Inappropriate Sexual Behaviors in Dementia

Abstract

Dementias are the most common type of neurodegenerative disorder. Behavioral disturbances are seen in more than 80% of patients suffering from these disorders. Although sexually inappropriate behaviors are not as common as some of the other behaviors seen in dementia, they can cause immense distress to all those who are affected. There are no randomized trials for the treatment of these behaviors, but the available data suggest efficacy for some commonly used treatment modalities. In this review, we systematically discuss various aspects of these behaviors and available treatments.

Uncontrolled Sexual Behaviour in Dementia

“…There should be a good balance between openness to the patients need for normal sexual expression while preventing uncontrolled sexual behaviour [12]. It is also critical to prepare students for uncontrolled sexual behaviour.…”

“…In some reviews of the literature, three types were suggested, i.e. sex talk, sexual acts, and implied sexual acts [11][12][13]. Sex talk is regarded as the most common form and involves inappropriate language, that is not in line with the patient's premorbid personality.…”

“…Case studies demonstrated that dysfunction of interconnected brain structures may cause uncontrolled sexual behaviour. Four major brain systems have been suggested [12,13], i.e. the frontal lobes, the temporo-limbic system, the striatum, and the hypothalamus.…”

“…To the patient, many behavioural strategies may be initiated depending on the form of behaviour, the contributing factors, and the patients cognitive functioning (possibilities for new learning). Examples of behavioural strategies are distraction during presence of uncontrolled sexual behaviour via substitution of other activities, redirecting via conversation or humour, ignore unwanted behaviour and encourage appropriate behaviour, modification of social cues that are being misinterpreted, removing 'triggers' of the behaviour, substitute caregivers to the sex that does not match their sexual preference, avoidance of external cues such as over stimulating television or radio programs, trousers that open in the back or with zippers in case of exposing behaviour, providing single rooms, "not disturb" signs, and/or allowing doors to remain shut to provide privacy to let the patient satisfy their sexual needs [9,12,[27][28][29]. To the significant others or spouses it is useful to give additional information to reframe the behaviour and reassurance that these behaviours are not a reflection of their relationship.…”

“…What is the mental/cognitive status? [12,20]. These questions may be answered by direct observation of the patient, in an open discussion with main staff and significant others, and/or a standardised measurement, like the SBDQ [6].…”