Management of inappropriate sexual behaviors in dementia: a literature review

Tucker, Inese

doi:10.1017/s1041610210000189

Cited by 80 publications

(68 citation statements)

References 39 publications

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“…These findings support the use of treatments to reduce sexual arousal in dementia (Ozkan, Wilkins, Muralee, & Tampi, 2011; Tucker, 2010). Among those with HD, these findings suggest developmental or genetic differences in the ability of the right anterior temporal lobe to inhibit limbic and subcortical areas for sexual arousal.…”

Section: Discussionsupporting

confidence: 69%

“…Frontal infarctions, prefrontal lobotomies, and orbitofrontal trauma can increase sexual behavior as part of behavioral disinhibition (Baird et al, 2007; Levine & Albert, 1951; Miller, Cummings, McIntyre, Ebers, & Grode, 1986). Furthermore, many dementia patients have impulsive sexual acts as their disorder affects the frontal lobes (Alkhalil et al, 2004; Black et al, 2005; Nagaratnam & Gayagay, 2002; Tucker, 2010). For example, one patient in our bvFTD cohort tried to touch and kiss female staff when he encountered them, another had Witzelsücht and made sexually-related comments, and a third would touch his crouch in the presence of women.…”

Section: Discussionmentioning

confidence: 99%

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Hypersexual Behavior in Frontotemporal Dementia: A Comparison with Early-Onset Alzheimer’s Disease

Mendez

Shapira

2013

Arch Sex Behav

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The basis of hypersexual behavior among patients with dementia is not entirely clear. Hypersexual behavior may be a particular feature of behavioral variant frontotemporal dementia (bvFTD), which affects ventromedial frontal and adjacent anterior temporal regions specialized in interpersonal behavior. Recent efforts to define Hypersexual Disorder indicate an increasing awareness of heightened sexual activity as a source of personal distress and functional impairment, and clarification of hypersexuality in bvFTD could contribute to understanding the neurobiology of this behavior. This study reviewed 47 patients with bvFTD compared to 58 patients with Alzheimer’s disease (AD) for the presence of heightened sexual activity to the point of distress to caregivers and others. Hypersexual behavior occurred in 6 (13%) bvFTD patients compared to none of the AD patients. Caregivers judged all six bvFTD patients with hypersexual behavior as having a dramatic increase in sexual frequency from premorbid levels. All had general disinhibition, poor impulse control, and actively sought sexual stimulation. They had widened sexual interests and experienced sexual arousal from previously unexciting stimuli. One patient, with early and predominant right anterior temporal involvement, was easily aroused by slight stimuli, such as touching her palms. Although previously considered to be predominantly disinhibited sexual behavior as part of generalized disinhibition, these patients with dementia illustrate varying degrees of increased sexual desire. We conclude that bvFTD is uniquely associated with hypersexuality; it is more than just cognitive impairment with frontal disinhibition but also involves alterations in sexual drive, possibly from right anterior temporal-limbic involvement in this disease.

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Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Hypersexual Behavior in Frontotemporal Dementia: A Comparison with Early-Onset Alzheimer’s Disease

Mendez

Shapira

2013

Arch Sex Behav

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“…Rather than focusing on the resident perspective, most reviews on aged sexuality in long-term care settings either adopt a bird-eyes view on the matter (Bauer et al, 2007;Bouman et al, 2006;Makimoto et al, 2014;Parker, 2006;Roelofs et al, 2014) or zoom in on a specific issue of importance such as barriers to residents' sexual expression (Elias and Ryan, 2011;Hajjar and Kamel, 2003), the attitudes and knowledge of nursing staff (Mahieu et al, 2011), and sexual abuse or hypersexuality (Rosen et al, 2010;Tucker, 2010). However, since both the need for and expression of sexual intimacy are highly individual (Bauer et al, 2007;Gott, 2005); it is of critical importance to gain insight into the residents' views and experiences of sexuality and sexual expression in institutionalized elderly care (Elias and Ryan, 2011;Mahieu et al, 2014;Roelofs et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Older residents’ perspectives on aged sexuality in institutionalized elderly care: A systematic literature review

Mahieu

Gastmans

2015

International Journal of Nursing Studies

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Relatively little work has been published on older residents' perspectives regarding aged sexuality in institutionalized elderly care. If, however, we wish to devote ourselves to individualized or person-centered nursing care, we will have to gain more insight into the patient's perspective and take notice of the needs, expectations, attitudes, experiences and behaviors of residents with regard to (aged) sexuality. Hence more research is needed that depicts the issue of aged sexuality in institutionalized elderly care from a patient's and thus resident oriented perspective.

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“…Agitation and aggression are among the most challenging BPSD for caregivers, and along with psychosis and depression are the leading predictors of institutionalization 120. When present, inappropriate sexual behaviors have been rated by caregivers as the most difficult symptom of BPSD to manage 121,122…”

Section: Managing and Treating Bpsdmentioning

confidence: 99%

Clinical features and multidisciplinary approaches to dementia care

Grand¹,

Caspar²,

MacDonald³

2011

JMDH

112

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Dementia is a clinical syndrome of widespread progressive deterioration of cognitive abilities and normal daily functioning. These cognitive and behavioral impairments pose considerable challenges to individuals with dementia, along with their family members and caregivers. Four primary dementia classifications have been defined according to clinical and research criteria: 1) Alzheimer’s disease; 2) vascular dementias; 3) frontotemporal dementias; and 4) dementia with Lewy bodies/Parkinson’s disease dementia. The cumulative efforts of multidisciplinary healthcare teams have advanced our understanding of dementia beyond basic descriptions, towards a more complete elucidation of risk factors, clinical symptoms, and neuropathological correlates. The characterization of disease subtypes has facilitated targeted management strategies, advanced treatments, and symptomatic care for individuals affected by dementia. This review briefly summarizes the current state of knowledge and directions of dementia research and clinical practice. We provide a description of the risk factors, clinical presentation, and differential diagnosis of dementia. A summary of multidisciplinary team approaches to dementia care is outlined, including management strategies for the treatment of cognitive impairments, functional deficits, and behavioral and psychological symptoms of dementia. The needs of individuals with dementia are extensive, often requiring care beyond traditional bounds of medical practice, including pharmacologic and non-pharmacologic management interventions. Finally, advanced research on the early prodromal phase of dementia is reviewed, with a focus on change-point models, trajectories of cognitive change, and threshold models of pathological burden. Future research goals are outlined, with a call to action for social policy initiatives that promote preventive lifestyle behaviors, and healthcare programs that will support the growing number of individuals affected by dementia.

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Management of inappropriate sexual behaviors in dementia: a literature review

Cited by 80 publications

References 39 publications

Hypersexual Behavior in Frontotemporal Dementia: A Comparison with Early-Onset Alzheimer’s Disease

Hypersexual Behavior in Frontotemporal Dementia: A Comparison with Early-Onset Alzheimer’s Disease

Older residents’ perspectives on aged sexuality in institutionalized elderly care: A systematic literature review

Clinical features and multidisciplinary approaches to dementia care

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