Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-13T05:56:57.809Z Has data issue: false hasContentIssue false
  • English
  • Français

Management of inappropriate sexual behaviors in dementia: a literature review

Published online by Cambridge University Press:  15 March 2010

Inese Tucker
Inese Tucker*
Affiliation:
Royal Melbourne Hospital, Melbourne, Australia
*
Correspondence should be addressed to: Dr Inese Tucker, Royal Melbourne Hospital – Royal Park Campus, Poplar Road, Parkville 3050, Australia. Phone +613 93427000. Email: ineset@iinet.net.au.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: This paper reviews published literature on the pharmacological and non-pharmacological treatment of inappropriate sexual behavior in dementia.

Methods: A literature search of Psychinfo and Cochrane databases was performed and data from case reports and case series were analyzed.

Results: No randomized controlled trials exist for any treatment of sexual disinhibition in dementia and there are no trials comparing different pharmacological agents. Case reports and case series report a wide range of pharmacotherapies as efficacious in the treatment of inappropriate sexual behaviors in dementia. There is only one case report of non-pharmacological strategies to manage inappropriate sexual behavior.

Conclusions: Inappropriate sexual behaviors in dementia can be difficult to treat. Frequently, multiple psychoactive medications are used and many pharmacotherapies are trialed prior to finding an effective agent. More research is needed to clarify the usefulness of these medications and to identify non-pharmacological strategies to prevent unnecessary use of medications.

Keywords

hypersexualitysexual disinhibitionbehavioral disturbances in dementia
Type
Review Article
Information
International Psychogeriatrics , Volume 22 , Issue 5 , August 2010 , pp. 683 - 692
Copyright
Copyright © International Psychogeriatric Association 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Amadeo, M. (1996). Antiandrogen treatment of aggressivity in men suffering from dementia. Journal of Geriatric Psychiatry and Neurology, 9, 143–145.CrossRefGoogle ScholarPubMed
Alagiakrishnan, K., Sclater, A. and Robertson, D. (2003). Role of cholinesterase inhibitor in the management of sexual aggression in an elderly demented woman. Journal of the American Geriatrics Society, 51, 1326.Google Scholar
Alagiakrishnan, K. et al. (2005). Sexually inappropriate behaviour in demented elderly people. Postgraduate Medical Journal, 81, 463–466.CrossRefGoogle ScholarPubMed
Alkhalil, C., Hahar, N., Alkhalil, B., Zovrox, G. and Lowenthal, D. (2003). Can gabapentin be a safe alternative to hormonal therapy in the treatment in inappropriate sexual behavior in demented patients? International Urology and Nephrology, 35, 299–301.CrossRefGoogle ScholarPubMed
Alkhalil, C., Tanvir, F., Alkhalil, B. and Lowenthal, D. T. (2004). Treatment of sexual disinhibition in dementia: case reports and review of the literature. American Journal of Therapeutics, 11, 231–235.CrossRefGoogle ScholarPubMed
Bird, M. and Moniz-Cook, E. (2008). Challenging behavior in dementia: a psychosocial approach to intervention. In Woods, R. and Clare, L. (eds), Handbook of the Clinical Psychology of Ageing. 2nd edn. (pp 571–594). New York: John Wiley & sand Sons Ltd.CrossRefGoogle Scholar
Bird, M., Llewellyn-Jones, R., Smithers, H. and Korten, A. (2002). Psychosocial Approaches to Challenging Behavior in Dementia: A Controlled Trial. Report to the Commonwealth Department of Health and Ageing. Canberra: Commonwealth Department of Health and Ageing.Google Scholar
Black, B., Muralee, S. and Tampi, R. R. (2005). Inappropriate sexual behaviors in dementia. Journal of Geriatric Psychiatry and Neurology, 18, 155–162.CrossRefGoogle ScholarPubMed
Bowers, M.B., van Woert, M. and Davis, L. (1971). Sexual behavior during L-dopa treatment for Parkinsonism. American Journal of Psychiatry, 127, 1691–1693.CrossRefGoogle ScholarPubMed
Burns, A., Jacoby, R. and Levy, R. (1990). Psychiatric phenomena in Alzheimer's disease IV: disorders of behavior. British Journal of Psychiatry, 157, 86–94.CrossRefGoogle Scholar
Chemali, Z. (2003). Donepezil and hypersexuality: a report of two cases. Primary Psychiatry, 10, 78–79.Google Scholar
Coen, R. F., Swanwick, G. R. J., O'Boyle, C. A. and Coadkley, D. (1997). Behaviour disturbance and other predictors of carer burden in Alzheimer's disease. International Journal of Geriatric Psychiatry, 12, 331–336.3.0.CO;2-J>CrossRefGoogle ScholarPubMed
Cooper, A. J. (1987). Medroxyprogesterone acetate (MPA) treatment of sexual acting out in men suffering from dementia. Journal of Clinical Psychiatry, 48, 368–370.Google ScholarPubMed
de Medeiros, K., Rosenberg, P. B., Baker, A. S. and Onyike, C. U. (2008). Improper sexual behaviors in elders with dementia living in residential care. Dementia and Geriatric Cognitive Disorders, 26, 370–377.CrossRefGoogle ScholarPubMed
Dhikav, V., Anand, K. and Aggarwal, N. (2007) Grossly disinhibited sexual behavior in dementia of Alzheimer's type. Archives of Sexual Behavior, 36, 133–134. doi:10.1007/s10508-006-9144-1.CrossRefGoogle ScholarPubMed
Freymann, N., Michael, R., Dodel, R. and Jessen, F. (2005). Successful treatment of sexual disinhibition in dementia with carbamazepine. Pharmacopsychiatry, 38, 144–145.CrossRefGoogle ScholarPubMed
Haddad, P. M. and Benbow, S. M. (1993). Sexual problems associated with dementia. Part 2: aetiology, assessment and treatment. International Journal of Geriatric Psychiatry, 8, 631–637.CrossRefGoogle Scholar
Hashmi, F. H., Krady, A. I., Qayum, F. and Grossberg, G. T. (2000). Sexually disinhibited behavior in the cognitively impaired elderly. Clinical Geriatrics, 8, 61–68.Google Scholar
Haussermann, P., Goeker, D., Beier, K. and Schroeder, S. (2003). Low-dose cyproterone acetate treatment of sexual acting out in men with dementia. International Psychogeriatrics, 15, 181–186.CrossRefGoogle ScholarPubMed
Jensen, C. F. (1989). Hypersexual agitation in Alzheimer's disease. Journal of the American Geriatrics Society, 37, 917–918.CrossRefGoogle ScholarPubMed
Kyomen, H. H., Nobel, K. W. and Wei, J. Y. (1991). The use of estrogen to decrease aggressive physical behavior in elderly men with dementia. Journal of the American Geriatrics Society, 39, 1110–1112.CrossRefGoogle ScholarPubMed
Leo, R. J. and Kim, K. Y. (1995). Clomipramine treatment of paraphilias in elderly demented patients. Journal of Geriatric Psychiatry and Neurology, 8, 123–124.CrossRefGoogle ScholarPubMed
Levitsky, A. M. and Owens, N. J. (1999). Pharmacologic treatment of hypersexuality and paraphilias in nursing home residents. Journal of the American Geriatrics Society, 47, 231–234.CrossRefGoogle ScholarPubMed
Lichtenberg, P. A. and Strzepek, D. M. (1990). Assessments of institutionalized dementia patients’ competencies to participate in intimate relationships. Gerontologist, 30, 117–120.CrossRefGoogle ScholarPubMed
Light, S. A. and Holroyd, S. (2006). The use of medroxyprogesterone acetate for the treatment of sexually inappropriate behavior in patients with dementia. Journal of Psychiatry and Neuroscience, 31, 132–134.Google ScholarPubMed
Lothstein, L. M., Fogg-Waberski, J. and Reynolds, P. (1997). Risk management and treatment of sexual disinhibition in geriatric patients. Connecticut Medicine, 61, 609–618.Google ScholarPubMed
MacKnight, C. and Rojas-Fernandez, C. (2000). Quetiapine for sexually inappropriate behavior in dementia. Journal of the American Geriatrics Society, 48, 707–711.CrossRefGoogle ScholarPubMed
Mania, I., Evcimen, H. and Mathews, M. (2006). Citalopram treatment for inappropriate sexual behavior in a cognitively impaired patient. Primary Care Companion to the Journal of Clinical Psychiatry, 8, 106.Google Scholar
Meston, C. M. and Frohlich, P. F. (2000). The neurobiology of sexual function. Archives of General Psychiatry, 57, 1012–1030.CrossRefGoogle ScholarPubMed
Miller, L. J. (2001). Gabapentin for treatment of behavioral and psychological symptoms of dementia. Annals of Pharmacotherapy, 35, 427–431.CrossRefGoogle ScholarPubMed
MIMS Online (2009). Available at: http://www.mimsonline.com.au. Last accessed 29 December 2009.Google Scholar
Moak, G. S. (2004). Screaming, groping, and wandering in the nursing home setting. Geriatric Psychiatry in Long-Term Care, 2, 1–13.Google Scholar
Nadal, M. and Allgulander, S. (1993). Normalization of sexual behaviour in a female with dementia after treatment with cyproterone. International Journal of Geriatric Psychiatry, 8, 265–267.CrossRefGoogle Scholar
Nagaratnam, N. and Gayagay, G. (2002). Hypersexuality in nursing care facilities – a descriptive study. Archives of Gerontology and Geriatrics, 35, 195–203.CrossRefGoogle ScholarPubMed
Onishi, J. et al. (2006). Behavioral, psychological and physical symptoms in group homes for older adults with dementia. International Psychogeriatrics, 18, 75–86.CrossRefGoogle ScholarPubMed
Ott, B. R. (1995). Leuprolide treatment of sexual aggression in a patient with dementia and the Kluver-Bucy syndrome. Clinical Neuropharmacology, 18, 443–447.CrossRefGoogle Scholar
Ozkan, B., Wilkins, K., Muralee, S. and 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, 344–354.CrossRefGoogle ScholarPubMed
Prakash, R., Pathak, A., Munda, S. and Bagati, D. (2009) Quetiapine effective in treatment of inappropriate sexual behavior of Lewy body disease with predominant frontal lobe signs. American Journal of Alzheimer's Disease and Other Dementias, 24, 136–140.CrossRefGoogle ScholarPubMed
Rosenthal, M., Berkman, P., Shapira, A., Gil, I. and Abramovitz, J. (2003). Urethral masturbation and sexual disinhibition in dementia: a case report. Israel Journal of Psychiatry and Related Sciences, 40, 67–72.Google ScholarPubMed
Series, H. and Degano, P. (2005). Hypersexuality in dementia. Advances in Psychiatric Treatment, 11, 424–431.CrossRefGoogle Scholar
Srinivasan, S. and Weinberg, A. D. (2006). Pharmacologic treatment of sexual inappropriateness in long-term care residents with dementia. Annals of Long Term Care, 14, 20–28.Google Scholar
Steele, C., Rovner, B., Chase, G. A. and Folstein, M. (1990). Psychiatric symptoms and nursing home placement of patients with Alzheimer's disease. American Journal of Psychiatry, 147, 1049–1051.Google ScholarPubMed
Stewart, J. and Shin, K. J. (1997). Paroxetine treatment of sexual disinhibition in dementia. American Journal of Psychiatry, 154, 1474.Google ScholarPubMed
Szasz, G. (1983). Sexual incidents in an extended care unit for aged men. Journal of the American Geriatrics Society, 31, 407–411.CrossRefGoogle Scholar
Tosto, G., Talarico, G., Lenzi, G. L. and Bruno, G. (2008). Effect of citalopram in treating hypersexuality in an Alzheimer's disease case. Neurological Sciences, 29, 269–270. doi:10.1007/s10072-008-0979-1.CrossRefGoogle Scholar
Tsai, S. J., Hwang, J. P., Yang, C. H., Liu, K. M. and Lirng, J. (1999). Inappropriate sexual behaviors in dementia: a preliminary report. Alzheimer Disease and Associated Disorders, 13, 60–62.CrossRefGoogle ScholarPubMed
Tune, L. E. and Rosenbery, J. (2008). Nonpharmacological treatment of inappropriate sexual behavior in dementia: the case of the pink panther. American Journal of Geriatric Psychiatry, 16, 612–613.CrossRefGoogle ScholarPubMed
Weiner, M. F., Denke, M., Williams, K. and Guzman, R. (1992). Intramuscular medroxyprogesterone acetate for sexual aggression in elderly men. The Lancet, 339, 1121–1122.CrossRefGoogle ScholarPubMed
Wiseman, S. V., McAuley, J. W., Freidenberg, G. R. and Freidenberg, D. L. (2000). Hypersexuality in patients with dementia: possible response to cimetidine. Neurology, 54, 2024.CrossRefGoogle ScholarPubMed