Sundowning Snydrome remains somewhat of a mystery in gerontology and a endless source of frustration to caregivers. Some persons with dementia, regardless of the type of dementia, never experience sundowning. For others, this is a daily struggle for caregivers. Simply put, Sundowning is a behavior occuring in the late afternoon or early evening that can involve agitation or combativeness. In many instances, the person with dementia is attempting to leave the current environment regardless of weather, time, safety issues or reality.
In earlier stages of the disease process, (Stages Three, Four and Five) a person with dementia is able to verbalize a reason to leave, such as picking up children, returning "home," going to work, etc. This is referred to as "purposeful wandering." In other words, the person can state the reason he or she needs to leave. In Stage Six, the person may still attempt to leave, but due to the advancement of the disease process, can no longer state a reason. This is known as "wandering without a purpose," that is, the person still feels the need to leave, but is no longer able to articulate a reason.
Several theroies exist for Sundowning. Restless leg syndrome, agitation, fatigue, or noticing there is a change in staff around three or four p.m. In my opinion, Sundowning is more realistically tied to an inate human behavior that is hardwired into our evolution. Since humans began, we performed a number of tasks throughout the daylight hours, but as the sun began to move into the lower sky, we stopped the day activity, moved to another area and begin to prepare for the evening and nighttime.
THink about it like this: cavemen stopped humting and returned to the cave, farmers stopped farming and returning to the cabin, and in your own lifetime you have lived within the same timeframe.
As a child, you were aware that a parent came home in the afternoon/evening, a meal was prepared and then bedtime occurred. School started and you became actively involved in these events. You left school to return home for the evening. As an adult, you probably continued this pattern, you left work and returned home. Or if you stayed at home, you stopped your daytime activities and begin to prepare the evening meal, etc.
Sundowning is simply the human brain continuing this evolutionary behavior. The difficulty is when the person with dementia has difficulty realizing and recognizing that he or she is already home and another person is performing those previous tasks. The challenge for caregivers then is how to address Sundowning in a manner thats the least stressful for everyone involved, the caregiver and the person with dementia.