Alzheimer’s disease is a progressive brain disorder that affects memory, thinking, and behavior. One common and distressing symptom for many people with Alzheimer’s is **restlessness in the evening**, often called “sundowning.” This restlessness can include agitation, pacing, confusion, irritability, and difficulty settling down as the day ends. Families and caregivers frequently ask whether Alzheimer’s drugs can help reduce this evening restlessness.
The short answer is that **Alzheimer’s drugs may help somewhat with restlessness in the evening, but their effects are limited and vary widely among individuals**. These medications primarily target the underlying brain changes in Alzheimer’s or help improve cognition, but they are not specifically designed to treat behavioral symptoms like restlessness or agitation. Managing evening restlessness usually requires a combination of approaches, including non-drug strategies and sometimes medications, but the drugs approved for Alzheimer’s do not reliably eliminate this symptom.
To understand why, it helps to look at the types of drugs used in Alzheimer’s and what they do:
1. **Cholinesterase inhibitors** (such as donepezil, rivastigmine, and galantamine) are the most commonly prescribed Alzheimer’s drugs. They work by increasing levels of acetylcholine, a brain chemical important for memory and attention. These drugs can modestly improve cognition and daily functioning in some patients. However, their effect on behavioral symptoms like evening restlessness is inconsistent. Some people report feeling more alert or less confused, which might reduce agitation, but others experience side effects such as vivid dreams, insomnia, or increased anxiety, which can worsen restlessness at night.
2. **Memantine** is another Alzheimer’s drug that works differently by regulating glutamate, a brain chemical involved in learning and memory. Memantine may help with cognition and daily activities in moderate to severe Alzheimer’s. Its impact on restlessness or agitation is also variable. Some patients may experience slight calming effects, but memantine is not a sedative and does not directly reduce evening restlessness.
3. **Newer drugs targeting amyloid plaques**, such as donanemab and aducanumab, aim to slow the progression of Alzheimer’s by clearing abnormal protein buildup in the brain. These drugs have shown promise in slowing cognitive decline but have not been proven to reduce behavioral symptoms like evening restlessness. Their main benefit is in potentially delaying disease progression rather than managing specific symptoms.
When restlessness and agitation become severe or dangerous, doctors sometimes prescribe **antipsychotic medications** or other psychotropic drugs off-label. These can have sedating effects that might reduce evening restlessness temporarily. However, these medications carry significant risks, including increased mortality in older adults with dementia, worsening cognition, falls, and other side effects. Therefore, they are used cautiously and only when non-drug approaches have failed.
Non-drug strategies remain the cornerstone of managing evening restlessness in Alzheimer’s. These include:
– **Addressing unmet needs** such as hunger, thirst, pain, or the need to use the bathroom, which can cause agitation if ignored.
– **Creating a calm, predictable environment** in the evening with dim lighting, soothing music, and familiar routines.
– **Encouraging daytime activity and exposure to natural light** to help regulate the sleep-wake cycle.
– **Avoiding caffeine, heavy meals, or stimulating activities close to bedtime.**
– **Using relaxation techniques** like gentle massage or aromatherapy.
In some cases, low doses of certain antidepressants or sleep aids may be considered, but these must be carefully balanced against potential side effects.
In summary, while Alzheimer’s drugs can modestly improve cognition and daily function, their ability to reduce evening restlessness is limited and inconsistent. Managing restlessness in the evening usually requires a holistic approach combining careful assessment of physical needs, environmental adjustments, behavioral strategies, and sometimes cautious use of medications beyond standard Alzheimer’s treatments. Each person’s response is unique, s