Sundowning may be a response to one’s environment

Ask Dr. Keith Roach M.D

Sundowning may be a response to one’s environment

DEAR DR. ROACH: Can you explain what sundown syndrome is? My mother is 96 and has been diagnosed with it, but said they could do nothing about it. Is there some medication out there for this type of syndrome? She says she sleeps well. — P.S.

ANSWER: The term ‘sundowning’ is used to describe a change in behavior in older people with some element of dementia, usually an increased level of confusion in the late afternoon and evening hours. However, I get concerned when I hear the term, because it makes me worry about acute delirium. Delirium is a medical emergency (one of my colleagues in geriatrics calls it ‘chest pain of the brain’), and it often indicates serious medical problems requiring immediate and thorough evaluation. This could be infection or metabolic derangement, which is changes to normal physiology such as low oxygen levels or too-low or toohigh blood sodium levels.

Sundowning, as part of a usual pattern or after a thorough workup, often is a response to a change in the person’s environment. This could be a change in lighting or noise, or loss of a familiar companion. As such, it’s been my experience that it is better treated with reorienting the person than with medication. Although medication often is used — from sleep aids, like melatonin, to major tranquilizers, like haloperidol — I would strongly recommend working on keeping a calm and familiar environment for your mother in the evening hours. I also would recommend that she avoid excessive stimulation, including television, loud noises, caffeine and exercise in the last hours of the afternoon.

DEAR DR. ROACH: When my doctor went over my blood test results, she mentioned only good results. Later, I noticed that there were actually two items that were outside the reference range: Urea nitrogen (BUN) was 6 mg/dL (normal range: 8-25), and the BUN/creatinine ratio was 7.0 (normal range: 10-28). Should I be concerned, or is a result a little lower than the reference range not a big deal on these particular items? — D.S.C.

ANSWER: Blood urea nitrogen (BUN) is a measure of urea, a waste product of protein metabolism. High levels occur with most kinds of kidney disease. Low levels are unusual, but can happen when people are not getting adequate protein, usually in cases of starvation or in the presence of severe liver disease. However, I commonly see slightly low levels, like yours, in healthy people who don’t eat a lot of meat and who are relatively thin.

Occasionally, the BUN-tocreatinine ratio can be low in people with low thyroid hormone levels. If you had symptoms of hypothyroidism, it might be worthwhile to check your thyroid hormone level, if that has not been done before.

DEAR DR. ROACH: What is blue waffle disease? -D.C.M.

ANSWER: ‘Blue waffle disease’ is an urban myth. It doesn’t exist. It supposedly is a sexually transmitted disease affecting women (in some versions of the myth, it is due to poor hygiene or excessive sexual activity), but there is no legitimate documentation of such a disease, and it may have started off as a joke that has taken on a life of its own. *** Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cor nell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall. com.