Dementia is a condition that affects the brain and changes the way a person thinks, remembers, and behaves. One of the most common and noticeable changes in people with dementia is confusion, especially as the day goes on. Many families and caregivers notice that their loved ones seem more confused, agitated, or restless in the late afternoon and evening, a phenomenon often called sundowning. But can dementia actually cause someone to mix up morning and evening, or lose track of what time of day it is? The answer is yes, and this confusion is a real and well-documented part of dementia.
When a person has dementia, their brain is not working the way it used to. The parts of the brain that help with memory, thinking, and understanding time are damaged. This means that someone with dementia might not be able to keep track of the hours in the day, or they might forget whether it is morning or evening. For example, a person might wake up and think it is time for dinner, or they might want to go to bed in the middle of the afternoon. This kind of confusion is not just about forgetting the time, but about losing the sense of when certain activities should happen, like eating, sleeping, or getting dressed[1].
Sundowning is a term used to describe the increase in confusion, agitation, and restlessness that happens in the late afternoon and evening for many people with dementia. The symptoms of sundowning can include anxiety, agitation, pacing, disorientation, hallucinations, and trouble sleeping[1]. These symptoms often start as the light begins to fade and can last into the night. Some people may even want to be physically closer to their loved ones, following them around for reassurance[1]. Others may become more confused and not remember conversations or meals from earlier in the day. They might want to eat dinner again right after finishing a meal they do not remember, or they might not recognize their home or the people who care for them[1].
The reason why sundowning happens is not fully understood, but experts believe it is related to changes in the brain that affect the body’s internal clock, also known as the circadian rhythm. The circadian rhythm helps the body know when to be awake and when to sleep. In people with dementia, this rhythm can become disrupted, making it harder for them to tell the difference between morning and evening[1]. Hormonal changes, brain deterioration, environmental factors, and disruptions to the circadian rhythm are all thought to play a role in sundowning[1].
Sundowning is not a disease, but a symptom of dementia. It is not something that everyone with dementia will experience, but it is common enough that many caregivers and healthcare professionals are familiar with it. Studies suggest that about one in five people with Alzheimer’s disease, the most common type of dementia, will experience sundowning at some point[2]. However, sundowning can also occur in older people who do not have a formal diagnosis of dementia, especially if they have other health issues or are in a new or unfamiliar environment[2].
The confusion between morning and evening is not just about the time of day. People with dementia may also have trouble with their sleep patterns. They might sleep during the day and be awake at night, or they might wake up frequently during the night and not be able to fall back asleep. This can make the confusion worse, as the person may not be able to tell if it is night or day based on their own sleep-wake cycle[2]. Sleep problems, such as insomnia, are often linked to sundowning and can make the symptoms more severe[2].
Environmental factors can also play a role in the confusion between morning and evening. Changes in light, routines, and sleep patterns can trigger confusion, irritability, and an increase in sundowning symptoms[6]. For example, the change in daylight saving time, when clocks are moved forward or backward, can be especially challenging for people with dementia. The sudden shift in the schedule can cause more confusion and make it harder for them to adjust to the new time[3]. This is why caregivers are often advised to keep routines as consistent as possible and to make gradual changes when necessary[6].
The confusion between morning and evening can also be affected by other factors, such as fatigue, pain, depression, and boredom. When a person is tired, in pain, or feeling down, they may be more likely to experience confusion and agitation. This is why it is important for caregivers to pay attention to the overall well-being of the person with dementia and to address any underlying issues that might be contributing to the confusion[2].
In some cases, the confusion between morning and evening can be a sign that the dementia is progressing. As the disease gets worse, the brain damage becomes more severe, and the person may have more difficulty with time, memory, and understanding their surroundings. This can lead to more frequent and intense episodes of confusion, especially in the late afternoon and evening[1]. However, it is important to remember that each person with dementia is different, and the way they experience confusion and sundowning can vary widely[1].
Caregivers and family members can help by creating a calm and predictable environment, keeping routines consistent, and making sure the person gets enough rest and stimulation during the day. It can also be helpful to use clocks, calendars, and other visual cues to help the person keep track of the time. If the confusion is severe or is causing distress, it is important to talk to a healthcare professional for advice and support[2].
In summary, dementia can definitely cause confusion between morning and evening. This confusion is a result of changes in the brain that affect memory, thinking, and the body’s internal clock. Sundowning is a common symptom of dementia that can make this confusion worse, especially in the late afternoon and evening. Environmental factors, sleep problems, and other health issues can also play a role. Caregivers and family members can help by creating a supportive environment and seeking professional advice when needed[1][2][3][6].
Sources:
[1] Womens Health Magazine
[2] Caring Senior Service
[3] KSL.com
[6] Aegis Living
