Click here to download

Dementia and sexual behaviour
Journal Title: RIVISTA DI SESSUOLOGIA CLINICA 
Author/s: Luigi Lombardo, Roberta Rossi 
Year:  2016 Issue: Language: Italian 
Pages:  18 Pg. 33-50 FullText PDF:  276 KB
DOI:  10.3280/RSC2016-001002
(DOI is like a bar code for intellectual property: to have more infomation:  clicca qui   and here 


Although sexuality, love and intimacy remain important parts of life in older people and demented patients, a myth believed by society is that individuals with dementia are asexual and that sexual desires and needs for connection will wane overtime. In reality sexuality in individuals with dementia may be expressed as inappropriate sexual behaviours (ISB). There is not conformity in the literature regarding how to define this type of behaviour, however these ISB involve any verbal or physical action of a sexual nature which is displayed in an inappropriate social context. Examples of ISB include: exposure of genitals in public/ward environments, masturbation in public areas and all types of sexual assault. Expressing sexuality by demented subjects and dealing with inappropriate sexual expression are source of concerns for the nursing staff, other residents, and families. Little research has been done concerning treatment for this behavioural disorde, so the literature regarding treatment is limited. Non-pharmacologic interventions for ISB (eg. distraction, behavioural tecniques, participation in craft) might be effective when tailored to individual patients. A number of drug treatments (eg. antidepressant, antiandrogen, antipsychotic, and anticonvulsivant madications) have been proposed, however, evidence to support drug treatments is limited, adverse effects remain an important consideration, and it is unclear which should be used as firstline versus second-line treatments.
Keywords: Dementia, sexual behaviour, Alzheimer’s disease, Frontotemporal dementia, disinibition, hypersexuality, aggressive behaviour

  1. Abdo C.H. (2013). Sexuality and couple intimacy in dementia. Current Opinion in Psychiatry, 26(6): 593-8., 10.1097/YCO.0b013e328365a262DOI: 10.1097/YCO.0b013e328365a262
  2. Ahmed R.M., Kaizik C., Irish M., Mioshi E., Dermody N., Kiernan M.C., Piguet O., HodgesJ.R. (2015). Characterizing sexual behavior in Frontotemporal Dementia. Journal of Alzheimer’s Disease, 46(3): 677-86., 10.3233/JAD-150034DOI: 10.3233/JAD-150034
  3. Alagiakrishnan K., Lim D., Brahim A., Wong A., Wood A., Senthilselvan A., Chimich W.T., Kagan L. (2005). Sexually inappropriate behaviour in demented elderly people. Postgraduate Medical Journal, 81: 463-6., 10.1136/pgmj.2004.028043DOI: 10.1136/pgmj.2004.028043
  4. Alkhalil C., Tanvir F., Alkhalil B., Lowenthal D.T. (2004). Treatment of sexual disinhibition in dementia: cese reports and review of the literature. American Journal of Therapeutics, 11(3): 231-5.
  5. Anneser J.M., Jox R.J., Borasio G.D. (2007). Inappropriate sexual behaviour in a cse of ALS and FTD: successful treatment with sertraline. Amyotrophic Lateral Sclerosis, 8(3): 189-90.
  6. Bartelet M., Waterink W., van Hooren S. (2014). Extreme sexual behavior in dementia as a specific manifestation of disinhibition. Journal of Alzheimer’s Disease, 42 Suppl 3: S 119-24., 10.3233/JAD-132378DOI: 10.3233/JAD-132378
  7. Bauer M., Nay R., Tarzia L., Fetherstonhaugh D., Wellman D., Beattie E. (2014). ‘We need to know what’s going on’: views of family members toward the sexual expression of people with dementia in residential aged care. Dementia (London, England), 13(5): 571-85., 10.1177/1471301213479785DOI: 10.1177/1471301213479785
  8. Benbow S.M., Beetson D. (2012). Sexuality, aging, and dementia. International Psychogeriatrics, 24(7): 1026-33., 10.1017/S1041610212000257DOI: 10.1017/S1041610212000257
  9. Brüne M., Schröder S.G. (2003). Erotomania variants in dementia. Journal of Geriatric Psychiatry and Neurology, 16(4): 232-4.
  10. Burgess A.W., Brown K., Bell K., Ledrav L.E., Poarch J.C. (2005). Sexual abuse of older adults. The American Journal of Nursing, 105: 66-71.
  11. Burgess A.W., Hanrahan N.P. (2004). Issues in elder sexual abuse in nursing homes. Nursing and Health Policy Review, 3: 5-17.
  12. Burgess A.W., Phillips S.L. (2006). Sexual abuse and dementia in older people. Journal of the American Geriatrics Society, 54: 1154-5.
  13. Burgess A.W., Ramsey-Klawsnik H., Gregorian S.B. (2008). Comparing routes of reporting in elder sexual abuse cases. Journal of Elder Abuse and Neglect, 20: 336-52., 10.1080/08946560802359250DOI: 10.1080/08946560802359250
  14. Chemali Z. (2003). Donepezil and hypersexuality: a report of two cases. Primary Psychiatry, 10(7): 78-9.
  15. Chen S.T. (2010). Treatment of a patient with dementia and inappropriate sexual behaviors with citalopram. Alzheimer Disease and Associated Disorders, 24(4): 402-3., 10.1097/WAD.0b013e3181ec16ecDOI: 10.1097/WAD.0b013e3181ec16ec
  16. Chihowski K., Huges S. (2008). Clinical issues in responding to alleged elder sexual abuse. Journal of Elder Abuse and Neglect, 20: 377-400., 10.1080/08946560802359383.DOI: 10.1080/08946560802359383.
  17. Cross B.S., DeYoung G.R., Furmaga K.M. (2013). High-dose oral medroxyprogesterone for inappropriate hypersexuality in elder men with dementia: a case series. The Annals of Pharmacotherapy, 47(1): e1., 10.1345/aph.1R533DOI: 10.1345/aph.1R533
  18. Davies H.D., Sridhar S.B., Newkirk L.A., Beaudreau S.A., O’Hara R. (2012). gender differences in sexual behaviors of AD patients and their relationship to spousal caregiver well-being. Aging and Mental Health, 16(1): 89-101., 10.1080/13607863.2011.609532DOI: 10.1080/13607863.2011.609532
  19. De Medeiros K., Rosenberg P.B., Baker A.S., Onyike C.U. (2008). Improper sexual behaviors in elders with dementia living in residential care. Dementia and Geriatric Cognitive Disorders, 26(4): 370-7., 10.1159/000163219DOI: 10.1159/000163219
  20. Derouesnè C. (2005). Sexuality and dementia. Psychologie and Neuropsychiatrie du Vieillissement, 3(4): 281-9.
  21. Derouesnè C. (2009). The so-called hypersexual behaviors in dementia. Psychologie and Neuropsychiatrie du Vieillissement, 7(2): 101-8., 10.1684/pnv.2009.0164DOI: 10.1684/pnv.2009.0164
  22. Di Napoli E.A., Breland G.L., Allen R.S. (2013). Staff Knowledge and perception of sexuality and dementia of older adults in nursing homes. Journal of Aging and Health, 25(7): 1087-105., 10.1177/0898264313494802DOI: 10.1177/0898264313494802
  23. Dupras A., Boucher S. (2014). Sexuality and Alzheimer’s in care facilities. Soins. Gèrontologie, (109): 16-8.
  24. Fonseca L., Simões S., Ferreira P., Mesquita J., Machado A. (2010). Ciproterone effect on compulsive masturbation in a frontotemporal dementia patient. The Journal of Neuropsychiatry and Clinical Neurosciences, 22(3): 352b.e3-352.e3., 10.1176/appi.neuropsych.22.3.352-b.e3DOI: 10.1176/appi.neuropsych.22.3.352-b.e3
  25. Freymann N., Michael R., Dodel R., Jessen F. (2005). Successful treatment of sexual disinhibition in dementia with carbamazepine – a case report. Pharmacopsychiatry, 38(3): 144-5.
  26. Georgiadis J.R., Kringelbach M.L. (2012). The human sexual response cycle: Brain imaging evidence linking sex to other pleasures. Progress in Neurobiology, 98: 49-81., 10.1016/j.pneurobio.2012.05.004DOI: 10.1016/j.pneurobio.2012.05.004
  27. Guay D.R. (2008). Inappropriate sexual behaviors in cognitively impaired older individuals. The American Journal of Geriatric Pharmacotherapy, 6(5): 269-88., 10.1016/j.amjopharm.2008.12.004DOI: 10.1016/j.amjopharm.2008.12.004
  28. Haussermann P., Goecker D., Beier K., Schroeder S. (2003). Low-dose cyproterone acetate treatment of sexual acting out in men with dementia. International Psychogeriatrics, 15(2): 181-6.
  29. Hayward L.E., Robertson N., Knight C. (2013). Inappropriate sexual behavior and dementia: an exploration of steff experiences. Dementia (London, England), 12(4): 463-80., 10.1177/1471301211434673DOI: 10.1177/1471301211434673
  30. Iannotta C. (2015). Classificazione delle Demenze. Testo disponibile al sito: http://www.neuropsicologia.itcontent/view/245/105.
  31. Ibrahim C., Reynaert C. (2014). Hypersexuality in neurocognitive disorders in elderly people – a comprehensive review of the literature and case study. Psychiatria Danubina, 26 Suppl 1: 36-40.
  32. Johnson C., Knight C., Alderman N. (2006). Challenges associated with the definition and assessment of inappropriate sexual behaviour amongst individuals with an acquired neurological impairment. Brain Injury, 20(7): 687-93.
  33. Joller P., Gupta N., Seitz D.P., Frank C., Gibson M., Gill S.S. (2013). Approach to inappropriate sexual behaviour in people with dementia. Canadian Family Physician Médicine de Famille Canadienne, 59(3): 255-260.
  34. Kämpf C., Abderhalden C. (2012). Disruptive sexual behaviour among patients with dementia. Fortschritte der Neurologie-Psychiatrie, 80(10): 580-8., 10.1055/s-0031-1299363DOI: 10.1055/s-0031-1299363
  35. Kettl P. (2008). Inappropriate sexual behavior in long-term care. Annals of Long-Term Care, 16: 29-35.
  36. Light A.S., Holroyd S. (2006). The use of medroxyprogesterone acetate for the treatment of sexually inappropriate behaviour in patients with dementia. Journal of Psychiatry and Neuroscience, 31(2): 132-4.
  37. Lindbloom E.J., Brandt J., Hough L.D., Meadows S.E. (2007). Elder mistreatment in the nursing home: a sistematic review. Journal of the American Medical Directors Association, 8: 610-6.
  38. Lo Coco D., Cannizzaro E. (2010). Inappropriate sexual behaviors associated with donepezil treatment: a case report. Journal of Clinical Psychopharmacology, 30(2): 221-2., 10.1097/JCP.0b013e3181d35c14DOI: 10.1097/JCP.0b013e3181d35c14
  39. Makimoto K., kang H.S., Yamakawa M., Konno R. (2014). An integrated literature review on sexuality of elderly nursing home residents with dementia. International Journal of Nursing Practice,, 10.1111/ijn.12317DOI: 10.1111/ijn.12317
  40. Mendez M.F., Shapira J.S. (2013). Hypersexual Behavior in Frontotemporal Dementia: A Comparison with Early-Onset Alzheimer’s Disease. Archives of Sexual Behaviors, 42(3): 501-9., 10.1007/s10508-012-0042-4DOI: 10.1007/s10508-012-0042-4
  41. Ozkan B., Wilkins K., Muralee S., Tampi R.R. (2008). Pharmacotherapy for inappropriate sexual behaviors in dementia: a systematic review of literature. American Journal of Alzheimer’s Disease and Other Dementias, 23(4): 344-54., 10.1177/1533317508318369DOI: 10.1177/1533317508318369
  42. Perego G., Dijk B., Schiaffino O.S. (2013). Comportamento sessuale inadeguato e demenza: gabapentin quale alternativa efficace e sicura all’uso di neurolettici e terapia ormonale. Psicogeriatria, 3: 63-8.
  43. Poetter C.E., Stewart J.T. (2012). Treatment of indiscriminate, inappropriate sexual behavior in frontotemporal dementia with carbamazepine. Journal of Clinical Psychopharmacology, 32(1): 137-8., 10.1097/JCP.0b013e31823f91b9DOI: 10.1097/JCP.0b013e31823f91b9
  44. Poulos C.A., Sheridan D.J. (2008). Genital injuries in postmenopausa women after sexual assault. Journal of Elder Abuse & Neglect, 20: 323-35., 10.1080/08946560802359243DOI: 10.1080/08946560802359243
  45. Ramsey-Klawsnik H., Teaster P.B., Mendiondo M.S. (2008). Sexual predators who target elders: Findins from the first national study of sexual abuse in care facilities. Journal of Elder Abuse and Neglect, 20: 353-76., 10.1080/08946560802359375DOI: 10.1080/08946560802359375
  46. Robinson K.M., Davis S.J. (2013). Influence of cognitive decline on sexuality inindividuals with dementia and their caregivers. Journal of Gerontological Nursing, 39(11): 30-6., 10.3928/00989134-20130916-05DOI: 10.3928/00989134-20130916-05
  47. Roelofs T.S., Luijkx K.G., Embregts P.J. (2015). Intimacy and sexuality of nursing home residents with dementia: a sistematic review. International Psychogeriatrics, 27(3): 367-84., 10.1017/S1041610214002373DOI: 10.1017/S1041610214002373
  48. Rosen T., Lachs M.S., Pillemer K. (2010). Sexual aggression between residents in nursing homes: literature synthesis for an underrecognized issue. Journal of the American Geriatric Society, 58(10): 1970-1979., 10.1111/j.15325415.2010.03064.xDOI: 10.1111/j.15325415.2010.03064.x
  49. Rosenthal M., Berkman P., Shapira A., Abramovitz J. (2003). Uretral masturbation and sexual disinhibition in dementia: a case report. The Israel Journal of Psychiatry and Related Sciences, 40(1): 67-72.
  50. Sanzovo S., Rosso C. (2014). La sessualità inadeguata della demenza. Testo disponibile al sito: http://www.psychiatryonline.it/node/4795. Consultato il 21/5/2015.
  51. Segrec N., Zaman R., Pregelj P. (2015). Increased libido associated with donezepil treatment: a case report. Psychogeriatrics., 10.1111/psyg.12113DOI: 10.1111/psyg.12113
  52. Simonelli C., Tripodi F., Rossi R., Fabrizi A., Lembo D., Cosmi V., Pierleoni L. (2008). The influence of caregiver burden on sexual intimacy and marital satisfaction in couples with an Alzheimer spouse. International Journal of Clinical Practice, 62(1): 47-52.
  53. Stubbs B. (2011). Displays of inappropriate sexual behaviour by patients with progressive cognitive impairment: the forgotten form of challenging behaviour? Journal of Psychiatric and Mental Health Nursing, 18(7): 602-7., 10.1111/j.1365-2850.2011.01709.xDOI: 10.1111/j.1365-2850.2011.01709.x
  54. Tabak N., Shemesh-Kigli. (2006). Sexuality and Alzheimer’s disease: can the two go together? Nursing Forum, 41(4): 158-86.
  55. Tarzia L., Fetherstonhaugh D., Bauer M. (2012). Dementia, sexuality and consent in residential aged care facilities. Journal of Medical Ethics, 38(10): 609-13.
  56. Teaster P.B., Ramsey-Klawsnik H., Mendiondo M.S., Abner E., Cecil K., Tooms M. (2007). From behind the shadows: A profile of the sexual abuse of older men residing in nursing homes. Journal of Elder Abuse and Neglect, 19: 29-45.
  57. Tosto G., Talarico G., Lenzi G.L., Bruno G. (2008). Effect of citalopram in treating hypersexuality in an Alzheimer’s disease case. Neurological Sciences, 29(4): 269-70., 10.1007/s10072-008-0979-1DOI: 10.1007/s10072-008-0979-1
  58. Tremolizzo L., Ferrarese C. (2008). Clinica delle demenze. Giornale di Gerontologia, 56(1): 34-39.
  59. Tucker I. (2010). Management of inappropriate sexual behaviors in dementia: a literature review. International Psychogeriatrics, 22(5): 683-92., 10.1017/S1041610210000189DOI: 10.1017/S1041610210000189
  60. Tzeng Y.L., Lin L.C., Shyr Y.I., Wen J.K. (2009). Sexual behaviour of institutionalized residents with dementia – a qualitative study. Journal of Clinical Nursing, 18(7): 991-1001., 10.1111/j.1365-2702.2008.02708.xDOI: 10.1111/j.1365-2702.2008.02708.x
  61. Vierthaler K. (2008). Best practices for working with rape crisis centers to ad dress elder sexual abuse. Journal of Elder Abuse and Neglect, 20: 306-322., 10.1080/08946560802359235DOI: 10.1080/08946560802359235
  62. Villar F., Celdràn M., Fabà J., Serrat R. (2014). Staff attitudes towards sexual ralationships among institutionalized people with dementia: does an extreme cautionary stance predominate? International Psychogeriatrics, 26(3): 403-12., 10.1017/S1041610213002342DOI: 10.1017/S1041610213002342
  63. Wallace M., Safer M. (2009). Hypersexuality among cognitively impaired older adults. Geriatric Nursing, 30(4): 230-7., 10.1016/j.gerinurse.2008.09.00DOI: 10.1016/j.gerinurse.2008.09.00
  64. Wick J.Y., Zanni G.R. (2005). Disinibition: clinical challenges in the long-term care facility. The Consultant Pharmacist, 20(12): 1006-8.

Luigi Lombardo, Roberta Rossi, Dementia and sexual behaviour in "RIVISTA DI SESSUOLOGIA CLINICA" 1/2016, pp. 33-50, DOI:10.3280/RSC2016-001002

   

FrancoAngeli is a member of Publishers International Linking Association a not for profit orgasnization wich runs the CrossRef service, enabing links to and from online scholarly content