Periodic Leg Movements in Sleep and Restless Legs Syndrome: Considerations in Geriatrics

PLMS and RLS are exceedingly common in ambulatory, noninstitutionalized, noncognitively impaired elderly populations and may occur in demented patients, where they may be manifested by signs of late afternoon and evening wandering. Risk factors operating for these conditions in geriatrics include many of the same factors acknowledged to be of importance in middle-aged patients (eg, diabetes, neuropathy or radiculopathy, renal insufficiency, cardiovascular disease) but occurring with relatively high prevalence in the elderly and particularly salient in this age group. Altered iron metabolism may also be a risk if the RLS is long-standing. It must never be assumed that PLMS, in the absence of frank RLS symptomatology, represents a cause of poor sleep or daytime sleepiness in old age. Ample evidence demonstrates that many geriatric patients present with PLMS who have no symptomatic correlate. In such cases, intervention is premature and unnecessary. There are no natural history data that suggest that the presence of asymptomatic PLMS is a harbinger for any later pathology, and overlap between RLS and parkinsonism remains in doubt. Nonetheless, symptomatic RLS is a major problem for many geriatric patients and deserves full recognition as a highly treatable condition. Particularly in the dementia population with nocturnal wandering (as a potential sign of RLS) implementation of new treatment should be carefully entertained, and cessation of potentially aggravating medications always should be considered initially. © 2006 Elsevier Inc. All rights reserved.