Treatment of Sexual Disinhibition in Dementia: Case Reports and Review of the Literature

Abstract

Behavioral problems are common in dementia patients. They are complex in nature and are often the presenting symptoms of dementia. Its management poses continuous challenge. Gabapentin is an antiepileptic agent that has a role in the management of behavioral problems in demented patients such as agitation and aggression. Its role in treating sexual disinhibition has never been addressed. We describe 3 nursing home residents in 2 dementia units whose sexual disinhibition was effectively treated with gabapentin.

Pharmacological alternatives to antipsychotics to manage BPSD

“…51 Gabapentin showed a reduction in agitation and inappropriate sexual behaviour in vascular dementia 52 and AD. 53 Little is known about oestrogens and LHRH analogues, and there are no controlled studies for anti-androgens for the treatment of sexual disinhibition in dementia, 54 but they were used in sexual offenders. 5 There are few reports on oestrogens for treating hypersexuality associated with dementia: more robust evidence is needed, and especially for oestrogen, as it is associated with cardiovascular-related deaths.…”

Hormone Profile in Hypersexuality Women

“…It is being thought that severe military conflicts in Africa shorten the expected lifetime for more than 2 years. In general, WHO had calculated that 269 thousand people had died in 1999 due to the effect of wars and that loss of 8.44 million healthy years of life had occurred (2,3). Wars negatively affect the provision of health services.…”

Uncontrolled Sexual Behaviour in Dementia

“…Synonyms used are 'Disinhibited sexual behaviour' [7], 'Inappropriate sexual behaviour' [8,9], 'Inappropriate sexual expression' [2], 'Increased sexual activity' [10], and 'Hypersexuality' [11]. All phrases imply that this behaviour is a sexual act (verbal or physical) which is unacceptable, inappropriate, disinhibited, or uncontrolled within the (social) context in which it is carried out.…”

“…First, some behavioural problems, including depression, hyperactivity, or mania, may increase sexual interest and result in uncontrolled sexual behaviour [19]. Other diagnoses, such as delirium, epileptic seizures and alcohol abuse may also cause uncontrolled sexual behaviour [7,21]. Second, the amount of sexual interest is also determined by premorbid patterns of sexual activity [20].…”

“…For example, atypical antipsychotics can induce uncontrolled sexual behaviour by blocking the effects of selective serotonin reuptake inhibitors [23]. The reason for this is, that selective serotonin reuptake inhibitors typically suppresses sexual drive [7,[24][25][26]. In sum, a careful assessment provides information to choose an appropriate treatment (strategy) and a good baseline to properly evaluate the process and the effects of treatments.…”