Kathy C Richards1, Richard P Allen2, Janet Morrison3, Liam Fry4, Christine R Kovach5, Angelica Rangel3, Ana Loera3, Yanyan Wang3, Alexandra L Hanlon6, Alicia J Lozano6, Donald L Bliwise7. 1. School of Nursing, University of Texas at Austin, Austin, TX, USA. Electronic address: kricha@utexas.edu. 2. Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 3. School of Nursing, University of Texas at Austin, Austin, TX, USA. 4. Dell Medical School, University of Texas at Austin, Austin, TX, USA. 5. College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA. 6. Center for Biostatistics and Health Data Science, Virginia Tech, Blacksburg, VA, USA. 7. Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
Abstract
OBJECTIVES: Nighttime agitation or "sundowning" is challenging for clinicians and caregivers to manage in older adults in the dementia stage of Alzheimer's disease (AD-D). Our research previously revealed that nighttime agitation might be a manifestation of restless legs syndrome (RLS). The current study aims to describe the characteristics of older adults with AD-D, nighttime agitation, and RLS, and to evaluate sleep disturbance and iron status in relation to nighttime agitation severity. DESIGN: An observational study with baseline descriptive and correlational data from a clinical trial. SETTING AND PARTICIPANTS: Long-term care (n = 69) and independent living (n = 7); age 82.91 ± 9.46 years, with AD-D, nighttime agitation, and RLS. MEASUREMENTS: Trained observers counted nighttime agitation behaviors. Independent variables were age; cognition measured by the Mini-Mental State Examination; minutes slept from actigraphy; transferrin saturation percentage (TS%) and transferrin from fasting blood samples; and illness severity using the Cumulative Illness Rating Scale for Geriatrics. Bivariate and multivariable linear regression models were generated. RESULTS: In the multivariable model, sleep minutes (P = .002) and TS% (P = .003) were negatively associated with frequency of nighttime agitation behaviors, and they explained 20% of the variance. Seventy-nine percent received 1 or more medications that worsen RLS symptoms, such as antihistamines and serotonin reuptake inhibitors. CONCLUSIONS AND IMPLICATIONS: We encourage clinicians to consider nighttime agitation as a manifestation of RLS. Treatment of iron deficiency indicated by low TS% and deprescribing medications that exacerbate RLS may decrease nighttime agitation, improve sleep, and enhance quality of life in older adults with AD-D.
OBJECTIVES: Nighttime agitation or "sundowning" is challenging for clinicians and caregivers to manage in older adults in the dementia stage of Alzheimer's disease (AD-D). Our research previously revealed that nighttime agitation might be a manifestation of restless legs syndrome (RLS). The current study aims to describe the characteristics of older adults with AD-D, nighttime agitation, and RLS, and to evaluate sleep disturbance and iron status in relation to nighttime agitation severity. DESIGN: An observational study with baseline descriptive and correlational data from a clinical trial. SETTING AND PARTICIPANTS: Long-term care (n = 69) and independent living (n = 7); age 82.91 ± 9.46 years, with AD-D, nighttime agitation, and RLS. MEASUREMENTS: Trained observers counted nighttime agitation behaviors. Independent variables were age; cognition measured by the Mini-Mental State Examination; minutes slept from actigraphy; transferrin saturation percentage (TS%) and transferrin from fasting blood samples; and illness severity using the Cumulative Illness Rating Scale for Geriatrics. Bivariate and multivariable linear regression models were generated. RESULTS: In the multivariable model, sleep minutes (P = .002) and TS% (P = .003) were negatively associated with frequency of nighttime agitation behaviors, and they explained 20% of the variance. Seventy-nine percent received 1 or more medications that worsen RLS symptoms, such as antihistamines and serotonin reuptake inhibitors. CONCLUSIONS AND IMPLICATIONS: We encourage clinicians to consider nighttime agitation as a manifestation of RLS. Treatment of iron deficiency indicated by low TS% and deprescribing medications that exacerbate RLS may decrease nighttime agitation, improve sleep, and enhance quality of life in older adults with AD-D.
Authors: Richard P Allen; Arthur S Walters; Jacques Montplaisir; Wayne Hening; Andrew Myers; Timothy J Bell; Luigi Ferini-Strambi Journal: Arch Intern Med Date: 2005-06-13
Authors: Constantine G Lyketsos; Maria C Carrillo; J Michael Ryan; Ara S Khachaturian; Paula Trzepacz; Joan Amatniek; Jesse Cedarbaum; Robert Brashear; David S Miller Journal: Alzheimers Dement Date: 2011-09 Impact factor: 21.566
Authors: Kathy C Richards; James E Bost; Valerie E Rogers; Lisa C Hutchison; Cornelia K Beck; Donald L Bliwise; Christine R Kovach; Norma Cuellar; Richard P Allen Journal: Sleep Date: 2015-03-01 Impact factor: 5.849
Authors: Richard P Allen; Sarah Auerbach; Huzefa Bahrain; Michael Auerbach; Christopher J Earley Journal: Am J Hematol Date: 2013-03-12 Impact factor: 10.047