An Epidemiologic Study Of Restless Leg Syndrome Among Elders And The Clinical Characteristics Of Parkinson's Disease With Restless Leg Syndrome

Part One An Epidemiologic Study of Restless Leg Syndrome among Elders in Bureaus of Military Retiree in BeijingObjectives:To investigate the prevalence of restless legs syndrome(RLS)among military elders and its risk factors.Methods:Firstly,we conducted a cross-sectional study among the elders in bureaus of military retiree in Beijing from 2005 to 2006.We divided these elders into four groups according to their ages and compare their prevalences of RLS.Then we evaluated the severity of each RLS patient's symptoms as "mild, moderate and severe",and compared the compositions of symptom severity among different age-section RLS patients.At last,we investigated the rate of correct diagnosis of RLS.Secondly,we conducted a case-control study between 148 old male RLS patients and 155 non-RLS male elders in bureaus of military retiree in Beijing to investigate the risk factors of RLS.Each case-control group was matched for gender and age.Univariate and multivariate analyses were conducted using Logistic regression model.Results:1.There were 559 RLS patients in 3472 older subjects.The prevalence of RLS was 16.1%.The prevalence in male elders was 15.8%.The prevalence of RLS in male elders increased significantly with advancing age(P＜0.05).There were no significant difference in the compositions of the severity of symptoms among different age-section RLS patients(P＞0.05).Only 3.22%RLS patients had been previously diagnosed and none was on normal therapy.2.In univariate analysis,only history of Parkinson's Disease(PD)(P=0.041)and increased serum creatinine(P=0.000)were risk factors for RLS(p＜0.05). 3.Multivariate analysis showed that after adjusting for potential confounders, histories of PD and peripheral nerve disease(PNP),and increased serum creatinine increased the risk of RLS.The values of OR(95%CI)were 5.68(1.05-30.85),4.13 (1.05-15.37),1.02(1.01-1.04),respectively.Conclusions:The study demonstrated that the prevalence of RLS among military elders was 16.1%.The prevalence in male elders was 15.8%,which was higher than the prevalence among ordinary old adults abroad.The prevalence of RLS in male elders increased significantly with advancing age.The severity of symptoms of RLS had no obvious relationship with advancing age.Now,the rate of correct diagnosis and therapy of old RLS patients in our nation is very low.It is must be emphasized in our whole society to take acknowledge of RLS.Histories of PD and PNP and increased serum creatinine were risk factors for RLS. Part Two A Study of the Effect of Restless Leg Syndrome on Sleep,Mood and Cognition among Male EldersObjectives:To investigate the effect of different severity of RLS symptoms on sleep,mood and cognition among old male RLS patients.Methods:This was a cross-sectional and control study among male elders. According to severity of symptoms based on scores from the RLS Symptom Severity Scale,we divided 114 old male RLS patients into three groups which were mild group,moderate group and severe group.65 non-RLS male elders were selected as control group.Each case-control group was matched for gender,age and culture degree.The items of sleep,mood and cognition were compared between each RLS group and control group.In addition,we investigated the relationship between the severity of RLS symptoms and these items.Univariate analysis and linear correlation and regression analysis were used.Results:Significant differences were found in PSQI global score,sleep latency,sleep duration,sleep efficiency,nocturnal awake frequency,scores of ESS,HAD scores and scores of verbal fluency test and trail making test,when we compared severe RLS group to control group(P＜0.05).When we compared mild and moderate RLS group to control group respectively,only scores of ESS were found significantly different(P＜0.05).Correlation and regression analysis showed that PSQI global score,sleep latency,sleep duration,sleep efficiency,nocturnal awake frequency and scores of ESS were significantly related to severity of RLS symptoms respectively,while no mood and no cognition items correlated with severity of RLS symptoms.Conclusions:Severe RLS symptoms roundly affected old adults' sleep quality, including sleep efficiency,sleep duration,et al.The daily functioning of old male RLS patients was not good,but hadn't achieved to the standard of EDS. Severe RLS symptoms also had an obvious negtive impact on patients'mood,but this impact was not overall.In addition,severe RLS symptoms could negtively affect old patients' frontal lobe cognition. Part ThreeThe Clinical Characteristics of Parkinson's Disease with Restless Leg SyndromeObjectives:To investigate the clinical feature of Parkinson's Disease(PD)with Restless Leg Syndrome(RLS)and the pathogenesis of RLS.Methods:We conducted a cross-sectional and control study.The case group concluded 31 PD with RLS patients,meanwhile 39 PD patients were selected as the control group.The two groups were matched for gender and age.Clinical history,clinical manifestations,complications,laboratory examinations and therapy were compared respectively between the two groups.A healthy control group was set up when compared laboratory examinations.In addition,we investigated the relationship between severity of RLS symptoms and UPDRS-Ⅲscores,serum iron and ferritin,sensory nerve conduction velocity of sural nerve,H-reflex latency of tibial nerve,et al,respectively.Univariate analysis and linear correlation and regression analysis were used.Results:All the RLS symptoms were on occurrences after the onset of PD. Significant differences were found in UPDRS-Ⅲ,HAMD,HAMA,PSQI scores and the occurrences of complications,such as swallow disturbance,constipation, illusion and akathisia,when we compared the two PD groups(P＜0.05).Compared with the PD or healthy group,the level of serum ferritin and the H-reflex latency of tibial nerve were significantly decreased in PD with RLS group(P＜0.05). There were no obvious differences in cardinal symptoms,MMSE and ESS scores and the usage of dopaminergic drugs when we compared the two PD groups (P＞0.05).Correlation and regression analysis showed that the course of treatment with L-dopa was significantly related to the severity of RLS symptoms.Conclusions:Secondary RLS is a complication of PD.Deficiency of iron and decreased inhibition function of spinal cord may lead to the occurrence of RLS in PD patients.When their motor symptoms are serious and complications are more, PD patients are more possible to have RLS symptoms.Severity of RLS symptoms had a positive correlation with the course of treatment with L-dopa in PD with RLS patients.