Sundowning can happen at any stage of dementia but is more common during the middle stage and later stages. Therefore, there is no specific stage of dementia that is associated with sundowning. Sundowning is an increase in agitation, distress, or confusion that may affect people with dementia at certain times of the day, usually from late afternoon through the night. It is not a disease but a set of symptoms or dementia-related behaviors that may include difficulty sleeping, anxiety, agitation, hallucinations, pacing, and disorientation.