Periodic Leg Movements in Sleep in Elderly Patients with Parkinsonism and Alzheimer's Disease

• Authors: Donald Bliwise, Emory University; Lynn Marie Trotti, Emory University; Jerome A. Yesavage, Stanford University; David Rye, Emory University
• Journal Title: European Journal of Neurology
• Volume: Volume 19, Number 6
• Publisher: Wiley: 12 months | 2012-06, Pages 918-923
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1111/j.1468-1331.2012.03673.x
• Subjects: Biology, Neuroscience
• Keywords: Parkinsonism; Alzheimer’s Disease; Periodic Leg Movements in Sleep; Restless Legs Syndrome; Willis-Ekbom Disease

Abstract

Background Periodic Leg Movements in Sleep (PLMS) are non-epileptiform, repetitive movements of the lower limbs that have been associated with apparent dopamine deficiency. We hypothesized that elderly patients with a disease characterized primarily by dopamine depletion (Parkinsonism) would have higher rates of PLMS than aged matched controls or a different neurodegenerative condition not primarily involving a hypodopaminergic state, Alzheimer’s Disease (AD). Methods We compared rates of PLMS derived from in-lab overnight polysomnography in patients with Parkinsonism (n = 79), AD (n = 28), and non-neurologically impaired, community-based controls (n = 187). Results Parkinsonian patients not receiving levo-dopa had significantly higher rates of PLMS than did Parkinsonian patients receiving levo-dopa, as well as higher rates than seen in AD and controls. Other medications did not appear to exert the pronounced effect of levo-dopa on PLMS in this Parkinsonian patient population. The symptom of leg kicking was reported more frequently in Parkinsonism, and it was associated with higher rates of PLMS. Caregiver reported leg kicking was unrelated to PLMS in AD. Conclusions Results are broadly compatible with a dopaminergic hypothesis for PLMS in Parkinsonism. The clinical significance of the negative findings in AD patient requires further investigation.