And what are the implications for dementia care?
July 18 through 25th is Restless Leg Syndrome (RLS) Awareness week. In this article you can test your restless leg syndrome IQ and then, if you are like I was, raise your awareness of this common disorder. Finally, in keeping with our focus on dementia care, we review a key issue for both the person with dementia and the family dementia care provider.
Try this short True or False quiz:
- Restless Leg Syndrome is worse at night.
- Restless Leg Syndrome is primarily a disorder of the elderly.
- Restless Leg Syndrome rarely occurs in men.
- There are no good treatments for RLS.
- RLS is an issue of concern in dementia care.
- Bonus question: What is the other name for RLS?
What is Restless Leg Syndrome? RLS is a neurological disorder characterized by various unpleasant sensations in the legs and an uncontrollable and often overwhelming urge to move the legs. Symptoms occur mainly at night when a person is relaxing or trying to sleep. Symptoms usually increase in severity during the night. Some people have a particularly symptom-free period in the morning. Moving the legs relieves the discomfort. As you might expect, this can create significant problems with obtaining a good night's sleep!
RLS occurs at any age and in both men and women. It is about twice as common in women as men. The symptoms generally get worse as one ages. It is estimated that about 10% of the US population is affected. Nearly 5 million Americans (2-3%) have moderate or severe symptoms.
What causes RLS? The actual cause of RLS is not known. However, like many neurological disorders, it can be associated with other physical problems. So taking a careful medical history and physical is important. RLS is often associated with kidney failure, diabetes, or peripheral neuropathy. Some medications can worsen RLS symptoms including anti-nausea drugs, anti-psychotic drugs, anti-depressants that increase serotonin (SSRIs), and some cold and allergy medications with antihistamines.
How is RLS treated? Some lifestyle changes may reduce symptoms including
- reduce or eliminate the use of caffeine, alcohol, and tobacco
- dietary supplements to restore low iron, folate, or magnesium levels
- change and/or maintain a regular sleep pattern
- engage regularly in moderate exercise
- massage the legs,
- take a hot bath, or use a heating pad or ice pack
Most people find some improvement in symptoms with these changes. But usually RLS is not entirely eliminated.
There are some medications that can help many people with RLS symptoms. Trying various drugs, under physician supervision of course, may be necessary. Also, medications taken regularly may lose their effect over time, making it necessary to change meds from time to time.
What are the implications of RLS for dementia care? Sleep disorders, including RLS, are more common in certain types of dementias, and particularly so in Lewy Body Dementia. As noted above some antidepressants and antipsychotics, both of which are used to treat dementia patients, can aggravate RLS. Unfortunately, research has also shown that dementia care patients were unable to understand and reliably answer the RLS diagnostic interview. Thus, a sleep study may be necessary for proper diagnosis.
Also of note is that behaviors such as pacing at night can be associated with dementia by itself, but also with RLS as pacing relieves the pain. Since these behaviors can disturb the much needed sleep of the family dementia care provider, it is especially important to determine if the pacing is a result of RLS.
- Willis-Ekbom Disease