Nighttime Agitation in Persons with Dementia as a Manifestation of Restless Legs Syndrome

Kathy C. Richards, Richard P. Allen, Janet Morrison, Liam Fry, Christine R. Kovach, Angelica Rangel, Ana Loera, Yanyan Wang, Alexandra L. Hanlon, Alicia J. Lozano, Donald L. Bliwise

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish (US)
Pages (from-to)1410-1414
Number of pages5
JournalJournal of the American Medical Directors Association
Issue number7
StatePublished - Jul 2021


  • Alzheimer's disease
  • Behavioral Indicators Test–Restless Legs
  • RLS
  • agitation
  • sleep disorders

ASJC Scopus subject areas

  • Nursing(all)
  • Health Policy
  • Geriatrics and Gerontology


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