Your parent with dementia gets worse every evening. Here is what to track and what to try.

Around four in the afternoon, a parent who was fine at noon starts pacing, arguing, or insisting they need to go home. The National Institute on Aging describes it as restlessness, agitation, irritability, or confusion that begins or gets worse as daylight fades. It is called sundowning.

Mayo Clinic is clear that sundowning is not a disease. It is a group of symptoms tied to the time of day, and it often shows up in people with Alzheimer's disease or another dementia. The exact cause is unknown. The leading explanation, according to the NIA, is that changes in the brain may disrupt the body's internal clock and sleep-wake cycle. That does not mean there is nothing you can do.

This article is general information for caregivers, not medical advice. Your parent's doctor decides what is safe and what is causing it. Your job is to watch the pattern and bring the doctor facts.

What it looks like

• More confusion or anxiety than earlier in the day
• Pacing or wandering
• Yelling, aggression, or ignoring directions
• Trouble sleeping once night comes

It usually starts in the late afternoon or early evening and can last into the night.

Check for a fixable cause first

Do not assume it is just the dementia. The NIA, Mayo Clinic, and the Alzheimer's Association list things that can make late-day behavior worse, and several of them are things you can fix:

• Hunger or thirst
• Pain
• Being overtired, or a day that was too full
• Boredom
• Depression
• A medication side effect
• An infection, such as a urinary tract infection
• Low light and shadows that get misread as something else

Track it for a week

The Alzheimer's Association's advice is to note what happens before an episode so you can spot patterns. A week of notes shows you things you cannot see while you are in the middle of it.

• What time it started.
• What happened in the hour before. A nap, a visitor, noise, a TV show, a skipped snack.
• What it looked like. Pacing, yelling, asking to go home.
• What you did, and whether it helped.
• The last meal, drink, medication, and nap.

Bring the notes to the doctor. "He is worse in the evenings" is easy to wave off. "It starts between four and five, about three days out of seven, after the afternoon nap" gives the doctor something to work with. The dementia binders include a Behavior and Mood Log with columns for time, behavior, possible trigger, and your response.

Fix the day

• Move appointments, outings, and bathing to the morning or early afternoon, when your parent is usually more alert.
• Get daylight. Time outside or by a window. The NIA says bright light can help reset the body clock.
• Get some exercise every day, such as a walk.
• Keep naps short and not late in the day.
• Keep caffeine to the morning, and skip alcohol, which can add to confusion and anxiety.
• Do not overfill the schedule. A packed day is tiring, and tired makes the evening worse.
• Make lunch the bigger meal and dinner the lighter one.
• Keep the same times for waking, meals, activities, and bed.

Fix the evening

• Turn the lights on before it gets dim, and use a night light after bedtime.
• Lower the noise, clutter, and number of people in the room.
• Turn off the news and anything upsetting. A familiar show is fine.
• Offer a favorite snack, a drink, or a simple job, like folding towels.
• Try soft, familiar music or a photo album.
• Let your parent pace while you supervise, or take a walk together.
• Listen calmly and reassure. Steer away from whatever upset them instead of correcting them.
• Never physically restrain your parent. The Alzheimer's Association says it can make agitation worse.

Your own state matters too. The Alzheimer's Association notes that a person with dementia can pick up on your stress and frustration, which can add to theirs. If you are the only one doing every evening, the early signs of caregiver burnout are worth reading.

When to call the doctor

Talk to the doctor if it keeps happening after you change the day and the evening, if it started suddenly, or if you think pain, a medication, depression, or another condition is behind it. The NIA says an exam may find a cause such as pain, a sleep disorder, another illness, or a medication side effect.

• Ask whether any current medication could be adding to it, and whether the times of day for the doses can change. If your parent is skipping pills, here is what to check first.
• If the doctor suggests something for sleep or calming, ask about side effects. The NIA says some of these medications raise the risk of dizziness, falls, and confusion, and doctors generally recommend them only for short periods.
• Ask before trying melatonin or any supplement. Mayo Clinic says some research suggests a low dose may help, and says to check with a healthcare professional first.
• If your parent is also eating less, here is when to call.

If your parent leaves the house and you cannot find them, call 911. For advice on a hard evening, the Alzheimer's Association Helpline is 1-800-272-3900.

The short version

You are not going to stop every evening from going badly. You are trying to find the two or three triggers you can move, and make the evening shorter and quieter.

Sources

• National Institute on Aging, Tips for Coping with Sundowning
• Alzheimer's Association, Sundowning fact sheet
• Mayo Clinic, Sundowning: Late-day confusion