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‘Inappropriate’ sexual behaviours in dementia

Published online by Cambridge University Press:  14 December 2012

Rosalind F Ward  and
Simon Manchip
Rosalind F Ward*
Affiliation:
Avon and Wiltshire Mental Health Partnership NHS Trust, Swindon, UK
Simon Manchip
Affiliation:
Avon and Wiltshire Mental Health Partnership NHS Trust, Swindon, UK
*
Address for correspondence: Dr Rosalind Ward, Older Peoples Mental Health Services, Victoria Centre, 53 Downs Way, Swindon, Wiltshire SN3 6BW, UK. Email address: [email protected]
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Summary

Human sexuality is a complex interaction of biological, social and emotional factors. When any or all of these factors are disrupted by a progressive dementia it is unsurprising that sexual ‘problems’ are identified. Most sexual behaviour ‘problems’ relate to expressions of normal sexuality complicated by changes in relationships, care needs and cognitive function, and complex ethical and legal considerations emerge. Rarely, new and severe hypersexual or paraphilic behaviours arise de novo, usually due to damage to certain brain areas, and sometimes due to medication side-effects, psychiatric disorder or delirium. Evidence and approaches to assess and to manage sexual behaviour problems in dementia are discussed.

Keywords

dementiasexual behaviourhypersexualitysexual disinhibition
Type
Neuropsychiatry of old age
Information
Reviews in Clinical Gerontology , Volume 23 , Issue 1 , February 2013 , pp. 75 - 87
Copyright
Copyright © Cambridge University Press 2012

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References

1Szasz, G. Sexual incidents in an extended care unit for aged men. J Am Geriatr Soc 1983; 31: 407–11.CrossRefGoogle Scholar
2Burns, A, Jacoby, R, Levy, R. Psychiatric phenomena in Alzheimer's disease IV: disorders of behaviour. Br J Psychiatry 1990; 157: 86–94.CrossRefGoogle ScholarPubMed
3Tsai, SJ, Hwang, JP, Yang, CH, Liu, KM, Lirng, JF. Inappropriate sexual behaviours in dementia: a preliminary report. Alzheimer Dis Assoc Disord 1999; 13: 60–62.CrossRefGoogle ScholarPubMed
4Alagiakrishnan, K, Lim, D, Brahim, A, Wong, A, Wood, A, Senthilselvan, A, Chimich, WT, Kagan, L. Sexual inappropriate behaviour in demented elderly people. Postgrad Med J 2005; 81: 463–66.CrossRefGoogle ScholarPubMed
5de Medeiros, K, Rosenberg, PB, Baker, AS, Onyike, CU. Improper sexual behaviours in elders with dementia living in residential care. Demen Geriatr Cogn Disord 2008; 26: 370–77.CrossRefGoogle ScholarPubMed
6Zeiss, AM, Davies, HD, Tinklenberg, JR. An observational study of sexual behavior in demented male patients. J Gerontol A: Biol Sci Med Sci 1996; 51A: M325–29.CrossRefGoogle Scholar
7Derouesné, C, Guigot, J, Chermat, V, Winchester, N, Lacomblez, L. Sexual behavioural changes in Alzheimer's disease. Alzheimer Dis Assoc Disord 1996; 10: 86–92.CrossRefGoogle Scholar
8Ehrenfeld, M, Bronner, G, Tabak, N, Alpert, R, Bergman, R. Sexuality among institutionalised elderly patients with dementia. Nursing Ethics 1999; 6: 144–49.CrossRefGoogle ScholarPubMed
9Bardell, A, Lau, T, Fedoroff, JP. Inappropriate sexual behaviour in a geriatric population. Int Psychogeriatr 2011; 23: 1182–88.CrossRefGoogle Scholar
10Knight, C, Alderman, N, Johnson, C, Green, S, Birkett-Swan, L, Yorstan, G. The St Andrews sexual behaviour assessment (SASBA): development of a standardised recording instrument for the measurement and assessment of challenging sexual behaviour in people with progressive and acquired neurological impairment. Neurol Rehabil 2008; 18: 129–59.CrossRefGoogle Scholar
11Guay, D.Inappropriate sexual behaviors in cognitively impaired older individuals. Am J Geriatr Pharmacotherapy 2008; 6: 269–88.CrossRefGoogle ScholarPubMed
12Harris, I, Weir, M. Inappropriate sexual behaviour in dementia: a review of the treatment literature. Sexuality Disability 1998; 16: 205–17.CrossRefGoogle Scholar
13Black, B, Muralee, S, Tampi, RR. Inappropriate sexual behaviours in dementia. J Geriatr Psychiatry Neurol 2005; 18: 155–62.CrossRefGoogle Scholar
14Ozkan, B, Wilkins, K, Muralee, S, Tampi, RR. Pharmacotherapy for inappropriate sexual behaviors in dementia: a systematic review of literature. Am J Alzheimer's Disease Other Dement 2008; 23: 344–54.CrossRefGoogle ScholarPubMed
15Series, H, Degano, P. Hypersexuality in dementia. Adv Psychiat Treatment 2005, 11: 424–31.CrossRefGoogle Scholar
16Johnson, C, Knight, C, Alderman, N. Challenges associated with the definition and assessment of inappropriate sexual behaviour amongst individuals with an acquired neurological impairment. Brain Inj 2006; 20: 687–93.CrossRefGoogle ScholarPubMed
17Stubbs, B.Displays of inappropriate sexual behaviour by patients with progressive cognitive impairment: the forgotten form of challenging behaviour? J Psychiatr Ment Health Nurs 2011; 18: 602–7.CrossRefGoogle ScholarPubMed
18Ward, R, Vass, AA, Aggarwal, Net al.A kiss is still a kiss? The construction of sexuality in dementia care. Dementia 2005; 4: 49–72.CrossRefGoogle Scholar
19Wallace, M, Safer, M. Hypersexuality among cognitively impaired older adults. Geriatr Nurs 2009; 30: 230–37.CrossRefGoogle ScholarPubMed
20Tsatali, MS, Tsolaki, MN, Christodoulou, TPet al.The complex nature of inappropriate sexual behaviours in patients with dementia: Can we put it into a frame? Sexuality Disability 2011; 29: 143–56.CrossRefGoogle Scholar
21Archibald, C. Caregiving challenges. Sexuality and dementia: the role dementia plays when sexual expression becomes a component of residential care work. Alzheimer's Care Quarterly 2003; 4: 137–48.Google Scholar
22Tabak, N, Shemesh-Kigli, R. Sexuality and Alzheimer's disease: can the two go together? Nursing Forum 2006; 41: 158–66.CrossRefGoogle ScholarPubMed
23Benbow, SM, Beeston, D. Sexuality, ageing and dementia. Int Psychogeriatr 2012; 24: 1026–33.CrossRefGoogle Scholar
24Stahl, SM. Stahl's Essential Psychopharmacology: Neuroscientific Basis and Practical Applications, 3rd edn.New York: Cambridge University Press, 2008.Google Scholar
25Dunn, KM, Croft, PR, Hackett, GI. Association of sexual problems with social, psychological and physical problems in men and women: a cross sectional population survey. J Epidemiol Community Health 1999; 53: 144–48.CrossRefGoogle ScholarPubMed
26Wright, LK. Affection and sexuality in the presence of Alzheimer's disease: a longitudinal study. Sexuality Disability 1998; 16: 167–79.CrossRefGoogle Scholar
27Hajjar, R, Kamel, H. Sexuality in the nursing home, part 1: attitudes and barriers to sexual expression. J Am Med Dir Assoc 2003; 4: 152–56.CrossRefGoogle ScholarPubMed
28World Health Organisation. Defining Sexual Health: Report of a Technical consultation on Sexual Health. Geneva: WHO, 2006.Google Scholar
29Tzeng, YL, Lin, LC, Shyr, YI, Wen, JK. Sexual behaviour of institutionalised residents with dementia – a qualitative study. J Clin Nurs 2009; 18: 991–1001.CrossRefGoogle ScholarPubMed
30Taylor, A, Gosney, MA. Sexuality in older age: essential considerations for healthcare professionals. Age Ageing 2011; 40: 538–43.CrossRefGoogle ScholarPubMed
31White, CB. Sexual interest, attitudes, knowledge and sexual history in relation to sexual behaviour in the institutionalized aged. Archives Sexual Behav 1982; 11: 11–21.CrossRefGoogle ScholarPubMed
32Kuppuswamy, M, Davies, HD, Spira, APet al.Sexuality and intimacy between individuals with Alzheimer's disease and their partners: caregivers describe their experiences. Clin Gerontol 2007; 30: 75–81.CrossRefGoogle Scholar
33Duffy, LM. Sexual behaviour and marital intimacy in Alzheimer's couples: a family theory perspective. Sexuality Disability 1995; 13: 239–54.CrossRefGoogle Scholar
34Davies, HD, Zeiss, AM, Tinklenberg, JR. Til death do us part: Intimacy and sexuality in the marriages of Alzheimer's patients. J Psychosocial Nursing 1992; 30: 5–10.Google ScholarPubMed
35Davies, HD, Newkirk, LA, Pitts, CB, Coughlin, CA, Sridhar, SB, Zeiss, LM, Zeiss, AM. The impact of dementia and mild memory impairment on intimacy and sexuality in spousal relationships. Int Psychogeriatr 2010; 22: 618–28.CrossRefGoogle ScholarPubMed
36Davies, HD, Zeiss, AM, Shea, EAet al.Sexuality and intimacy in Alzheimer's patients and their partners. Sexuality Disability 1998; 16: 193–203.CrossRefGoogle Scholar
37Mittleman, M, Zeiss, AM, Davies, HDet al.Specific stressors of spousal caregivers: difficult behaviours, loss of sexual intimacy and incontinence. In Coon, DW, Gallagher-Thompson, D, Thompson, LW (eds). Innovative Interventions to Reduce Dementia Caregiver Distress: A Clinical Guide, pp. 79–98. New York: Springer Publishing Company, 2002.Google Scholar
38Mahieu, L, Gastmans, C. Sexuality in institutionalised elderly persons: a systematic review of argument-based ethics literature. Int Psychogeriatr 2011; 24: 346–57.CrossRefGoogle Scholar
39Elias, J, Ryan, A. A review and commentary on the factors that influence expressions of sexuality by older people in care homes. J Clin Nurs 2011; 20: 1668–76.CrossRefGoogle ScholarPubMed
40Shoyama, M, Yamamoto, M, Iwatani, Jet al.Increased libido during fluvoxamine treatment. Psychogeriatr 2008; 8: 98–100.CrossRefGoogle Scholar
41Ward, R. Inappropriate sexual behaviours in dementia – do we have a consensus? Proceedings of The Royal College of Psychiatrists Faculty of Old Age Psychiatry Annual Residential Meeting, 14–16 March 2012, Cardiff.Google Scholar
42Chemali, Z. Donepezil and hypersexuality: a report of two cases. Primary Psychiatry 2003; 10: 78–79.Google Scholar
43Coco, DL, Cannizaro, E. Inappropriate sexual behaviour associated with donepezil treatment: A case report. J Clin Psychopharmacol 2010; 30: 221–22.CrossRefGoogle ScholarPubMed
44Klos, KJ, Bower, JH, Josephs, KAet al.Pathological hypersexuality predominantly linked to adjuvant dopamine agonist therapy in Parkinson's disease and multiple system atrophy. Parkinsonism Relat Disord 2005; 11: 381–86.CrossRefGoogle ScholarPubMed
45Joyal, CC, Black, DN, Dassylva, B. The neuropsychology and neurology of sexual deviance: A review and pilot study. Sexual Abuse 2007; 19: 155–73.CrossRefGoogle ScholarPubMed
46Bradford, J. The neurobiology, neuropharmacology and pharmacological treatment of the paraphilias and compulsive sexual behaviour. Can J Psychiatry 2001; 46: 26–34.CrossRefGoogle ScholarPubMed
47Poetter, CE, Stewart, JT. Treatment of indiscriminate inappropriate sexual behaviour in frontotemporal dementia with carbamazepine. J Clin Psychopharmacol 2012; 32: 137–38.CrossRefGoogle ScholarPubMed
48Mendez, MF, Chow, T, Ringman, J, Twitchell, G, Hinkin, CH. Pedophilia and temporal lobe disturbances. J Neuropsychiatry Clin Neurosci 2000; 12: 71–76.CrossRefGoogle ScholarPubMed
49Braun, CM, Dumont, M, Duval, J, Hamel, I, Godbout, L. Opposed left and right brain hemisphere contributions to sexual drive: A multiple lesion case analysis. Behav Neurol 2003; 14: 55–61.CrossRefGoogle ScholarPubMed
50Monga, TN, Monga, M, Raina, MS, Hardjasudarma, M. Hypersexulaity in Stroke. Arch Phys Med Rehabil 1986; 67: 415–17.Google ScholarPubMed
51Ehrenfeld, M, Tabak, N, Bronner, G, Bergman, R. Ethical dilemmas concerning sexuality of elderly patients suffering from dementia. Int J Nurs Pract 1997; 3: 255–59.CrossRefGoogle ScholarPubMed
52Kamel, HK, Hajjar, RR. Sexuality in the nursing home, Part 2: Managing abnormal behaviour- legal and ethical issues. J Am Med Dir Assoc 2003; 4: 203–6.CrossRefGoogle Scholar
53Martin, LS. Walking the tightrope: ethical decision-making in dementia care. Canadian Nursing Home 2003; 14: 24–25.Google Scholar
54Tune, LE, Rosenberg, J. Non-pharmacological treatment of inappropriate sexual behaviour in dementia: the case of the Pink Panther. Am J Geriatr Psychiatry 2008; 16: 612–13.CrossRefGoogle Scholar
55Rosen, T, Lachs, MS, Pillemer, K. Sexual aggression between residents in nursing homes: literature synthesis of an under recognized problem. J Am Geriatr Soc 2010; 58: 1070–79.CrossRefGoogle Scholar
56Tucker, I. Management of inappropriate sexual behaviors in dementia: a literature review. Int Psychogeriatr 2010; 22: 683–92.CrossRefGoogle ScholarPubMed
57Chen, ST. Treatment of a patient with dementia and inappropriate sexual behaviours with citalopram. Alz Dis Assoc Disord 2010; 24: 402–3.CrossRefGoogle ScholarPubMed
58Na, HR, Lee, JW, Park, SM, Ko, SB, Kim, S, Cho, ST. Inappropriate sexual behaviours in patients with vascular dementia: possible response to finasteride. J Am Geriatr Soc 2009; 57: 2161–62.CrossRefGoogle ScholarPubMed
59Wiseman, SV, McAuley, JW, Friedenberg, GR. Hypersexuality in patients with dementia: possible response to cimetidine, Neurology 2000; 54: 2024–25.CrossRefGoogle ScholarPubMed
60Lothstein, L M, Fogg-Waberski, J, Reynolds, P. Risk management and treatment of sexual disinhibition in geriatric patients. Connecticut Medicine 1997; 61: 609–18.Google ScholarPubMed
61Ott, B. Leuprolide treatment of sexual aggression in a patient with dementia and Kluver-Bucy syndrome. Clin Neuropharmacol 1995; 18: 443–47.CrossRefGoogle Scholar
62Alagiakrishnan, K, Sclater, A, Robertson, D. Role of cholinesterase inhibitor in the management of sexual aggression in an elderly woman. J Am Geriatr Soc 2003; 51: 1326.Google Scholar
63Stimmel, GL, Gutierrez, MA. Sexual dysfunction and psychotropic medications. CNS Spectr 2006; 11: 24–30.CrossRefGoogle ScholarPubMed
64Clossius, MIet al.Reversible effects of antiepileptic drugs on reproductive endocrine function in males and females with epilepsy – a prospective randomised double-blind withdrawal study. Epilepsia 2007; 48: 1875–82.CrossRefGoogle Scholar
65Gauthier, S, Loft, H, Cummings, J. Improvement in behavioural symptoms in patients with moderate to severe Alzheimer's disease by memantine: A pooled data analysis. Int J Geriatr Psychiatry 2008; 235, 537–45.CrossRefGoogle Scholar
66Scott, K, Lawrence, RM, Duggal, Aet al.Prescribing patterns for psychotic and behavioural symptoms in dementia: a national survey. Psychiatric Bulletin 2002; 26: 288–90.CrossRefGoogle Scholar
67Banerjee, S. The use of antipsychotic medication for people with dementia: Time for action. London: DOH, 2009.Google Scholar
68Everett, B. Supporting sexual activity in long term care. Nursing Ethics 2008; 15: 87–96.CrossRefGoogle ScholarPubMed
69Kuhn, D. Intimacy, sexuality and residents with dementia. Alzheimer's Care Quarterly 2002; 3: 165–76.Google Scholar
70Lichtenberg, P, Steizepeck, D. Assessments of institutionalised dementia patients’ competencies to participate in intimate relationships. The Gerontologist 2000; 30: 117–20.CrossRefGoogle Scholar
71The Mental Capacity Act (2005) Code of Practice. London: TSO, 2007.Google Scholar
72Department of Health. No secrets: guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse. London: DOH, 2000.Google Scholar
73Bartlett, P. Sex, Dementia, capacity and care homes. Liverpool Law Rev 2010; 31: 137–54.CrossRefGoogle Scholar