Sundowner Syndrome Assessment
Use when asked to administer, score, or explain a Sundowner Syndrome Assessment — evaluation using the Cohen-Mansfield Agitation Inventory and Neuropsychiatric Inventory — grounded in FormExamples/form-examples.
Sundowner syndrome (sundowning) evaluation using Cohen-Mansfield Agitation Inventory (CMAI) scoring and Neuropsychiatric Inventory (NPI) for behavioural symptoms in elderly patients, particularly those with dementia.
Scoring
Instruments: CMAI (29–203, 29 items scored 1–7) + NPI (0–144, 12 domains, frequency × severity).
- Mild — occasional restlessness, redirectable, CMAI 29–45.
- Moderate — daily episodes, requires intervention, CMAI 46–75.
- Severe — aggressive behaviour, safety risk, CMAI 76–120.
- Critical — self-harm risk, requires constant supervision, CMAI > 120.
What it covers
Demographics; cognitive status; behavioural symptoms; temporal pattern assessment; trigger identification; sleep-wake cycle; medication review; environmental assessment; carer impact and support; and management plan.
Common pitfalls
- Assessing behaviour without documenting the temporal pattern — "sundowning" is defined by its characteristic late-afternoon/evening timing; without capturing that pattern explicitly, the assessment can't distinguish it from agitation with a different (or no) temporal pattern.
- Missing environmental triggers — lighting changes, noise, shift changes, and disrupted routine are common, modifiable environmental contributors; skipping this section misses interventions that don't require medication.
- Underweighting carer impact — sundowning is often as distressing and exhausting for carers as for the patient; carer support needs are a legitimate, not secondary, part of the management plan.
Learn more
- FormExamples: sundowner-syndrome-assessment for the full implementation, clinical references, and worked examples.
- Cognitive Assessment, Confusion Assessment Method for related assessments in dementia and delirium.