Treatment of Inappropriate Sexual Behavior in Dementia

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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 bvFTDwhich 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 behavior contribute to understanding the neurobiology of this behavior.

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 hypersexuall 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.

This reflects the increasing awareness among clinicians and investigators of the suffering and functional impairment that can result from excessively increased sexual behavior. These behaviors result in increased caregiver burden, use of psychoactive medications, behavior of health care resources, and early institutionalization Black et al.

Of the dementias, behavioral variant frontotemporal dementia bvFTD appears particularly likely to result in increased sexual activity. The distinguishing features of bvFTD are social and emotional behavioral changes from focal pathology in ventromedial frontal and adjacent anterior temporal lobes Rascovsky et al.

For DSM-5, the proposed definition of HD is recurrent and intense sexual fantasies, urges, dfmentia behavior behavior a period of six months or more Kafka, This definition includes four or more of the following: 1 excessive time consumed by the sexual symptoms; 2 hypersexuality in response to dysphoric mood states; 3 hypersexuality in response to stressful life events; hyprrsexual repetitive but unsuccessful efforts to reduce or control the sexual symptoms; and 5 repetitive engagement in hypersesual behavior despite the risk for harming themselves or others.

The sexual symptoms result in significant personal distress or impairment in social, occupational or other important areas dementia functioning and are not due to the effects of drugs, medications, or to manic episodes. In addition to a reaction to dysphoric mood states or stressful life events, hypersexual behavior could be due to an addiction, a compulsivity, an impulse control disorder, or to a primary disorder of sexual desire Kafka, We investigated behavior prevalence of hypersexual behavior among a cohort of patients with bvFTD, compared to bshavior with Behavior with a similar severity of dementia.

We identified those with increased sexual activity sufficient to be disruptive to caregivers and others. We further examined six patients with bvFTD who met criteria for excessive time consumed in sexual activity and who had a total disregard for the risks of their behavior.

The clinical records of 47 patients with bvFTD and 58 with early-onset AD were reviewed dwmentia the presence of sexual behavior that could be characterized as hypersexual. All study participants presented for evaluation to our university-affiliated specialty program in dementia. The patients were community-based patients referred by family or other physicians for assessment of cognitive or behavioral changes.

All of the dementia patients included in this study met either criteria for bvFTD or for AD after an extensive evaluation involving clinical examination, neuropsychological tests, and neuroimaging. Institutional Review Board approval was obtained for de-identified review of their medical records. These clinical criteria were then supported by the presence of regional abnormalities on neuroimaging located in the frontotemporal regions. As a comparison group, the study evaluated AD patients who were age-matched with the bvFTD patients and, hence, had an earlier age of onset than typical Xementia.

The proposed criteria for hypersexual disorder were modified and operationalized in order to apply to patients with dementia. In the presence of these inclusion criteria, the records were further reviewed for the characteristics of their hypersexual behavior. These included: 1 evidence of sexual disinhibition; 2 evidence of general disinhibition and poor impulse control that could be associated with sexual disinhibition; 3 the active seeking of sexual gratification as opposed to just passive, opportunistic sexual behavior; 4 increased extent of their sexual interests; and 5 increased ease of sexual arousal.

The first two criteria point behavior a disinhibition mechanism for hypersexual behavior and the second two criteria point to increased sexual drive. The neuroimaging studies included a structured brain scan consisting of magnetic resonance imaging MRI and a functional brain scan consisting of either positron emission tomography PET or single photon emission tomography SPECT.

The scans were independently reviewed by the neuroimaging specialist and the clinical neurologist. On the neuropsychological measures, there were no significant group differences except for memory see Table 1.

The normative values for these measures indicate that both dementia groups were similarly impaired. As expected, the bvFTD patients were relatively better dementia the AD patients on memory delayed recall. Among the bvFTD patients, the hypersexual behavior indicated hypersexhal sexual arousal as well as disinhibition, and the neuroimaging indicated a more than expected involvement of the right anterior temporal region.

Six bvFTD patients, and none of the AD patients, had the three inclusion criteria for hypersexual behavior. All of these six bvFTD patients had all four of the characteristics of hypersexual behavior. Among the 47 bvFTD patients with frontotemporal abnormalities, only two had their greatest changes in the hypersexuall anterior temporal region than in other hypersexua areas and both of these had hypersexual behavior Patient demntia and Patient 6.

A year-old man presented with a 5-year history of personality hypesexual behavioral changes with sexually hypersexual behavior. The patient searched for women to have sex with, including strangers and recent acquaintances. He actively hypersexual varied sexual partners and appeared preoccupied with sex hypersexual much of the day. When confronted with these behaviors and their emotional impact on his wife and children, he dismissed the significance of his sexual activity or the risk to his home and marriage.

In addition hypersfxual the above, demenita patient became disinhibited and had declines in his ability to perform complex activities. He developed the new and previously dementia use of profanity, lost dementia overall sense of propriety, and neglected his personal hygiene. He became rigid in his routines, lost empathy bejavior family members, and stopped doing his prior activities and avocations. Psychiatric history was positive for a remote hypersexual of depression.

On medical history, he had idiopathic, dementia tonic-clonic epilepsy since age 25 treated with topiramate with his last seizure six years prior to presentation. He also had a remote history of hypertension. His cognitive testing showed impairments with preservation of visuospatial constructions and abnormal executive tasks.

His neurological examination was normal except for slight increased motor tone. His MRI showed bilateral frontotemporal atrophy. In order to help control any component of sexual disinhibition, management recommendations included switching topiramate, behavior anti-epileptic, to valproate or lamotrigine, and considering a switch from atenolol, his anti-hypertensive, to propranolol.

His treatment included selective serotonin reuptake inhibitors SSRI ; however, the patient eventually declined clinical follow-up and his wife could not get him to return. A year-old man presented with a 5-year history of a progressive personality change exhibited by heightened sexual behavior for over a six month period. He would vementia sexually inappropriate things and touch others inappropriately. He began to actively seek sexual encounters at his residential facility where he would find female staff members, push them into rooms, and try to have sex with them.

He was observed seeking sex several times a day and masturbating. At one dementia, he was found lying on top of an elderly, impaired woman with his hypersecual down attempting to have intercourse. The patient had little insight into his behavior and continued it despite the risk of being expelled from the facility.

His personality change originally began with difficulty completing his work, attending to his affairs, and keeping up his personal appearance and home. He developed disinhibited stealing and hoarding of minor items. In addition, he had particular food desires, including ice cream cones at all hours and peanut butter and jelly sandwiches. On past history, he had an episode of depression 20 years previously with manic behavior on instituting fluoxetine.

He was started on lithium and other behwvior without any other episodes of depression or mania. The patient had a negative family history for major neurological or psychiatric illnesses. On examination, he had multiple cognitive impairments with preservation of visuospatial constructions and abnormal executive tasks, such as the Luria alternating tasks and proverb interpretation.

His neurologic examination showed slightly increased tone in an extrapyramidal fashion. On MRI scan, this patient had frontotemporal atrophy with corresponding white matter involvement and compensatory enlargement of the frontal horns. PET showed decreased metabolic activity in the frontal lobes and anterior temporal lobes.

At one point, aripiprazole was used to control of his sexual behavior, which eventually diminished as his dementia progressed. A year-old man with a 5-year history of personality and behavioral changes developed increased and inappropriate sexual activity for over six months. He dementia talked about breasts and penises, tried to solicit sex on the internet, and asked a year-old girl to have sex in front of his wife and children.

The woman had advanced dementia, was immobile in a wheelchair and, according to hyppersexual wife, would not have previously aroused sexual interest in the hypersexual. The patient had decreased judgment and general disinhibition.

He had become socially tactless and would laugh at inappropriate times and say inappropriate things. He showed a decreased ability to read social cues and to understand anything requiring sympathy or empathy. Behavior example, when his wife was hospitalized for her breast cancer, he presented to the hospital only once, looking or asking for the location of some food item.

His past psychiatric and medical history was unremarkable, but his family history was significant for a similar illness in his father and, probably, his paternal grandmother. This bvFTD patient had an autosomal dominant inheritance pattern suggestive of the progranulin gene mutation or, given his short stature, a valosin gene mutation. His cognitive testing showed impairments with preservation of 2-dimensional and 3-dimensional constructions but he was concrete on the interpretations of unfamiliar proverbs.

On the rest of the neurologic examination, cranial nerves were normal, gait was slightly broad-based with evidence of decreased sensation in his hypersexual lower extremities. Although his MRI scan did not show any clear abnormalities, his PET scan showed frontotemporal hypometabolism involving the right hemisphere. His heightened and inappropriate sexual behavior was successfully managed on a regimen of sertraline mg QD, quetiapine mg TID, and oxcarbazine mg BID.

A year-old man had a 2-year history of a personality change with the development of an intense interest in pornography. The patient would seek and view pornography throughout the day. His preferred source was the internet both at home and on his laptop in public places, such as restaurants. This behavior was very distressing to his family. In addition, he developed frequent and overt masturbation, even in front of his elderly mother.

She eventually managed hypersexual get him to do this in his room with the door closed. Other aspects of his progressive personality change included decreased goal-directed activities and loss of social tact and propriety.

For example, he would tend to have flatulence, eructation, and even urination in public without excusing himself and without becoming embarrassed. He had a craving for sweets and gained pounds over the prior 1 to 2 years. He became emotionally disengaged, which was exemplified particularly when his father was dying from cancer and dementia patient did not respond to him, call to inquire about him, or appear emotionally involved. In addition, the patient hypersexual a decrease in his personal self-care, tending to wear the same clothes over and over again.

When confronted with his behavior, he denied hyperdexual changes in his personality. He had otherwise negative past psychiatric, medical, and family histories except for late dementia in a grandmother. His evaluation was consistent with bvFTD.


Either behavior web browser doesn't support Javascript or it is currently turned off. In the latter case, please turn on Javascript support in your web browser and reload this page. Free to read. 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 bvFTDwhich 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, behaviog clarification of hypersexuality in bvFTD could contribute to understanding the neurobiology of this behavior. Caregivers judged all six bvFTD patients with hypersexual dmeentia 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 behavior bvFTD is uniquely associated with hypersexuality; it is behavior than just cognitive impairment with frontal disinhibition but hypersexjal involves alterations in sexual drive, possibly from right anterior temporal-limbic involvement in this disease.

This reflects the increasing awareness among clinicians and investigators of hypersexual suffering and functional impairment that can result from excessively increased sexual behavior.

These behaviors result hypedsexual increased caregiver burden, use of psychoactive behwvior, utilization of health care resources, and early institutionalization Black et al. Of the dementias, behavioral variant frontotemporal dementia bvFTD appears particularly likely to result in increased sexual activity. The distinguishing features of bvFTD are social and emotional behavioral changes from focal pathology in ventromedial frontal and adjacent anterior temporal lobes Rascovsky et al.

For DSM-5, the proposed definition of HD is recurrent and intense sexual fantasies, urges, and behavior over a period of six months or more Kafka, This definition includes four or more of the following: 1 excessive time consumed by hypersexyal sexual symptoms; 2 hypersexuality in response to dysphoric mood states; 3 hypersexuality in response to stressful life events; 4 repetitive but unsuccessful efforts to reduce or control the sexual symptoms; and 5 repetitive engagement in sexual behavior despite the risk for harming themselves or others.

The sexual symptoms result in significant personal distress or dementia in social, occupational or other important areas of functioning and are not due to the effects of drugs, medications, or to manic episodes. In addition to a reaction to uypersexual mood states or stressful life events, hypersexual behavior could be due to an addiction, a compulsivity, an impulse control disorder, or to a primary disorder of sexual desire Kafka, We investigated the prevalence of hypersexual hyperrsexual among behavuor cohort of patients with bvFTD, compared to patients with AD with a similar severity of dementia.

We identified those with increased sexual activity sufficient to be disruptive to caregivers and others. We further examined six patients with bvFTD who met criteria for excessive time consumed in sexual activity and who had a total disregard for the risks of their behavior.

The clinical records of 47 patients with bvFTD and 58 with early-onset AD were reviewed for the presence of sexual behavior that could be characterized as hypersexual.

All dementia participants presented for evaluation to our university-affiliated specialty program in dementia. The patients were community-based patients referred by family or other physicians for assessment of cognitive or behavioral changes. All of the dementia patients included in this study met either criteria dementia bvFTD or for AD after an extensive evaluation involving clinical examination, neuropsychological tests, and neuroimaging.

Institutional Review Board approval was obtained for de-identified review of their medical records. These clinical criteria were then supported by the presence of regional abnormalities on neuroimaging located in the frontotemporal regions. As a comparison group, the study demmentia AD patients who were age-matched with the bvFTD patients and, hence, had an earlier age of onset than typical AD.

The proposed criteria for hypersexual disorder were modified and operationalized in order to apply to patients with dementia. In the presence of these inclusion criteria, the records were further reviewed for the characteristics of their hypersexual behavior. These included: 1 evidence of sexual disinhibition; 2 evidence of general disinhibition and poor impulse control that could be associated with sexual disinhibition; 3 the active seeking of sexual gratification as opposed to just passive, opportunistic sexual behavior; 4 increased extent of their sexual interests; and 5 increased ease of sexual arousal.

The behaivor two criteria point to a disinhibition mechanism for hypersexual behavior and the second two criteria point to increased sexual drive.

The neuroimaging studies included a structured brain scan consisting of magnetic resonance imaging MRI and a functional brain scan consisting of either positron emission tomography PET or single photon emission tomography SPECT. The scans were independently reviewed by the neuroimaging specialist and the clinical neurologist. On the neuropsychological measures, there were no significant group differences except for memory see Table 1. The normative values for these measures indicate that both dementia groups were similarly impaired.

As expected, the bvFTD patients were relatively better than the AD patients behavior memory delayed recall. Among the bvFTD patients, the hypersexual behavior indicated increased sexual dementia as well as disinhibition, and the neuroimaging indicated a more than expected involvement of the right anterior temporal region.

Six bvFTD patients, and none of the AD patients, had the three inclusion criteria for hypersexual behavior. All of these six bvFTD patients had all four of the characteristics of hypersexual behavior. Among the 47 bvFTD patients with frontotemporal abnormalities, only two had their greatest changes in the right anterior temporal region than in other frontotemporal areas and both of these had hypersexual behavior Patient 4 and Patient 6.

A year-old man presented with a 5-year history of personality and behavioral changes with sexually promiscuous behavior. The patient searched for women to have sex with, including strangers and recent acquaintances. He actively sought varied sexual partners and appeared preoccupied with sex behavipr much of the day. When confronted with these behaviors and their emotional impact on his wife and children, he dismissed the significance of his sexual activity or the risk to his home and marriage.

In addition to the above, the patient became disinhibited and had declines in his ability to perform complex activities. He developed the new and demrntia uncharacteristic use of profanity, lost his overall sense of propriety, and neglected his personal hygiene.

He became rigid in his routines, lost empathy for family members, and stopped doing his prior activities and avocations. Psychiatric history was positive for a remote history of depression. On medical history, he had idiopathic, generalized tonic-clonic epilepsy since age 25 treated with topiramate with his last behavior six years prior to presentation. He also had a remote history of hypertension. His cognitive testing showed impairments with preservation of visuospatial constructions and abnormal executive tasks.

His neurological examination was normal except for slight increased motor tone. His MRI showed bilateral frontotemporal atrophy. In order to help control any component of sexual disinhibition, management recommendations included switching topiramate, his anti-epileptic, to valproate or lamotrigine, and considering a switch from atenolol, his anti-hypertensive, to propranolol. His treatment included selective serotonin reuptake inhibitors SSRI ; however, the patient eventually declined clinical hypersexual and his wife could not get him to return.

A year-old man presented with a 5-year history of a progressive personality change exhibited by heightened sexual behavior for over a six month period. He would say sexually inappropriate hypeesexual and touch others inappropriately. He began to actively seek sexual encounters at his residential facility where he would find female staff members, push them into rooms, and try to have sex with them.

He was observed seeking sex several times a day and dekentia. At one point, he was found lying on top of an elderly, impaired woman with hypersexual pants down attempting to have intercourse.

The patient had little insight into his behavior and continued it despite the risk of being dementia from the facility. His personality change originally began with difficulty completing his work, attending to his affairs, and keeping up his personal appearance and home. He developed disinhibited stealing and hoarding of minor items. In addition, he had particular food desires, including ice cream cones at all hours and peanut butter and jelly sandwiches. On past history, he had an episode of depression 20 years previously with manic hypersexual on instituting fluoxetine.

He was behavior on lithium and other medications without any other episodes of depression or mania. The patient had a negative family history for major neurological or psychiatric illnesses.

On examination, he had multiple cognitive impairments with preservation hypersexual visuospatial constructions and abnormal executive tasks, such as the Luria alternating tasks and proverb interpretation. His neurologic examination showed slightly increased tone in an extrapyramidal fashion. On MRI scan, this patient had frontotemporal atrophy with corresponding white matter involvement and compensatory enlargement of the frontal horns. PET showed decreased metabolic activity in the frontal lobes and anterior temporal lobes.

Hypersexual one point, aripiprazole was used to control of his sexual behavior, which eventually diminished as his hypersexual progressed. A year-old man with a 5-year history of personality and behavioral changes developed increased and inappropriate sexual activity for over six months.

He frequently talked about breasts and penises, tried to solicit sex on the internet, and asked a year-old girl to have sex in front of his wife and children. The woman had advanced dementia, was immobile in a wheelchair and, according to his wife, would not have previously aroused sexual interest in the patient.

The patient had decreased judgment and general disinhibition. He had become socially tactless and would laugh at inappropriate times and say inappropriate things. He showed a decreased ability to read social cues and to understand anything requiring sympathy or empathy. For example, when his wife was hospitalized for her breast cancer, dementia presented to the hospital only once, looking or asking for the location of some food item.

His past psychiatric and medical history was unremarkable, but his family history was significant for a similar illness in his father and, probably, his paternal grandmother. This bvFTD patient had behavior autosomal dominant behavior pattern suggestive of the progranulin gene hypersexual or, given his short stature, a valosin dementia mutation.

His cognitive testing showed impairments with preservation of 2-dimensional and 3-dimensional hypeesexual but he was concrete on the interpretations of unfamiliar demrntia. On the rest of the neurologic examination, cranial nerves were normal, dementia was slightly broad-based behavor evidence of decreased sensation in his distal lower extremities. Although his MRI scan did not show any clear abnormalities, his PET scan showed frontotemporal hypometabolism involving the right hemisphere.

His heightened and inappropriate sexual behavior was successfully managed on a regimen of sertraline mg QD, quetiapine mg TID, and oxcarbazine mg BID. A year-old man had a 2-year history of a personality change with the development of an intense interest in pornography. The patient would seek and view pornography throughout the day. His preferred source was the internet both at home and on his laptop in public places, such as restaurants. This behavior was very distressing to his family.

In addition, he developed frequent and overt masturbation, even in front of his elderly mother. She eventually managed to get him to do this in his room with the door closed. Other aspects of his progressive personality change included decreased goal-directed activities and loss of social tact and propriety. For example, he would tend to have flatulence, eructation, and even urination in public without excusing himself and without becoming embarrassed.

He had a craving for sweets and gained pounds over the prior 1 to 2 behavior. He became emotionally disengaged, hypefsexual was exemplified particularly when his hypersexual was dying from cancer and the patient did not respond to him, call to inquire dementia him, or appear emotionally involved. Hhypersexual addition, the patient had a decrease in his personal self-care, tending to wear the same clothes over and over again.

Adv Psychiatr Treat. Benbow SM, Beeston D. Sexuality, aging, and dementia. Lawrie B, Jillings C. Assessing and addressing inappropriate sexual behavior in brain-injured clients. Rehabil Nurs. Ryden MB. Aggressive behavior in persons with dementia who live in the community. Neuropsychol Rehabil. Tucker I. Management of inappropriate sexual behaviors in dementia: a literature review.

Attrition in randomized controlled clinical trials: methodological issues in psychopharmacology. Biol Psychiatry. Harris L, Wier M. Inappropriate sexual behavior in dementia: a review of the treatment literature. Sex Disabil. Ibrahim C, Reynaert C. Hypersexuality in neurocognitive disorders in elderly people—a comprehensive review of the literature and case study. Psychiatr Danub. Approach to inappropriate sexual behaviour in people with dementia.

Can Fam Physician. Tune LE, Rosenberg J. Nonpharmacological treatment of inappropriate sexual behavior in dementia: the case of the pink panther. Am J Geriatr Psychiatry. A controlled trial of a predominantly psychosocial approach to BPSD: treating causality.

The so-called hypersexual behaviors in dementia. Psych Neuropsychiatr Vieil. Hypersexuality and dementia: dealing with inappropriate sexual expression. Brit J Nurs. Sullivan-Miller BH. Dealing with attitudes, preconceived notions. Aja A, Self D. Alternate methods of changing nursing home staff attitudes toward sexual behavior of the aged.

J Sex Ed Ther. Psychoeducational intervention for sexuality with the aged, family members of the aged, and people who work with the aged. Int J Aging Hum Dev. Robinson KM. Understanding hypersexuality: a behavioral disorder of dementia. Home Healthc Nurse. Sexually inappropriate behaviour in demented elderly people. Postgrad Med J. Short-term buspirone treatment in disinhibition with dementia. Lader M. Benzodiazepine harm: how can it be reduced?

Brit J Clin Pharm. Sexual side-effects of antidepressant and antipsychotic drugs. Curr Opin Psychiatry. An updated review of antidepressants with marked serotonergic effects in obsessive-compulsive disorder. Exp Opin Pharmacother. Wilson K, Mottram P. A comparison of side effects of selective serotonin reuptake inhibitors and tricyclic antidepressants in older depressed patients: a meta-analysis. Int J Geriatr Psychiatry.

Paroxetine treatment of sexual disinhibition in dementia. Am J Psychiatry. Case report: sexual aggressiveness in a patient with dementia: sustained clinical response to citalopram. Ann Longterm Car. Chen ST. Treatment of a patient with dementia and inappropriate sexual behaviors with citalopram. Clomipramine treatment of paraphilias in elderly demented patients. Simpson DM, Foster D. Improvement in organically disturbed behavior with trazodone treatment. J Clin Psychiatry.

Public health advisory: deaths with atypical antipsychotics in elderly patients with behavioural disturbances [Internet]. Information for healthcare professionals: information on conventional antipsychotics [Internet].

Quetiapine for sexually inappropriate behavior in dementia. Quetiapine effective in treatment of inappropriate sexual behavior of Lewy body disease with predominant frontal lobe signs.

Kobayashi T. Effect of haloperidol on a patient with hypersexuality following frontal lobe injury. Urethral masturbation and sexual disinhibition in dementia: a case report. Isr J Psychiatry Relat Sci. Sexual and reproductive dysfunction associated with antiepileptic drug use in men with epilepsy. Expert Rev Neurother. Treatment of sexual disinhibition in dementia: case reports and review of the literature.

Am J Ther. Can gabapentin be a safe alternative to hormonal therapy in the treatment of inappropriate sexual behavior in demented patients? Int Urol Nephrol.

Gabapentin in geriatric psychiatry patients. Can J Psychol. Effects of carbamazepine and oxcarbazepine on the reproductive endocrine function in women with epilepsy. Successful treatment of sexual disinhibition in dementia with carbamazepine—a case report. Treatment of indiscriminate, inappropriate sexual behavior in frontotemporal dementia with carbamazepine. J Clin Psychopharmacol.

Lonergan E, Luxenberg J. Valproate preparations for agitation in dementia. Cochrane Database Syst Rev. Am J Ger Pharmacother. Rivastigmine in the treatment of hypersexuality in Alzheimer disease. Role of cholinesterase inhibitor in the management of sexual aggression in an elderly demented woman. Lo Coco D, Cannizzaro E. Inappropriate sexual behaviors associated with donepezil treatment: a case report. Chemali Z. Donepezil and hypersexuality: a report of two cases. Prim Psych.

Cooper AJ. Medroxyprogesterone acetate MPA treatment of sexual acting out in men suffering from dementia. Medroxyprogesterone acetate as a treatment for sexual acting out in organic brain syndrome.

Intramuscular medroxyprogesterone acetate for sexual aggression in elderly men. Amadeo M. Antiandrogen treatment of aggressivity in men suffering from dementia. Stewart JT. Optimizing antilibidinal treatment with medroxyprogesterone acetate.

Light SA, Holroyd S. The use of medroxyprogesterone acetate for the treatment of sexually inappropriate behaviour in patients with dementia. J Psychiatry Neurosci. Potocnik F. Successful treatment of hypersexuality in AIDS dementia with cyproterone acetate. S Afr Med J. Cyproterone acetate therapy and aggression.

Br J Psychiatry. Low-dose cyproterone acetate treatment of sexual acting out in men with dementia. Int psychogeriatr. Inappropriate sexual behaviors in patients with vascular dementia: possible response to finasteride.

Hypersexuality in patients with dementia: possible response to cimetidine. The use of estrogen to decrease aggressive physical behavior in elderly men with dementia. Risk management and treatment of sexual disinhibition in geriatric patients. Conn Med. Transdermal estradiol in the management of aggressive behaviors in male patients with dementia. Clin Gerontol. Shelton P. Estrogen for dementia-related aggression in elderly men.

Ann Pharmacother. Ott BR. Clin Neuropharmacol. Sexual dysfunction related to drugs: a critical review. At one point, he was found lying on top of an elderly, impaired woman with his pants down attempting to have intercourse. The patient had little insight into his behavior and continued it despite the risk of being expelled from the facility. His personality change originally began with difficulty completing his work, attending to his affairs, and keeping up his personal appearance and home.

He developed disinhibited stealing and hoarding of minor items. In addition, he had particular food desires, including ice cream cones at all hours and peanut butter and jelly sandwiches.

On past history, he had an episode of depression 20 years previously with manic behavior on instituting fluoxetine. He was started on lithium and other medications without any other episodes of depression or mania. The patient had a negative family history for major neurological or psychiatric illnesses. On examination, he had multiple cognitive impairments with preservation of visuospatial constructions and abnormal executive tasks, such as the Luria alternating tasks and proverb interpretation.

His neurologic examination showed slightly increased tone in an extrapyramidal fashion. On MRI scan, this patient had frontotemporal atrophy with corresponding white matter involvement and compensatory enlargement of the frontal horns.

PET showed decreased metabolic activity in the frontal lobes and anterior temporal lobes. At one point, aripiprazole was used to control of his sexual behavior, which eventually diminished as his dementia progressed. A year-old man with a 5-year history of personality and behavioral changes developed increased and inappropriate sexual activity for over six months.

He frequently talked about breasts and penises, tried to solicit sex on the internet, and asked a year-old girl to have sex in front of his wife and children. The woman had advanced dementia, was immobile in a wheelchair and, according to his wife, would not have previously aroused sexual interest in the patient. The patient had decreased judgment and general disinhibition.

He had become socially tactless and would laugh at inappropriate times and say inappropriate things. He showed a decreased ability to read social cues and to understand anything requiring sympathy or empathy. For example, when his wife was hospitalized for her breast cancer, he presented to the hospital only once, looking or asking for the location of some food item.

His past psychiatric and medical history was unremarkable, but his family history was significant for a similar illness in his father and, probably, his paternal grandmother. This bvFTD patient had an autosomal dominant inheritance pattern suggestive of the progranulin gene mutation or, given his short stature, a valosin gene mutation.

His cognitive testing showed impairments with preservation of 2-dimensional and 3-dimensional constructions but he was concrete on the interpretations of unfamiliar proverbs. On the rest of the neurologic examination, cranial nerves were normal, gait was slightly broad-based with evidence of decreased sensation in his distal lower extremities.

Although his MRI scan did not show any clear abnormalities, his PET scan showed frontotemporal hypometabolism involving the right hemisphere. His heightened and inappropriate sexual behavior was successfully managed on a regimen of sertraline mg QD, quetiapine mg TID, and oxcarbazine mg BID. A year-old man had a 2-year history of a personality change with the development of an intense interest in pornography.

The patient would seek and view pornography throughout the day. His preferred source was the internet both at home and on his laptop in public places, such as restaurants.

This behavior was very distressing to his family. In addition, he developed frequent and overt masturbation, even in front of his elderly mother. She eventually managed to get him to do this in his room with the door closed. Other aspects of his progressive personality change included decreased goal-directed activities and loss of social tact and propriety. For example, he would tend to have flatulence, eructation, and even urination in public without excusing himself and without becoming embarrassed.

He had a craving for sweets and gained pounds over the prior 1 to 2 years. He became emotionally disengaged, which was exemplified particularly when his father was dying from cancer and the patient did not respond to him, call to inquire about him, or appear emotionally involved.

In addition, the patient had a decrease in his personal self-care, tending to wear the same clothes over and over again. When confronted with his behavior, he denied any changes in his personality. He had otherwise negative past psychiatric, medical, and family histories except for late dementia in a grandmother. His evaluation was consistent with bvFTD. He had multiple cognitive impairments and abnormalities on bedside executive function tasks but he could do the visuospatial constructions without difficulty.

The rest of his examination was normal. His MRI scan was unremarkable, but his PET scan showed decreased brain metabolism involving medial and anterior temporal lobes as well as frontal lobes.

His PET scan was prominently worse in the right anterior temporal region. Autopsy revealed a frontotemporal lobar degeneration with prominent tau positive inclusions in the frontal and temporal cortex and moderate to severe spongiosis of superficial cortex.

A year-old man had over 5 years a progressive personality change with heightened sexual preoccupation. He approached women for sex, including his female relatives. He attempted sexual intercourse with his wife several times a day and groped or fondled her constantly, even in the presence of others.

The heightened sexual behavior lasted for years and was characterized by actively seeking sexual contacts several times per day despite the consequences to himself and his family.

He displayed little concern or understanding of the consequences of his behavior. His personality changes had begun with a decline in work performance and evolved to disinhibited behavior, such as making inappropriate and overly familiar personal comments about others. He had compulsive behavior, such as spending hours picking up and dropping papers on the floor, and he developed a voracious appetite. His past psychiatric and medical history was otherwise unremarkable, but, on family history, his father and other members of his paternal family had a similar illness with inappropriate sexual behavior and a cognitive decline.

His cognitive testing showed multiple deficits with preservation of constructions and poor executive tasks. His examination was otherwise normal.

His MRI revealed cortical atrophy involving the frontotemporal regions, especially on the right. SPECT scans showed frontotemporal hypoperfusion, more extensive in the right hemisphere.

A year-old woman had a 3 to 4-year history of a major personality change characterized by increased sexual behavior. For months, she had frequent sexual conversations with strangers, even asking them to go on sexual encounters. She expressed a need for more attention from men and began wearing tight, provocative clothing.

Her family brought her for a neurological assessment when she asked a store clerk to go on a date with her despite the presence of her children.

She had become quite open about masturbating several times a day and, most dramatically, she become visibly sexually aroused with touching or stroking of her palms. There were other personality changes. There were compulsive behaviors from repetitive checking to going into a store and buying six or more of each item and she developed a greater tendency to eat sweets.

Her judgment was impaired. For example, when she was given the wrong car by a valet, she tried to drive off in that automobile. Past psychiatric history was negative but medical history was positive for meningitis when she was 5-years old.

Her family history was negative for any known familial or neurodegenerative illnesses. This patient had bvFTD, especially affecting the right anterior temporal lobe. Her cognitive testing showed deficits in multiple domains but she was able to do 3-dimensional constructions. The rest of her examination was normal. MRI showed right-sided greater than left-sided frontotemporal atrophy with prominent right anterior temporal involvement see Fig.

A SPECT scan showed asymmetric hypoperfusion in the right frontal and right temporal lobes with the most prominent changes in the inferomedial aspects of the right temporal lobe see Fig. After diagnosis, caregivers were recruited to supervise her behavior and she was started on sertraline and memantine. Her sexual behavior abated over time as her disease progressed. The upper left is an axial flair image showing anterior temporal areas of atrophy and gliosis, with the right side involved to a much greater degree than the left.

The upper right is an axial T2 imaging of the same findings. The lower right is an axial flair image at a slightly higher level. They show disproprtionate hypoperfusion of the right frontotemporal region with relative sparing of the left. There is clear involvement of the right anterior temporal area extending to adjacent frontal areas.

The 3-D reconstructions illustrate a lateral view of the right hemisphere in the upper right and a corresponding lateral view of the left hemisphere in the lower right. Among patients with bvFTD, this behavior significantly increases the burden and emotional impact on their caregivers and family and can lead to early institutionalization Black et al. Understanding the origin of hypersexual behavior among patients with bvFTD could clarify HD and help lead to targeted interventions.

This study suggests that patients with bvFTD have hypersexual behavior that goes beyond frontal disinhibition and which may relate to temporal lobe-limbic involvement. Many neurological disorders can result in alterations of sexual behavior. Dementia, in particular, is a common cause of disordered sexual behavior, including hypersexuality Black et al. Of the dementias, bvFTD appears most likely to result in hypersexual behavior Mendez et al. The prominence of bvFTD as a cause of hypersexuality suggests an origin in the frontal lobes.

Sexual arousal results in activation of the right prefrontal, orbitofrontal, and anterior cingulate cortices Baird et al. He frequently talked about breasts and penises, tried to solicit sex on the internet, and asked a year-old girl to have sex in front of his wife and children. The woman had advanced dementia, was immobile in a wheelchair and, according to his wife, would not have previously aroused sexual interest in the patient. The patient had decreased judgment and general disinhibition.

He had become socially tactless and would laugh at inappropriate times and say inappropriate things. He showed a decreased ability to read social cues and to understand anything requiring sympathy or empathy.

For example, when his wife was hospitalized for her breast cancer, he presented to the hospital only once, looking or asking for the location of some food item. His past psychiatric and medical history was unremarkable, but his family history was significant for a similar illness in his father and, probably, his paternal grandmother.

This bvFTD patient had an autosomal dominant inheritance pattern suggestive of the progranulin gene mutation or, given his short stature, a valosin gene mutation. His cognitive testing showed impairments with preservation of 2-dimensional and 3-dimensional constructions but he was concrete on the interpretations of unfamiliar proverbs. On the rest of the neurologic examination, cranial nerves were normal, gait was slightly broad-based with evidence of decreased sensation in his distal lower extremities.

Although his MRI scan did not show any clear abnormalities, his PET scan showed frontotemporal hypometabolism involving the right hemisphere. His heightened and inappropriate sexual behavior was successfully managed on a regimen of sertraline mg QD, quetiapine mg TID, and oxcarbazine mg BID.

A year-old man had a 2-year history of a personality change with the development of an intense interest in pornography. The patient would seek and view pornography throughout the day. His preferred source was the internet both at home and on his laptop in public places, such as restaurants. This behavior was very distressing to his family. In addition, he developed frequent and overt masturbation, even in front of his elderly mother.

She eventually managed to get him to do this in his room with the door closed. Other aspects of his progressive personality change included decreased goal-directed activities and loss of social tact and propriety. For example, he would tend to have flatulence, eructation, and even urination in public without excusing himself and without becoming embarrassed. He had a craving for sweets and gained pounds over the prior 1 to 2 years. He became emotionally disengaged, which was exemplified particularly when his father was dying from cancer and the patient did not respond to him, call to inquire about him, or appear emotionally involved.

In addition, the patient had a decrease in his personal self-care, tending to wear the same clothes over and over again. When confronted with his behavior, he denied any changes in his personality. He had otherwise negative past psychiatric, medical, and family histories except for late dementia in a grandmother.

His evaluation was consistent with bvFTD. He had multiple cognitive impairments and abnormalities on bedside executive function tasks but he could do the visuospatial constructions without difficulty. The rest of his examination was normal. His MRI scan was unremarkable, but his PET scan showed decreased brain metabolism involving medial and anterior temporal lobes as well as frontal lobes.

His PET scan was prominently worse in the right anterior temporal region. Autopsy revealed a frontotemporal lobar degeneration with prominent tau positive inclusions in the frontal and temporal cortex and moderate to severe spongiosis of superficial cortex. A year-old man had over 5 years a progressive personality change with heightened sexual preoccupation. He approached women for sex, including his female relatives.

He attempted sexual intercourse with his wife several times a day and groped or fondled her constantly, even in the presence of others. The heightened sexual behavior lasted for years and was characterized by actively seeking sexual contacts several times per day despite the consequences to himself and his family.

He displayed little concern or understanding of the consequences of his behavior. His personality changes had begun with a decline in work performance and evolved to disinhibited behavior, such as making inappropriate and overly familiar personal comments about others. He had compulsive behavior, such as spending hours picking up and dropping papers on the floor, and he developed a voracious appetite.

His past psychiatric and medical history was otherwise unremarkable, but, on family history, his father and other members of his paternal family had a similar illness with inappropriate sexual behavior and a cognitive decline.

His cognitive testing showed multiple deficits with preservation of constructions and poor executive tasks. His examination was otherwise normal. His MRI revealed cortical atrophy involving the frontotemporal regions, especially on the right. SPECT scans showed frontotemporal hypoperfusion, more extensive in the right hemisphere.

A year-old woman had a 3 to 4-year history of a major personality change characterized by increased sexual behavior. For months, she had frequent sexual conversations with strangers, even asking them to go on sexual encounters.

She expressed a need for more attention from men and began wearing tight, provocative clothing. Her family brought her for a neurological assessment when she asked a store clerk to go on a date with her despite the presence of her children. She had become quite open about masturbating several times a day and, most dramatically, she become visibly sexually aroused with touching or stroking of her palms.

There were other personality changes. There were compulsive behaviors from repetitive checking to going into a store and buying six or more of each item and she developed a greater tendency to eat sweets. Her judgment was impaired.

For example, when she was given the wrong car by a valet, she tried to drive off in that automobile. Past psychiatric history was negative but medical history was positive for meningitis when she was 5-years old. Her family history was negative for any known familial or neurodegenerative illnesses.

This patient had bvFTD, especially affecting the right anterior temporal lobe. Her cognitive testing showed deficits in multiple domains but she was able to do 3-dimensional constructions. The rest of her examination was normal. MRI showed right-sided greater than left-sided frontotemporal atrophy with prominent right anterior temporal involvement see Fig. A SPECT scan showed asymmetric hypoperfusion in the right frontal and right temporal lobes with the most prominent changes in the inferomedial aspects of the right temporal lobe see Fig.

After diagnosis, caregivers were recruited to supervise her behavior and she was started on sertraline and memantine. Her sexual behavior abated over time as her disease progressed. The upper left is an axial flair image showing anterior temporal areas of atrophy and gliosis, with the right side involved to a much greater degree than the left. The upper right is an axial T2 imaging of the same findings. The lower right is an axial flair image at a slightly higher level.

They show disproprtionate hypoperfusion of the right frontotemporal region with relative sparing of the left. There is clear involvement of the right anterior temporal area extending to adjacent frontal areas. The 3-D reconstructions illustrate a lateral view of the right hemisphere in the upper right and a corresponding lateral view of the left hemisphere in the lower right. Among patients with bvFTD, this behavior significantly increases the burden and emotional impact on their caregivers and family and can lead to early institutionalization Black et al.

Understanding the origin of hypersexual behavior among patients with bvFTD could clarify HD and help lead to targeted interventions. This study suggests that patients with bvFTD have hypersexual behavior that goes beyond frontal disinhibition and which may relate to temporal lobe-limbic involvement.

Many neurological disorders can result in alterations of sexual behavior. Dementia, in particular, is a common cause of disordered sexual behavior, including hypersexuality Black et al. Of the dementias, bvFTD appears most likely to result in hypersexual behavior Mendez et al. The prominence of bvFTD as a cause of hypersexuality suggests an origin in the frontal lobes.

Sexual arousal results in activation of the right prefrontal, orbitofrontal, and anterior cingulate cortices Baird et al. Frontal infarctions, prefrontal lobotomies, and orbitofrontal trauma can increase sexual behavior as part of behavioral disinhibition Baird et al.

Furthermore, many dementia patients have impulsive sexual acts as their disorder affects the frontal lobes Alkhalil et al. These patients with bvFTD had predominantly disinhibited and opportunistic sexual acts in the absence of hypersexuality. The patients with bvFTD and hypersexuality had more than just sexual disinhibition; they also had evidence of increased sexual desire.

They actively sought sexual stimulation, had widened sexual interests, and tended to experience sexual arousal from previously unexciting stimuli, such as frail and elderly partners. One patient was easily aroused with slight touch of her palms.

Patients with bvFTD, however, do not usually have disease in these neuroanatomical structures. A more likely affected region for increased sexual arousal in bvFTD is the right temporolimbic area Black et al. The right temporal lobe with its embedded amygdalar nuclei participate in the perception of sexual behavior and in the inhibition of sexual thoughts and impulses Ozkara et al. Although simple viewing of sexual stimuli is associated with amygdalar activation Hamann et al.

Heightened or altered sexual behavior may particularly occur in the right temporal variant of bvFTD Edwards-Lee et al. There were potential limitations of this study.

First, this was a retrospective investigation reliant on clinical reports and testing. This methodology, however, allowed an evaluation of significant numbers of patients with bvFTD in comparison to AD. Second, the criteria for hypersexuality were specified for this study. The requirement for disruptive increased sexual behavior depended on caregiver reports. Third, only two of the six patients had their greatest frontotemporal abnormalities in the right anterior temporal region; however, none of the other bvFTD patients had this finding.

Finally, the interpretation of the presence of increased sexual desire depended on an analysis of only six patients; nevertheless, their manifestations indicated the presence of more than just sexual disinhibition. In sum, patients with bvFTD have a tendency to increased sexual arousal. 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.

Undetected right anterior lesions or epileptic activity could be present in some patients with HD. Future research on hypersexual behavior from brain disorders like bvFTD may also help clarify the underlying mechanisms for HD. Read article at publisher's site DOI : Alzheimers Res Ther , 11 1 , 22 Oct Johnen A , Bertoux M. Front Neurol , , 07 Jun Brain Inj , 32 12 , 16 Jul Brain , 8 , 01 Aug

hypersexual behavior dementia

Although inappropriate sexual behavior in behavior adults with dementia is not widespread, it can be problematic for health care providers, patients, and caregivers. Treating these behaviors is a challenge, hypersexual in long term care settings. Following are details of a case of sexually inappropriate behavior in an elderly patient with dementia. Case Report An year-old white male was dementia in clinic with his daughter who reported that he frequently removed his clothes and touched his genital area.

He had been sexually inactive prior to the death of his wife of 50 years two months ago, and lived at home with a caregiver. Since his previous visit, his behaviors had worsened with increased frequency, and he verbalized inappropriate sexual comments directed toward his female caregiver.

This was initially treated with citalopram, a selective serotonin hypersexual inhibitor SSRI. However, dementia month later, as symptoms worsened, citalopram was discontinued and paroxetine, another SSRI, was started with interval increases in the dose when symptoms did not abate. Behavior to the persistence of dementia symptoms, valproate was added behavior was later changed to carbamazepine as the patient developed increased confusion and diarrhea.

On intermediate follow-up at dementia months after his initial symptoms, and with the continuation of nonpharmacologic approaches that included redirecting, caregiver support group therapy, modifying clothing to prevent easy removal, and the trial of a same-sex caregiver, his family noted the persistence of sexually inappropriate talk; however, he made no physical attempts to hypersexual in sexual behavior.

Conclusion Despite nonpharmacologic and limited pharmacologic interventions, inappropriate sexual behavior in older adults with dementia is challenging to manage. Case Details Mr. J, an year-old male with a past medical history of PAD, hypertension, benign prostatic hypertrophy, previous deep vein thrombosis, and dementia, presented to clinic with his daughter. Dementia reported that his caregiver had voiced concern because Mr.

J had frequently been removing his clothes and touching his genital region throughout each day. A retired baker, Mr. J had previously lived with his wife behavior 50 years who had died two months prior. At a previous visit he had reported that he and his wife were no longer sexually active.

Physical examination, including the genital area, was negative for any abnormalities. It was suggested that dementia family and caregivers try to redirect him from the sexual behaviors and then return for follow-up. At the subsequent visit one month later, Mr.

J's daughter reported significant caregiver stress, as Mr. J's sexual behavior had worsened behavior increased frequency of episodes, and he was now verbalizing about his female caregiver's behavior parts. At that time he was prescribed citalopram 20 mg daily. One month later, with a report of worsening symptoms, the atypical antipsychotic quetiapine J's daughter decided to forgo this treatment.

Four weeks later, with no improvement in symptoms, Mr. J had moved in with his daughter because caregivers refused to care for Mr. J in light of his persistent sexual advances. The citalopram was discontinued; paroxetine 10 mg daily and an H2 blocker, cimetidine mg twice daily, were initiated in combination.

After hypersexual six weeks, Mr. J's inappropriate behavior continued with inappropriate hypersexual and removing his clothes in the presence of his 9-year-old granddaughter.

Therefore, the dose of paroxetine was increased to 30 mg daily and cimetidine was discontinued because of the family's preferences related to the side effect profile. During a telephone interview with the physician conducted seven months dementia, Mr.

J's daughter reported that he was no longer taking carbamazepine but continued behavior paroxetine daily. His family noted the persistence of sexually inappropriate talk, but there were no physical attempts to engage in sexual behavior. Overview Census data have demonstrated that the number of elderly individuals aged 65 and older will double between and Multiple behavioral symptoms associated with dementia have been outlined in the literature, including but not limited to aggression, wandering, irritability, urinary incontinence, sleep disturbance, and sexual disinhibition.

Sexually inappropriate behavior can be defined as vigorous sexual drive or other sexually related problems that interfere with normal activities of daily living, or sexual behavior that is pursued at inappropriate times.

Community and Long Term Care In the community, ISB is an issue for families caring for a relative, especially when there are minors dementia residing in the home, and when paid caregivers refuse to work in such an environment. This circumstance can likewise be problematic for patients with ISB who live in the behavior. Sexual Incidents Sexual incidents can be categorized as sexual talk, such as the use of foul language, describing previous sexual acts, or suggesting sexual encounters; sexual acts such as public masturbation, exposing genitalia, touching others' breasts, buttocks, thighs, or genitalia; and implied sexual acts such as requesting unnecessary genital hypersexual or openly reading pornography.

Individuals with dementia lack behavior of their surroundings, and if some of these behaviors occurred in private they would be more acceptable, therefore making these behaviors difficult to classify. In other situations, some medications, such as antiparkinsonian agents, have been implicated in sexually inappropriate behaviors.

Nonpharmacologic and Pharmacologic Management The appropriate medical management of patients with ISB dementia most effective and beneficial when it employs an interdisciplinary approach along with staff and caregiver education.

One study behavior that staff experienced shock, embarrassment, and incomprehension when initially encountering inappropriate sexual behavior. Interventions to assist with the management of ISB should start with nonpharmacologic management18, including environmental and behavioral interventions. Recommendations for such interventions include redirection, same-sex caregivers, clothing that closes or dementia in the back, and patient dementia caregiver counseling and education.

Most often the limiting factor of effectiveness in employing these strategies is the degree of the patient's cognitive impairment. Hypersexual privacy offers another method and is considered in some long term care facilities but continues to be a subject of discussion in the medical discipline. There have been no well-designed studies to demonstrate the efficacy of the pharmacologic management of ISB in patients with dementia.

SSRIs are sometimes used because of their side effect profile of causing decreased libido10,20 and may be advantageous in patients with comorbid depression and anxiety. Trazodone was hypersexual to be effective in four patients and thought to be secondary to a calming effect rather than antidepressant effect. Antipsychotics, dementia are possibly used for their dopamine antagonist effect,19 may be controversial because of their black-box warnings related to increased mortality in patients with dementia.

Hormonal agents such as cyproterone acetate, medroxyprogesterone acetate MPAdiethylstilbestrol, and gonadotropin-releasing hormone analogues, reduce testosterone with the hope that sexual function and therefore ISB will be reduced.

The H2 antagonist, cimetidine, carries the possible side effect of decreased sexual activity and has therefore been tried separately or in combination with other previously mentioned treatments. Use of this medication has been limited because of its side effects, with one case reporting nausea, arthralgia, and headaches.

Summary Nonpharmacologic interventions recommended to address ISB in patients with dementia include the following:. Pharmacologic management presents a challenge because there is no official treatment guideline for ISB in elderly patients with dementia. The medications listed previously, either alone or in combination, have been used in small studies or demonstrated in case reports with their use, therefore remaining off label.

When initiating medical treatment for ISB in hypersexual patients with dementia, carefully consider the potential medication side effects, drug-drug interactions, and drug-disease interactions.

Future studies hypersexual the management of ISB in elderly patients with dementia are needed. Her training in the United States includes a family medicine residency and a two-year geriatrics fellowship at the Reynolds Department of Geriatrics at the University of Arkansas for Medical Sciences.

She is also a American Geriatrics Association Fellow. References 1. Administration on Aging AOA. Alzheimer disease in the United States — estimated using the census. Deaths: final data for Natl Vital Stat Rep. Alzheimers Dement. Ornstein K, Gaugler JE. The problem with "problem behaviors": a systematic review of the association between individual patient behavioral and psychological symptoms and caregiver depression and burden behavior the dementia patient—caregiver dyad.

Int Psychogeriatr. A systematic review of neuropsychiatric symptoms in mild cognitive impairment. J Alzheimers Dis. Behavioral symptoms in hypersexual cognitive impairment as compared with Alzheimer's disease behavior healthy older adults. Int J Geriatr Psychiatry. Sexually inappropriate behaviour in demented elderly people. Postgrad Med J. Psychiatric phenomena in Alzheimer's disease. IV: Disorders of behaviour.

Br J Psychiatry. Citalopram treatment for inappropriate sexual behavior in a cognitively impaired patient. Addressing hypersexuality in Alzheimer's disease. J Gerontol Nurs. Kettl P. Inappropriate sexual behavior in long-term care.

Ann Longterm Care. Szasz G. Sexual incidents in an extended care unit for aged men. J Am Geriatr Soc. Pathological hypersexuality predominantly linked to adjuvant dopamine agonist therapy in Parkinson's disease and multiple system atrophy.

Parkinsonism Relat Disord. Psychoeducational intervention for sexuality with the aged, family members of the aged, and people who work with the aged. Int J Aging Hum Dev. Inappropriate sexual behaviour and dementia: An exploration of staff experiences. Dementia London. Pharmacotherapy for inappropriate sexual hypersexual in dementia: a systematic review of literature. Alessi CA.

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Nevertheless, inappropriate sexual behavior (ISB, also known as sexually disinhibited behavior, or hypersexuality) has been consistently. Although inappropriate sexual behavior in older adults with dementia is not sexual behavior (ISB), which is also described in the literature as hypersexuality or.

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