Does "sundowning" happen ONLY in dementia, or can it happen in acutely ill hospitalized patients?

Final, I hope she is doing better now.

I do not think you have much to worry about. More than likely it was just a combination of quite a few things: the infection, the antibiotics, the hospital environment, nurses-aides-doctors walking in at all hours waking her up which messed up her sleep-wake cycle.

I am sure you remember the long nights during clinicals in med school, no matter how hard you tried, you could not sleep that well in the hospital - every little noise would waken you. At 25 your brain can handle it, at 85 with atrophy and most likely some mini-infarcts you cannot handle it as well.

I know the exact situation you are describing as well, except with me it was my grandmother. She had a CEA done a couple years ago, and since my aunts who were taking care of her knew better than the medical professional in the family (me), it became infected. She had to have an emergency debridement done, and the second night, which was spent in the SICU, she "sundowned". Since the staff knows me, they called me in, and I spent the entire night listening to my grandmother describe bugs on the ceiling, gardeners planting trees right outside her 5th floor window, and people walking out of secret doorways in the ceiling. She was the same way, we would get her calmed down and "aware" of where she was, and then a few minutes later she would start telling the same stories or screaming, as she thought they were trying to kill her. Eventually she had to be restrained as she started to try to pull out lines, and kicked me somehow managed to contort her body to kick me (making me sing soprano for a bit). The next morning, she was completely fine and claimed to only remember certain things-kicking me was not one of them (although she later apologized in her own way).

I am sure your mom will be fine, once she is able to get home to familiar surroundings and get back to her normal routine.

Sundowners Dementia

"Sundowning" is not really a medical diagnosis or syndrome, but rather a pretty common manifestation of delirium, an acute transient confusional state which occurs in many MANY elderly people when ill and particularly when they are taken out of their usual "element" such as, and particularly, being in the hospital. Anything from medications (even antibiotics) to the illness itself to anesthesia/surgery after-effects to the "weird" environment of having "lights on" all the time like in hospitals and nursing homes, can provoke it. The best treatment is the things you did -- being there, and looking for medications which could contribute.

It is very common in elderly hospitalized/acutely ill/postoperative patients. It is NOT an indicator or an early sign of dementia. Dementia is a slow and insidious process of worsening memory loss that does NOT wax and wane (like delirium (sundowning) does) but just progressively gets worse. People do not improve, with dementia, and it doesn't have a day/night off/on phenomenon. Some people with dementia *already diagnosed* are more prone to becoming delirious (or sundowning) when ill or in the hospital. However delirium does not cause, nor indicate, impending dementia.

Chances are, you mom was quite ill, was in a completely unfamiliar environment, and was exposed to a variety of medications including the antibiotic, which can precipitate delirium. Throw in a bit of dehydration and sleep deprivation, and you've created a perfect setup for delirium. It often, very often, happens in acutely ill hospitalized patients, as you've guessed.

Please don't lose sleep over worrying about dementia. If you google "delirium" vs. "Dementia" you'll see. Also, if you are concerned about true sings and symptoms of dementia, look under the Alzheimer's Association webpage, www.alz.org where you'll find helpful and accurate info. Hope this helps.

I suspect it is some sort of early dementia. I've cared for many "sundowners." It is also sometimes called "Midnight Madness." They're sweet little old ladies (or gentlemen) by day, the cookie-baking grandmothers you remember fondly from your childhood. And then, around 11 or 12 PM, they change into something completely different. I have been attacked by them, had them beat me over the head with their canes (I had one break one of my ribs one night about 2 AM), had them pick up bedside tables and break out the windows, or throw them at me. I've also had them scream at me to get out of "their house," or start screaming for help when I walk in the room and demand to know how I "broke in" to their house. They can exhibit bizarre demented behavior, be very aggressive, curse like pirates, almost like they're possessed. Then, about 7 AM, they convert back over to sweet little cookie-baking grandmas. Almost any nurse has witnessed this behavior. Some doctors deny it happens, but if they would go spend a few midnight shift on a Med-Surg floor, they'd see it for themselves. I can't tell you what causes it; I've never read any scientific explanation for it. I just know it happens, and not infrequently. I suspect it's some sort of early manifestation of Senile Dementia.

I have seen sundowning also in ICU patients on multi meds, and BTW/my elderly dog also sundowns; soI suspect it is a combination of several things--probably meds, unusual surroundings with a poor sleep-wake cycle, and tiny small old-age infarcts and atrophy in the brain, etc.

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They'd never do it. I think they like their little rat finks.