From the Guidelines
Managing hypersexuality in dementia patients requires a combination of non-pharmacological and pharmacological approaches, with a focus on minimizing medication use and maintaining dignity and safety for all involved. First, implement behavioral strategies such as distraction, redirection to appropriate activities, and maintaining a consistent routine. Ensure the environment is structured and provides appropriate stimulation. For caregivers, it's essential to respond calmly, avoid confrontation, and remember that the behavior stems from the disease rather than intentional actions. If non-pharmacological approaches are insufficient, medications may be considered. Options include SSRIs like sertraline (50-200 mg daily) or citalopram (10-40 mg daily), which can reduce sexual urges while having a relatively favorable side effect profile, as suggested by 1.
Some key points to consider when managing dementia patients with extreme sexuality include:
- Implementing non-pharmacological strategies as the first line of treatment
- Using medications like SSRIs or antipsychotics only when necessary and with careful monitoring of side effects
- Regular reassessment to minimize medication use and maintain dignity and safety
- Providing education and support to caregivers on managing behavioral symptoms
- Considering the use of antiandrogens or hormonal treatments for severe cases unresponsive to other interventions, as mentioned in 1
It's also important to note that dementia damages brain areas that regulate impulse control and social behavior, particularly the frontal and temporal lobes, leading to behavioral symptoms like hypersexuality, as discussed in 1. By prioritizing non-pharmacological approaches and minimizing medication use, healthcare providers can help maintain the dignity and safety of dementia patients while also reducing the risk of adverse effects.
From the Research
Dementia and Extreme Sexuality
- Dementia patients may exhibit extreme sexuality due to the decline in cognition, leading to inappropriate sexual behaviors (ISB) 2, 3.
- ISB in dementia can be categorized into two types: intimacy-seeking and disinhibited, which differ in their association with dementia type, severity, and concurrent behavioral disorders 2.
- The most likely change in sexual behavior of a person with dementia is indifference, but ISB can occur in moderate to severe stages of Alzheimer's dementia and early stages of frontotemporal dementia 2, 3.
Causes and Management of ISB
- ISB can be caused by the disruption of interconnected brain structures, including trauma to the temporal lobes, limbic system, and medial striatum of the basal ganglia 3.
- Non-pharmacological interventions are often preferred for managing ISB, as patients may be less responsive to psychoactive therapies, but these interventions do not always stop the behavior 2, 4.
- Serotonergic antidepressants have been shown to be effective in reducing overall neuropsychiatric symptoms, agitation, depressive symptoms, and care burden in patients with dementia, with small to very small effect sizes 5.
Types of Dementia and ISB
- Frontotemporal dementia is often associated with socially and sexually inappropriate behaviors due to the lack of insight and disinhibition 2, 3.
- Huntington's disease can exhibit hypersexuality, pedophilia, promiscuity, and marital infidelity due to the involvement of the medial striatum of the basal ganglia 3.
- Alzheimer's disease can also exhibit ISB, particularly in moderate to severe stages, but the prevalence and severity of ISB can vary depending on the individual and the stage of the disease 2, 3.