Evidence map›Paper›PMID 33347845›Full record

Observational studyJournal of the American Medical Directors Association2021

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 and 1 more

Open access · greenAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Journal of the American Medical Directors Association, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed
0.9field-weighted citation impact, top 24% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 17 citations in OpenAlex.

  1. Review
  2. Bridging Gaps in Sundown Syndrome Research: a Scoping Review and Roadmap for Future Multimodal Approaches.Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists · 2025
    Article
  3. Review
  4. Article
  5. Review
  6. Review
  7. Article
  8. Emotional and Neuropsychiatric Disorders Associated with Alzheimer's Disease.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2022
    Review
  9. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 5 institutions in 1 country.

Kathy C RichardsSchool of Nursing, University of Texas at Austin, Austin, TX, USA. Electronic address: kricha@utexas.edu.
Richard P AllenDepartment of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Janet MorrisonSchool of Nursing, University of Texas at Austin, Austin, TX, USA.
Liam FryDell Medical School, University of Texas at Austin, Austin, TX, USA.
Christine R KovachCollege of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA.
Angelica RangelSchool of Nursing, University of Texas at Austin, Austin, TX, USA.
Ana LoeraSchool of Nursing, University of Texas at Austin, Austin, TX, USA.
Yanyan WangSchool of Nursing, University of Texas at Austin, Austin, TX, USA.
Alexandra L HanlonCenter for Biostatistics and Health Data Science, Virginia Tech, Blacksburg, VA, USA.
Alicia J LozanoCenter for Biostatistics and Health Data Science, Virginia Tech, Blacksburg, VA, USA.
Donald L BliwiseDepartment of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
The University of Texas at Austin · USVirginia Tech · USEmory University · USJohns Hopkins University · USUniversity of Wisconsin–Milwaukee · US

Funding

The integrated Translational Health Research Institute of Virginia (iTHRIV): Using Data to Improve HealthUL1TR003015 · NCATS · UNIVERSITY OF VIRGINIA · PI BROWN, DONALD E, JOHNSTON, KAREN C. · 2019 to 2023
$20.3M
Nighttime Agitation and Restless Legs Syndrome in People with Alzheimer's DiseaseR01AG051588 · NIA · UNIVERSITY OF TEXAS AT AUSTIN · PI RICHARDS, KATHY CULPEPPER · 2016 to 2020
$4.5M
Validation of Measures of Restless Legs Syndrome for Elders with Memory DisordersR01AG027778 · NIA · POLISHER RESEARCH INSTITUTE · PI RICHARDS, KATHY CULPEPPER · 2007 to 2009
$1.4M
NCATS NIH HHS UL1 TR003015NIA NIH HHS R01 AG027778NIA NIH HHS R01 AG051588
6 · The paper itself

Abstract

objectivesNighttime 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.

designAn observational study with baseline descriptive and correlational data from a clinical trial. SETTING AND

participantsLong-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.

resultsIn 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.

Indexed as

DementiaRestless Legs SyndromeSleep Wake DisordersAgedAged, 80 and overHumansQuality of LifeSeverity of Illness IndexSleepagitationAlzheimer's diseaseBehavioral Indicators Test–Restless LegsRLSsleep disorders

Identifiers

PMID33347845
PMCPMC8211902
OpenAlexW3113294339

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.