By: Grace Huff
As the days shorten and the sun fades faster, many people living with dementia and related disorders will experience more than just cold weather. They might experience new confusion, disrupted sleep or emotional strain that feels sudden and unexpected or unsettling.
These symptoms are often not just “part of dementia,” they are signs of seasonal depression, a condition that can look very different in those with dementia. Depression may quietly appear as restlessness, withdrawal or worsening confusion rather than verbal or physical expressions of sadness, which can be easily confused with disease progression.
“In people living with dementia, seasonal depression often shows up not as sadness, but as worsening confusion, agitation, sleep disruption or withdrawal,” said Shellie-Anne Levy, PhD, assistant professor of clinical and health psychology in the College of Public Health and Health Professions and practicing clinical neuropsychologist at the Norman Fixel Institute for Neurological Diseases. “That makes it easy to miss.”
Someone who once enjoyed conversation and slept well may become quieter and begin waking frequently throughout the night. Evening hours can grow especially difficult due to a phenomenon known as sundowning. It may be present as agitation or pacing, which tends to worsen during the darker, winter months.
Seasonal changes can affect the brain in very powerful ways, affecting chemicals that are essential for mood regulation and sleep, such as reduced sunlight decreasing serotonin levels and the circadian rhythm. Cooler weather also limits some outdoor activity and social interaction, while darker evenings can increase disorientation.
“For people living with dementia, who are already neurologically vulnerable, these changes can be destabilizing,” Levy explained. “Winter can intensify agitation, sleep problems, withdrawal and irritability.”
Recognizing seasonal depression in this population requires careful observations, according to Gregory Pontone, MD, MHS, Louis and Roberta Fixel Endowed Chair and Co-Director of the Fixel Neuropsychiatry Program. “Cognitive impairment may make it more difficult for the patient to express their feelings directly, they may not accurately remember the duration of symptoms, and they may be more likely to make misattributions such that the seasonal change in mood is considered to be part of a less relevant process,” he said.
Families or caregivers might notice their loved one staying in bed longer, withdrawing socially, losing motivation or becoming more irritable in the winter months. “Caregiver observations and comprehensive evaluations are crucial in identifying and addressing seasonal depression in this population,” said Pontone. There is often pressure for caregivers to maintain certain traditions or push through busy schedules, but experts emphasize that simplicity and consistency matter far more than perfection.
“During the holidays, the best approach is to simplify, simplify, simplify,” Levy said. “Familiar routines and calm, predictable environments help people feel safe and supported.”
Simple daily habits can make a big difference in stability:
- Opening curtains each morning
- Spending time in bright spaces
- Keeping a familiar daily routine
- Encouraging gentle movement, shared nutritious meals and social connection
- Reducing noise, clutter and overstimulation, especially in the evening
Pontone adds that gentle persistence is key. “Depression tends to resist action,” he said. “Consistent encouragement and structured activity can help prevent withdrawal and worsening symptoms. These changes are not something families have to accept. With the proper support, your loved ones can feel calmer, more comfortable and more like themselves.
If mood or behavioral changes last more than a couple of weeks, worsen over time or interfere with daily life, families should talk with a healthcare provider. Seasonal depression is real, and it is treatable. Winter may feel heavier, but with understanding and support, families can help their loved ones even through the darkest days.