How Seasonal Changes Impact Dementia Sundowning Symptoms

Source: Jomarc Nicolai Cala/Unsplash

Sundowning is a phenomenon commonly experienced by those with dementia. As the day progresses into evening, symptoms such as confusion, agitation and restlessness can intensify. This can be distressing for both the individual and their caregivers. While the exact cause of sundowning isn’t fully understood, seasonal changes can play a significant role in worsening or alleviating symptoms.

Understanding Sundowning

Sundowning refers to a pattern of increased confusion, anxiety, or agitation that occurs in the late afternoon or evening. It’s most commonly observed in individuals with Alzheimer’s disease or other forms of dementia. Experts believe it’s linked to disruptions in your body’s internal clock — or circadian rhythm — which affects sleep-wake cycles. Environmental factors, fatigue, and even hunger can contribute to the severity of symptoms.¹

This condition can present in different ways. Some individuals become irritable or restless, while others may experience hallucinations or mood swings. You often notice pacing, wandering, or difficulty recognizing familiar surroundings as the day progresses. Identifying triggers and maintaining a structured routine can help reduce the impact of sundowning.1

How Seasonal Changes Affect the Body

The body relies on consistent environmental cues, such as sunlight and temperature, to regulate physiological processes. Seasonal changes can disrupt these cues, leading to hormonal imbalances that affect mood, sleep, and overall well-being.²

Two key hormones — melatonin and serotonin — are crucial for regulating sleep patterns and mood stability. Melatonin, which controls the sleep-wake cycle, is influenced by light exposure. Shorter daylight hours in winter lead to increased melatonin production in the evening, which can contribute to grogginess and disrupted sleep. Conversely, serotonin, known as the “feel-good” hormone, is produced in response to sunlight. Reduced sunlight in colder months can lower serotonin levels, potentially worsening depression and anxiety, which are already concerns for people with dementia.²

In addition to hormonal changes, seasonal allergies and fluctuating air quality can also impact cognitive function. High pollen counts in spring and fall can trigger inflammation, leading to discomfort, poor sleep, and increased irritability.

Indoor air quality in winter may also worsen due to dry, heated air, which can cause dehydration — a factor linked to confusion and cognitive decline. These environmental stressors can amplify sundowning symptoms, making it even more challenging for caregivers to manage their loved one’s well-being.

How Seasonal Changes Affect Sundowning

Seasonal shifts, especially shorter daylight hours in fall and winter, can worsen sundowning symptoms in people with dementia. Here’s how the changing seasons can impact sundowning.

Changes in Natural Light Exposure

Long summer days and short winter days impact your body’s internal clock. In winter, shorter daylight hours can disrupt circadian rhythms, leading to increased confusion and agitation in dementia patients.¹ Less sunlight exposure also means reduced melatonin production, which can further contribute to sleep disturbances.²

Temperature Variations

Seasonal temperature fluctuations can impact comfort levels. Extreme heat in summer may lead to dehydration, which is linked to cognitive decline. Conversely, colder months can make it harder for individuals to stay warm, potentially increasing discomfort and stress, which can exacerbate sundowning symptoms.

Routine Disruptions

For individuals with dementia, routine provides a sense of stability and reassurance.³ Knowing what to expect each day can help reduce confusion and anxiety, making their environment feel more familiar and secure. With each season comes a shift in daily routines. Daylight savings time, holiday gatherings, and changes in daily activities can confuse dementia patients. A lack of consistency in their schedule may make it harder for them to distinguish between daytime and nighttime, increasing agitation in the evenings.

Increased Seasonal Depression

Seasonal affective disorder (SAD) is a condition that affects about 5% of American adults during the darker months.⁴ Dementia patients aren’t immune to this and may experience worsening moods, lethargy, and irritability. A decline in mood can contribute to the severity of sundowning episodes.

Dementia Essential Reads

Dementia Is More Common Among the Married Than the Unmarried

Memory Loss or Dementia? Understanding the Key Differences

How to Manage Sundowning During Seasonal Changes

As daylight patterns shift with the seasons, managing sundowning requires extra attention to routine and environment. Being aware of these changes can help you reduce their impact on evening confusion and agitation.

Maintain a Consistent Routine

Stability is key. Keeping a regular daily schedule, regardless of the season, can help reduce confusion and anxiety. You should ensure meals, activities and bedtime occur at the same times each day.³

Maximize Natural Light Exposure

During the darker months, increase exposure to daylight by opening curtains and sitting near windows. Using light therapy lamps may also help.⁵ In summer, ensure exposure to natural light in the morning but avoid excessive evening light, which can interfere with sleep patterns.

Regulate Temperature Comfort

Ensure the living environment is appropriately heated in winter and cooled in summer. Proper hydration in hot weather and warm clothing in cold months can help maintain physical comfort, reducing stress and agitation.⁶

Encourage Calming Activities

Soothing activities such as listening to music, gentle exercise, or reading can help ease the transition into evening. You should avoid overstimulation, especially in the hours leading up to sunset.

Supporting Well-Being Through the Seasons

Seasonal changes can have a profound effect on sundowning symptoms in those with dementia. Understanding these influences allows you to make adjustments that can help ease distress and improve overall well-being. By maintaining consistent routines, optimizing light exposure and ensuring comfort throughout the year, you can minimize the impact of seasonal shifts.