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A diagnosis of Alzheimer’s disease can catch families off guard. When such a diagnosis is made, patients and their families typically have a host of questions, including how far the disease has progressed and what to expect as it advances.
One potential side effect of Alzheimer’s disease that can catch families off guard is sundowning. The National Institute on Aging notes that sundowning refers to the restlessness, agitation, irritability or confusion that can begin or worsen as daylight begins to fade.
Sundowning is difficult for Alzheimer’s sufferers, but also can be especially hard on their caregivers. As day turns to night, people serving as caregivers to Alzheimer’s patients tend to wear down, only to suddenly realize that the people they’re caring for are becoming increasingly difficult to handle.
The National Institute on Aging notes that sundowning can continue well into the night, compromising patients’ ability to fall asleep and stay in bed.
Sundowning will not affect every Alzheimer’s patient, but caregivers should prepare themselves to handle such a situation should it arise. Learning more about sundowning can be part of that preparation.
Why does sundowning occur?
The exact cause of sundowning, which is sometimes referred to as ‘late-day confusion,’ is unknown. However, the Mayo Clinic notes that certain factors may aggravate the feelings of confusion felt by Alzheimer’s patients who experience sundowning. Those factors include:
—Fatigue
—Low lighting
—Increased shadows
—Disruption of the body’s internal clock
—The presence of an infection, such as a urinary tract infection
The National Institute on Aging notes that one theory suggests Alzheimer’s-related changes in the brain can disrupt a person’s internal clock, confusing their sleep-wake cycles as a result. That can confuse Alzheimer’s patients and contribute to the feelings of agitation and irritability that are common among people who experience sundowning.
What can be done to combat sundowning?
The National Institute on Aging recommends looking for signs of sundowning in late afternoon and early evening and trying to determine what might be causing these behaviors. Try to avoid anything that appears to trigger these behaviors, if possible.
Reducing noise, clutter or the number of people in the room when sundowning symptoms typically appear may help reduce the confusion Alzheimer’s patients feel during this time of the day. In addition, scheduling a favorite activity or providing a favorite snack at this time of day can give Alzheimer’s patients something to focus on, potentially cutting off the confusion before it surfaces.
The institute also recommends making early evening a quiet time of day reserved for playing soothing music, reading or going for a walk. Caregivers who also have children to look after can explain the importance of this quiet time to youngsters and ask for their cooperation.
Closing curtains or blinds and turning on the lights at dusk can minimize shadows in the house, potentially making this time of day less confusing for Alzheimer’s sufferers.
Sundowning is a symptom of Alzheimer’s disease that can be difficult for caregivers to manage. More information about sundowning is available at www.nia.nih.gov.

Gov. John Bel Edwards said Monday that he will extend his stay at home order to May 15 despite earlier hopes that he would move more quickly to reopen the state economy.

Edwards said at Monday's daily press conference that he'd consulted four epidemiologists and officials with the Louisiana Department of Health about the progress in the fight against the spread of COVID-19, and relied on the Trump administration's guidance on a phased reopening of the economy.

"Obviously my hope ... was we would begin taking bigger steps toward reopening and moving toward some semblance of normalcy than what I'm able to announce today," Edward said. "The fact is we just don't meet the criteria."

Even so, the order will be modified in three ways beginning Friday:

--Restaurants with outdoor tables will be allowed to let customers eat there, but no table service will be permitted. Restaurants will still be restricted to takeout, drive-through and delivery orders for now.

--Malls will remain closed to the public except for stores with their own access to the outdoors. But stores can do business by way of curbside service.

--Employees who come into contact with the public in businesses that remain open must wear masks or other face coverings.

Otherwise, businesses that had been ordered closed, including barber and beauty shops, casinos and bars, will remain closed at least until May 15.

The governor's stay at home order had been scheduled to expire Thursday. Edwards said he'd relayed his decision to delay a reopening to Vice President Mike Pence.

"He told me he supports the decision, and quite frankly, that's not surprising," the governor said.

Louisiana still ranks sixth in the nation in the rate of COVID-19 spread, Edwards said.

Still, Louisiana Office of Public Health statistics have shown improvement over the last few weeks as mitigation measures are preventing a sudden spike in cases that would overwhelm health care resources.

"That's because of the people who took seriously the stay at home order," Edwards said. "They took seriously social distancing and hygiene. ... What we know is the action taken by Louisianians across the state has saved lives, many, many lives."

The goal is to reach the criteria set out in the Trump administration's Make America Open again guidelines, which set a goal of two weeks' worth of improvement in cases of COVID-19 and similar illnesses, deaths and hospitalizations before moving into a Phase One reopening.

"Phase 1 lifts the Stay at Home order and eases restrictions on some public spaces like houses of worship and restaurants and opens other businesses that have been closed such as barber shops and salons, but with restrictions on occupancy and strict requirements for personal distancing and masks to keep everyone safe," according to the Governor's Office website. "Phase One occupancy for these businesses will be limited to 25 percent."

The improvement in statewide COVID-19 numbers is being driven by an improving situation in Orleans Parish, said Dr. Alex Billioux, assistant secretary of the Louisiana Department of Health. At the regional level, Edwards said, the picture is "less rosy."

The number of COVID-19-like illnesses is decreasing statewide. But COVID-19 cases are increasing in Department of Health Region 2 in the Baton Rouge area; in Region 4 in Acadiana, including St. Martin; and in Region 8 in the Monroe area. Cases in Region 9 on the Northshore have reached a plateau.

Hospitalizations are increasing in Regions 2 and 8 and have plateaued in Region 7 in the Shreveport-Bossier area and in Region 5 in southwest Louisiana.

In Region 3, which includes St. Mary and Assumption, COVID-19 cases and hospitalizations are decreasing.

But 27,068 Louisiana people have tested positive for COVID-19, and 17,303 are believed to have recovered. So nearly 10,000 people are known to still be infected, Edwards said.

The goal now is to ramp up testing and contact tracing to 200,000 in May. Fewer than 150,000 tests are known to have been performed in Louisiana since the pandemic began.

Edwards ruled out a parish-by-parish easing of economic restrictions because one problem or another seems to persist in different parts of the state.

"I believe we have to be smart about reopening the economy," Edwards said, "because if we reopen too quickly, that won't be good for public health or the economy, and we would wind up having to slam on the brakes and actually go back to more restrictions."

The governor encouraged people to get outdoors to enjoy the spring weather while maintaining social distancing. The disease is much less likely to spread outdoors, Billioux said.

And Edwards made an appeal to Louisiana people to wear masks or other face coverings in public.

"We know this is very important," the governor said.

He encouraged business owners and faith leaders to use the two weeks before a possible easing of restrictions to make sure they have masks for employees and have made accommodations for proper social distancing.

Edwards said he plans to announce May 11 whether Louisiana has met the Phase One criteria.

COVID-19 infection numbers continued to improve in Monday's Louisiana Office of Public Health Report.

Two cases each were reported between noon Sunday and noon Monday in St. Mary, St. Martin and Assumption.

The numbers locally:

--St. Mary, up two positives to 181 after 983 tests. The death toll remains at 20.
--St. Martin, up two positives to 221 after 1,643 tests. The death toll remains at 15.
--Assumption, up two to 175 after 672 tests. The death toll remains at three.

Statewide:
--295 new positives for a total of 27,068 after about 147,000 tests.
--27 new deaths for a total of 1,697.
--1,683 people are in hospitals, and 262 are on ventilators.
--17,303 people are known to have recovered.

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Local banks are among those nationwide that are lending money through the U.S. Small Business Administration’s Paycheck Protection Program, which received congressional approval and President Donald Trump’s signature last week for a second round of funding.
M C Bank and Patterson State Bank are among those who are lending money through the program.
Patterson State Bank CEO and Board Chairman Bill Marin said he has heard that banks can start submitting applications for funding Monday.
The program was developed to help businesses pay their employees for an eight-week period. The loans are “100% forgivable” as long as 75% of the money given is used for employee salaries, according to M C Bank President Jeremy Callais.
“The bank will be paid off by the Small Business Administration as opposed to being paid off by the customer” as long as the requirements are met, Callais said.
The U.S. Small Business Administration guaranteed $350 billion in funding for the first round, and the second round is about $320 billion, Callais said.
The funding is available for those COVID-19-affected businesses with fewer than 500 employees.
Those who own franchises of corporations also can apply for their individual businesses.
The loan is calculated using 2.5 times employees’ monthly income in 2019 with a cap for each employee at $100,000. This can include health and retirement benefits.
The eight-week funding period begins at the time the money is received.
Marin said it was “a bit of a rocky start” for many banks in the beginning to work out problems getting on the SBA’s electronic system where submissions are sent.
“There were a lot of frustrated banks around the country that actually some of them I don’t think ever did get on that first round of money,” Marin said. “We were able to get on and ended up getting submissions done, getting SBA loan numbers, which in effect gave us the SBA guarantee.”
The program will run until the money dries up, with the cutoff being June 30.
Callais and Marin expect the new round of funding to go quickly, and Callais said he is unsure if it will be refunded.
“When the first one ran out, our senators and congressmen made it very well known ‘don’t worry, there’s going to be more money coming available,’” Callais said. “However, this time, you don’t hear that same chatter. I’m not saying there won’t be. I’m saying we were basically told ‘hey, look, when it runs out, don’t worry. We’re going to go get more.’ We’re not hearing that like we did the first time, and I guess it’s because things are starting to project to open back up.”
Marin said those who need to apply for funding should do so as soon as possible.
According to the Louisiana Bankers Association, Louisiana agencies had 26,635 loans totaling $5.1 billion approved for customers in the first round of funding.
Marin credited his employees for the work they have done during this process.
“While I guess overall it was a trying experience to start with, I can’t say enough about our team of workers,” he said. “Our tech people that got on this and figured out how to get through the etran system, and then after that was done, we had bankers that worked day and night staying at it and submitting and then funding the loans.”
The amount of money the SBA has lent during the COVID-19 pandemic is “unprecedented,” according to Marin, who has been in the banking industry since the early 1970s.
“The SBA has had its programs, but it’s been minor compared to this,” he said. “They’ve put out their numbers about what they typically do in an annual basis, and this dwarfs it, and I’m talking about only being two weeks old, it dwarfed what they generally do for years in that program.”