Medications that cause sundowning
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Medications That Cause Sundowning
Introduction to Sundowning in Dementia Patients
Sundowning refers to the phenomenon where individuals with dementia experience increased agitation, confusion, and delirium during the late afternoon and evening hours. This condition is particularly challenging for caregivers and healthcare providers, as it disrupts the patient's sleep-wake cycle and overall well-being.
Common Medications Linked to Sundowning
Antipsychotics and Sundowning
Antipsychotic medications are frequently used to manage behavioral symptoms in dementia patients, including agitation and psychosis. However, these medications can sometimes exacerbate sundowning symptoms. The use of antipsychotics has been documented in numerous reports over the past 30 years, but there is limited data explicitly linking their use to the time of day when sundowning occurs3. This suggests that while antipsychotics may be effective in managing general agitation, their impact on sundowning specifically remains unclear.
Benzodiazepines and Sundowning
Benzodiazepines are another class of medications commonly prescribed to manage anxiety and agitation in dementia patients. Similar to antipsychotics, benzodiazepines can sometimes worsen sundowning symptoms. The sedative effects of benzodiazepines may disrupt the sleep-wake cycle, leading to increased confusion and agitation during the evening hours1.
Cholinesterase Inhibitors and Sundowning
Cholinesterase inhibitors, used to treat cognitive symptoms of dementia, have also been implicated in sundowning. These medications can cause side effects such as insomnia and agitation, which may contribute to the worsening of sundowning symptoms1.
Alternative Treatments: Melatonin
Melatonin's Role in Managing Sundowning
Melatonin, a hormone that regulates sleep-wake cycles, has shown promise as an alternative treatment for sundowning. Several studies have found that melatonin administration can significantly reduce agitated behaviors and improve sleep in dementia patients1 4. Melatonin's ability to regulate circadian rhythms makes it a potential therapeutic option for managing sundowning symptoms without the adverse effects associated with traditional medications.
Efficacy of Melatonin in Clinical Studies
Research has demonstrated mixed results regarding the effectiveness of melatonin. While some studies report significant improvements in sundowning symptoms and sleep quality, others have found no significant effects1. Despite these mixed findings, melatonin remains a high-potential treatment due to its minimal side effects and role in circadian rhythm regulation.
Environmental Factors and PRN Medications
PRN Medications and Sundowning
Pro re nata (PRN) medications, administered as needed, are often used to manage acute agitation in dementia patients. A study conducted in a nursing home setting found that PRN medications were more frequently administered in the early morning and mid-afternoon, rather than during the evening when sundowning typically occurs2. This suggests that environmental factors, rather than the time of day, may play a more significant role in the administration of PRN medications for agitation.
Conclusion
In summary, while antipsychotics, benzodiazepines, and cholinesterase inhibitors are commonly used to manage agitation in dementia patients, they can sometimes exacerbate sundowning symptoms. Melatonin presents a promising alternative due to its role in regulating circadian rhythms and minimal side effects. However, further research is needed to fully understand the impact of these medications on sundowning and to develop more effective treatment strategies.
Sources and full results
Most relevant research papers on this topic
Effectiveness of Melatonin for Sundown Syndrome and Delirium
Melatonin shows potential as a high-potential, low-side effect treatment for sundown syndrome in dementia and delirium, potentially improving sleep-wake rhythm disturbances and reducing postoperative delirium.
Systematic Review
Rigorous JournalSundown syndrome: is it reflected in the use of PRN medications for nursing home residents?
Sundown syndrome may not be the sole factor influencing the use of PRN medications for agitation in Alzheimer's patients, as more medications were administered in early morning and mid-afternoon hours than at other times of the day.
Observational StudyThe Treatment of Sundowning
Future pharmacological studies should systematically assess behavior throughout the 24-hour day to provide relevant data for treating sundowning in dementia patients.
Literature ReviewMelatonin for treatment of sundowning in elderly persons with dementia - a preliminary study.
Melatonin administration significantly reduces agitated behaviors and daytime sleepiness in elderly nursing home residents with dementia, potentially improving their well-being and reducing caregiver burden.
Non-RCT
Highly CitedSundowning syndrome in aging and dementia: Research in mouse models
Sundowning syndrome in aging and dementia patients may be studied in mouse models, potentially facilitating the development of novel therapeutic approaches.
Literature ReviewTreatment options for sundowning in patients with dementia
Melatonin and antipsychotics show support for sundowning in dementia patients, while benzodiazepines show weaker evidence and cannot be recommended.
Systematic Review“Sundowning” as a biological phenomenon: current understandings and future directions: an update
Sundowning in elderly patients may be a biological phenomenon influenced by oxidative pathways, and understanding its biogenesis may provide novel treatment options.
Rigorous JournalSundowning in Patients with Dementia: Identification, Prevalence, and Clinical Correlates.
Sundowning is common in dementia patients and is associated with factors such as clinical dementia rating and memantine use.
Observational StudySundown Syndrome in Persons with Dementia: An Update
Sundown syndrome in dementia patients is associated with neuropsychiatric symptoms like agitation, confusion, anxiety, and aggression, and can be effectively treated with light therapy, melatonin, and various medications.
Rigorous JournalHighly CitedSundowning in Dementia: Clinical Relevance, Pathophysiological Determinants, and Therapeutic Approaches
Sundowning in dementia patients is common and associated with adverse outcomes, but its definition, pathophysiological determinants, and clinical and therapeutic approaches require further research.
Literature ReviewHighly Cited