Can a dementia patient sundown but then become lucid just prior to bedtime?
My 84 year old mother has dementia (mid-stage) & lives with me. I've noted that she starts to become agitated/worrisome, argumentative & more confused around 2 PM each day. Initially, this didn't happen until closer to 7pm but over the past 1-2 months I've noted that it has gradually started happening earlier & earlier & to a more intense degree until, as I said, it now starts around 2 PM.
I understand sundowning & I've seen it in others with Alzheimer's or other forms of dementia but I can't recall ever encountering someone who exhibits symptoms of sundowning that clear up approximately a half-hour to an hour before they go to bed. Like, I'm talking not knowing who I am, thinking her parents (who are LONG dead) are gonna be mad because she's not home yet, asking me for "the phone numbers of all of the people who have motorcycles that they want to get in out of the weather", calling me by my name but then saying she's got to call me, sitting for an hour fiddling with her purse trying to figure out how to unzip it to get inside, etc. I'm talking truly bizarre stuff...especially when you consider that, during the day, she is capable of drawing water into a cup from the tap, warming it with the 1-minute "quick button" on the microwave & adding a spoonful of instant coffee all on her own. Anyway, I've been watching her like a hawk for the past 2 or 3 evenings & I've noticed that her argumentativeness & restlessness lessen & her confusion all but disappears about 30 minutes to 1 hour before she goes to bed. Has anyone else seen the symptoms of sundowning appear so early in the day & disappear so suddenly around 9 PM? I've never seen a sundowner improve like that until they've had at least a few hours of sleep.
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Your mother is fairly lucid in the morning, has typical dementia symptoms in the afternoon and early evening, and then become more lucid again at night. Is that the pattern?
My husband had large fluctuations in his cognitive skills within a day or a week. That is a hallmark of the kind of dementia he had (Lewy Body Dementia). His fluctuations did not follow any pattern. They appeared random.
Since this is a change in her functioning, your mother's doctor should be told about this.
Maybe you should be very glad that Mom still has long periods of relative lucidity, and take advantage of those times of day for short outings, looking a scrapbooks, having her help with folding clothes -- whatever activities are meaningful to her.
Dementia gets worse. It is the nature of the disease. Perhaps this is just normal progression for whatever kind of dementia she has. But I'd discuss it with the medical professionals who know her, to see if there are some other details you should be looking at, such a PCVS's question about hydration.
Alzheimer's Compendium (endquote)
At the onset of sundowning. The demons of anxiety, anger, fear, hallucinations and paranoia come out. Sundowning is unpredictable, up and down cycles are present during day and night.
Alzheimer's Compendium(QUOTE) Broadly speaking, sundowning is a cyclical increase in agitation (which may include restlessness, confusion, disorientation, wandering, searching, escape behaviors, tapping or banging, vocalization, combativeness, and/or hallucinations) that takes place at roughly the same time every day.
Despite its name, and the wide-spread belief that sundowning occurs in the late afternoon and early evening, studies have found that the peak of sundowning activity is more likely to occur in the early- to mid-afternoon (e.g., around 1:00pm),
....
in some patients, it may occur late at night.
It may even peak in the early morning in a fairly high percentage of patients.
(endquote)
"A Common Sense Guide to Alzheimer's Care Kisses for Elizabeth"" is written for both family and professional caregivers of people with Alzheimer's disease and other dementias. It is a practical resource for anyone experiencing difficulty with significant behavioral issues but is also helpful to caregivers who simply want to provide the best possible care.
As already suggested, ask her doctor or other health practitioner. Maybe there's a medication reaction issue.