Management of Sundowning in Parkinson's Dementia

Critical Safety Considerations

When severe agitation disrupts care and environmental interventions fail, medications become necessary, according to the American Academy of Family Physicians 1
The benefit of controlling severe nocturnal agitation that disrupts other residents must be weighed against mortality risk 1
Tardive dyskinesia risk exists but is lower with atypical antipsychotics; monitor with AIMS scale every 3-6 months, as recommended by the American Academy of Child and Adolescent Psychiatry 2
Avoid combining quetiapine with other anticholinergic medications, as advised by the American Academy of Family Physicians 1

The patient's tamsulosin contributes to orthostatic hypotension risk and anticholinergic burden, according to the American Academy of Family Physicians and the Mayo Clinic 1, 3
Multiple anticholinergic medications may be worsening confusion; review necessity of all agents, as recommended by the American Academy of Family Physicians and the Mayo Clinic 1, 3
Quetiapine can be used cautiously with MAO-B inhibitors like rasagiline, but monitor for serotonin syndrome, as advised by the American Academy of Child and Adolescent Psychiatry 4

Do not combine quetiapine with typical antipsychotics, which will worsen parkinsonism, as warned by the American Academy of Family Physicians and the American Academy of Child and Adolescent Psychiatry 1, 2
Do not use benzodiazepines as an alternative, as they increase fall risk, cognitive impairment, and are on Beers Criteria, according to the Mayo Clinic Proceedings and the Journal of Clinical Sleep Medicine 3, 5