizophrenia	Childhood schizophrenia Disorganized (hebephrenic) schizophrenia Pseudoneurotic schizophrenia Simple-type schizophrenia
Other	Catatonia

Symptoms and uncategorized
Impulse-control disorder Klüver–Bucy syndrome Psychomotor agitation Stereotypy

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