---
name: sundowner-syndrome-assessment
description: 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 Assessment

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](https://github.com/FormExamples/form-examples/tree/main/forms/sundowner-syndrome-assessment) for the full implementation, clinical references, and worked examples.
- [[cognitive-assessment]], [[confusion-assessment-method]] for related assessments in dementia and delirium.