While Parkinson’s disease is known to affect movement, balance, and coordination, sometimes patients also develop Parkinson’s disease dementia.
People with this condition can experience a disturbing condition called sundowning, which typically begins in the late afternoon and lasts into the night.
According to the Weill Institute for Neurosciences Memory and Aging Center, most people with Parkinson’s start experiencing movement symptoms when they’re between 50 and 85 years old, although some show signs earlier.
Dr. Isabella Park, associate medical director and director of geriatrics and palliative care at Long Island Jewish Forest Hills, part of Northwell Health in New York, told The Epoch Times that a majority of patients with Parkinson’s disease will develop dementia, and those who do are at higher risk of experiencing sundowning.
Sundowning can occur at any stage of dementia but is more common during the middle and later stages.
Sundowning symptoms include:
“Sundowning can cause different behaviors in varying degrees,” said Park. “It can start out as subtle and can increase if not redirected or if the sleep pattern is not corrected.”
Up to 80 percent of people with Parkinson’s eventually develop dementia, according to the Weill Institute for Neurosciences. The average time from the onset of movement problems to the development of dementia is about 10 years.
“The exact cause [of sundowning] is complex and poorly understood, but it is thought to be a disruption in the biological clock caused by dementia,” said Park.
She explained that it could be triggered by various things, such as being overly tired, hungry, thirsty, or bored. Other triggers can include:
Here are some practical tips on how to help someone experiencing Parkinson’s disease-related sundowning.
Parkinson’s disease can disrupt the body’s internal clock, leading to sleep disturbances and other symptoms.
By establishing a regular routine, we can help regulate the body’s internal clock, making it easier to manage sundowning. People living with sundowning should wake up and go to bed at the same time each day, eat meals at regular times, and schedule their activities and rest periods throughout the day.
A 2019 study concluded that a lack of routine may cause symptoms of depression in older adults. Depression has been found to aggravate preexisting cognitive conditions.
According to a review in Psychiatry Investigation, sundowning can be triggered by overstimulation, so it’s important to create a calm and relaxing environment. Some ways to do this are by reducing noise levels and eliminating distractions that could cause anxiety or confusion.
“Any calming alternative methods such as essential oils, massages, and healing touch can ease anxiety and stress for the person,” said Park.
Relaxation techniques such as meditation and visualization can help reduce anxiety and promote relaxation.
A recent randomized clinical trial found that mindfulness meditation appears to be a “feasible and promising” strategy for managing depressive symptoms and maintaining emotional stability, and significantly benefits cognitive performance.
Exercise is an essential component of Parkinson’s disease management and can help improve sleep quality and reduce sundowning symptoms.
A large study from the Parkinson’s Foundation (pdf) shows that people with Parkinson’s who start exercising earlier in their disease for at least 2.5 hours per week experience a slowed decline in quality of life compared to those who start later, and that establishing early exercise habits is essential to overall disease management.
The Parkinson’s Foundation recommends an exercise program for Parkinson’s should include:
“Cut back on caffeine, sugar, and even liquids towards the evening to minimize bathroom needs overnight,” Park advised.
Caffeine and alcohol can disrupt sleep patterns and exacerbate symptoms of sundowning. Limit caffeine to the morning hours, and alcohol should be avoided since it can add to confusion and anxiety.
“There are herbs and supplements that can be helpful,” said Park. “Chamomile, melatonin, vitamins B, C, E, etc. are shown to calm and lessen sundown symptoms.”
Research suggests that taking melatonin—the naturally occurring hormone that makes us sleepy—alone or with exposure to bright light during the day could help ease sundowning. A 2014 review found that melatonin could help reduce agitation at night and improve sleep in people with dementia.
A randomized, controlled trial found that chamomile extract significantly improves sleep quality among elderly people and is a safe way to promote healthy sleep. This can prevent sleep problems associated with the condition.
Low vitamin B levels are often observed in patients with dementia and supplementation has been shown to improve memory and slow the progression of brain atrophy.
Other research finds that vitamin C deficiency impairs cognition, and also that supplementing with vitamin E has “specific protective action” against Parkinson’s.
“Sometimes if the symptoms are too difficult, other medications may need to be considered for the safety of the person and to help them reset their sleep cycle,” Park said.
Levodopa, a drug commonly used to manage symptoms of Parkinson’s disease, may also help relieve sundowning symptoms by increasing depleted levels of dopamine typical of the disease. Research suggests that sundowning in Parkinson’s patients might be caused by the depletion of dopamine in the brain.
According to the Psychiatry Investigation review, another class of medication used to manage symptoms is antipsychotics. These drugs are used to treat people experiencing severe agitation, aggression, or distress from symptoms like hallucinations and delusions. They’re often used as a “last resort” to relieve symptoms.
Park pointed out that the most effective way to deal with someone who experiences sundowning is to learn from each experience, and it’s helpful to keep a journal of the symptoms.
Questions like “what may have triggered them? How was this day different from others? What physical signs did they show? How long did the episode last? What worked to calm them this time?” are important to ask, said Park.
Using what you’ve learned from each occurrence will make it easier to deal with the next one.
“Perhaps you will be able to lessen each episode or reduce the frequency of the experiences, which will make it easier to manage,” she said.