Sundown syndrome and symptoms of anxiety and depression in hospitalized elderly

Abstract

Sundown syndrome is characterized by the sudden appearance of neuropsychiatric symptoms such as agitation, confusion and anxiety in a chronologic fashion, usually during late afternoon or early evening.ObjectiveTo evaluate the prevalence of sundown syndrome in university hospital wards and its relationship with anxiety/depression symptoms, cognitive decline, and clinical and demographic variables.MethodsWe evaluated 70 patients admitted to the Lauro Wanderley University Hospital (HULW), João Pessoa-PB, Brazil. Data collection instruments were the Confusion Assessment Method (CAM), the Mini-Mental State Exam (MMSE) and the Hospital Anxiety and Depression Scale (HADS).ResultsMean patient age was 68.4±6.4 years, 55.7% were male, 67.1% were illiterate or had incomplete primary education. It was observed that 14.3% of patients had delirium, 15.7% had cognitive deficits, while 21.4% and 18.6% had anxious and depressive symptoms, respectively. The age of patients with delirium (71.9±8.7) was significantly higher than those without (67.8±5.8). At 95% confidence, there was a significant difference in the groups with and without delirium for the MMSE and HADS-D scales.ConclusionWe verified the occurrence of delirium compatible with the sundown syndrome and associated with depressive symptoms and cognitive deficit, with no apparent relationship with infectious processes or fever, number of drugs used, hospital stay or anxious symptomatology.

Potential Pathways for Circadian Dysfunction and Sundowning-Related Behavioral Aggression in Alzheimer’s Disease and Related Dementias

“…For instance, Menegardo et al (2019) associated the aggressiveness and irritability of sundowning with increased nocturnal behavior such as wandering. Silva et al (2017) also associated sundowning with increased depressive and cognitive symptoms, suggesting that multiple emotional systems are disrupted in this syndrome and that these become even more compromised as AD progresses with more associated cognitive decline. Angulo Sevilla et al (2018) also noted an association of such sundowning symptoms with an increased severity of dementia, but also in association with insomnia and hypersomnia.…”

“…Indeed, during this same time, numerous more groups reported disturbances in AD and dementia patients that temporally and qualitatively match the traditional description of sundowning-related agitation and aggression ( Martino-Saltzman et al, 1991 ; Cohen-Mansfield et al, 1992 ; O’Leary et al, 1993 ; Burgio et al, 1994 ; Sloane et al, 1998 ). Even more recently, several observational studies defining sundowning as an increase in neuropsychiatric behaviors (including agitation and aggression) in the late afternoon and early evening have observed this phenomenon in AD patients in association with important circadian or AD-related factors ( Silva et al, 2017 ; Angulo Sevilla et al, 2018 ; Menegardo et al, 2019 ; Pyun et al, 2019 ; Shih et al, 2019 ). For instance, Menegardo et al (2019) associated the aggressiveness and irritability of sundowning with increased nocturnal behavior such as wandering.…”