Sundown...er....you better take care.....

So, my patient is in mid stage of Dementia w/Alzheimer's...and keeps thinking she's visiting us at our house for a BBQ.  The poor thing is so confused and has at times lashed out due to this. Along with the Dementia she has Sundowner's Syndrome which is now being classified as an anxiety disorder among seniors with Dementia.  Basically, the patient has a bit of anxiety due to being confused at the end of the day or within a couple of hours before I leave. Sundowner’s Syndrome is the name given to an ailment that causes symptoms of confusion with agitation and anxiety just before or after “sundown.” These symptoms appear in people who suffer from Alzheimer’s Disease or other forms of dementia. Not all patients who suffer from dementia or Alzheimer’s exhibit Sundowner’s symptoms, however. Some exhibit symptoms of dementia all day which grow worse in the late afternoon and evening, while others may exhibit no symptoms at all until the sun goes down.

Sundowner’s Syndrome largely remains a mystery to medical geniuses and there are loads of theories about why these symptoms begin at and/or near night time. A lot more studies are being conducted to determine the exact cause.
Doctors believe it’s an accumulation of all of the sensory stimulation from the day which begins to overwhelm and cause stress, thus anxiety, anger, agitation, etc... Plus, you're working with a human being who has pretty much all their lives been able to provide, care, etc... for themselves, and become agitated that they need to They speculate Sundowner’s Syndrome is also caused by hormonal imbalances that occur at night as well as the imbalance of their psyche due to the Dementia. Others believe that the onset of symptoms at night is due to simple fatigue and becoming anxious due to the inability to see well in the dark.

The theory that the symptoms have something to do with darkness have been somewhat supported by studies where some  symptoms seem to subside within an hour of the return of daylight. There is evidence nursing facility patients show an increase in Sundowner’s symptoms during winter which may have a connection with Seasonal Affective Disorder (SAD). SAD is believed to cause depression in the winter due to the shorter periods of sunlight, and it affects people of all ages. And as mentioned before, doctor's are now treating this as an anxiety disorder of sorts and should now  be treated as such since making the patient comfortable, happy with either a warm sweater, letting them watch their favie TV show or presenting them with a tasty treat doesn't seem to help ease the anxiety or anger.

Uh, yeah; it's all theory.  Nothing as of yet is found regarding a cure for Alzheimer's.  There is a new procedure that's out there where they can give you a sort of catscan/MRI like test to determine how advanced or how your brain is functioning re: Dementia.

Now this week was pretty funny actually.  Well, the week just started but it's been a long emotional ride as this lovely woman I've known for ages is just...deteriorating before my very eyes; and it's very heartbreaking!  She's more ambulatory as she has fallen again (not on MY shift mind you) and fractured her pelvic bone.  She's walking about and digging around and found my bag.  As I was doing her dishes after feeding her lunch I noticed she was a bit quieter than usual, so I went to investigate and found my stuff out of my bag...all over the couch and floor.  I noticed my tampons, ciggies, lighter and the lid to my very expensive coffee tumbler were missing. After playing the game of "search the hell outta the house for my schtuff" I finally found the missing items; my tampons and ciggies were by her bureau in her room, my lighter wrapped in a paper towel in the 'fridge and my lid to my tumbler on her bookshelf.  Funny.  She keeps telling me the story of how her brother made her sofa which is to this day still standing strong since 1950. She does have her off times, thus the deal regarding Sundowner's (sounds like the name of a country band.  It WAS a name of a country band....Joel Daley from ABC 7 Chicago, to be exact) and her anxiety and anger has been directed toward me.  I was told it was because she doesn't remember me and doesn't get as aggresive with her daughter for obvious reasons. It's a bit hard to not take her anger "personal" but I must be in nurse mode as well as friend mode and just do my darndest to make her happy and comfortable, and keep myself safe.