THE TREATMENT OF SUNDOWNING - A SELECTIVE REVIEW OF PHARMACOLOGICAL AND NONPHARMACOLOGICAL STUDIES

Sundowning refers to episodes of agitated behaviour that are more freq uent or are more severe at night. Although the effects of different ps ychoactive medications on agitated behaviour in dementia patients have been documented in hundreds of reports over the last 30 years, less t han 20 studies make explicit reference to time of day for which outcom e measures were derived, and even fewer have also examined sleep as an outcome. Thus, despite varying claims of efficacy and effectiveness f or various medications, there are few data to support informed managem ent of disruptive nocturnal behaviour in these patients. In this brief article, we selectively review those few studies explicitly mentionin g temporal dimensions of behavioural outcome, including some newer stu dies of unconventional types of treatment that may be useful for the t reatment of sundowning. We conclude that future pharmacological studie s should systematically assess behaviour throughout the 24-hour day to provide outcome data relevant to this phenomenon.