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Behavioral Indicator Test: Restless Legs

Richards KC, Lambert CW, Beck CK. Behavioral Indicator Test: Restless Legs. Poster session presented at: Associated Professional Sleep Societies, LLC Annual Meeting; 2007 Jun 9; Minneapolis, MN.

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Introduction: The purpose of this research was to develop an objective method to diagnose a prevalent sleep disorder, restless legs syndrome (RLS), in elders with dementia. RLS is characterized by uncomfortable leg sensations that disturb sleep and are associated with significantly decreased health and cognitive functioning. Cognitive and language deficits prevent elders with dementia from reporting sensory symptoms, and there are no objective methods to diagnose RLS. Elders with dementia are likely to have RLS because they often have RLS risk factors like iron deficiency and taking dopamine antagonists. Motor activity like leg movement and signs of leg discomfort like rubbing legs may indicate RLS. A National Institutes of Health (NIH) conference recommended testing the validity of these RLS objective indicators in elders with dementia. Methods: Our research team used the NIH recommendations and prior instrument development experience to develop an observational RLS measure, the 10-item Behavioral Indicators Test-Restless Legs (BITRL). After a 3-member expert panel reviewed the instrument, trained raters observed 39 elders with dementia in their homes from 7 pm -12 am Night 1 and 10 pm-6 am Nights 2 and 3 with the BIT-RL. The raters made 19 hours of observation with 228 discrete data points for each elder. Interrater reliability was 92% at training and 100% at 6-month intervals during data collection. Results: The 13 women and 26 men had a mean age of 79.9 years (s.d. 6.5); mean Mini- Mental State Examination score of 21.2 (s.d. 6.2); and mean behavioral indicators index (frequency of behaviors per hour) of 4.06 (s.d., 5.2, range 0-21.2). Sixteen (41%) exhibited 4 or more RLS indicators. The most frequent behaviors were periodic leg movements and flexing legs. Conclusion: Behaviors consistent with RLS were common in elders with dementia. Future research should determine the sensitivity, specificity, and optimal cut-off value for the BIT-RL.

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