How to manage hypersexuality in a patient with dementia?

From the Guidelines

Managing a hypersexual dementia patient requires a comprehensive approach that prioritizes non-pharmacological strategies as the first line of treatment, as recommended by the most recent guidelines 1.

Key Considerations

• Non-pharmacological strategies should be considered as first-line management for individuals with vascular cognitive impairment (VCI) who are displaying behavior changes, including hypersexuality, due to the moderate quality of evidence supporting this approach 1.
• For those individuals with mild VCI, cognitive behavioral, interpersonal, and/or problem-solving deficits, psychotherapeutic strategies may be considered to facilitate adaptive coping, although the evidence is of low quality 1.
• Structured and tailored activities that are individualized and aligned to current capabilities and take into account previous roles and interests may be considered, with low quality of evidence but a strong recommendation 1.

Medication Options

• If pharmacological treatment is required, selective serotonin reuptake inhibitors (SSRIs) like citalopram or sertraline may be considered, as they have been found to reduce sexual urges in some cases, although the primary evidence for their use comes from treating depression in dementia patients 1.
• Antipsychotics such as risperidone or quetiapine may help in severe cases but carry significant side effects and should be used judiciously, balancing potential benefits against harms, as highlighted by expert consensus and research evidence 1.

Care Approach

• Involve family members in care planning, educate them about the condition, and provide emotional support as they navigate this challenging aspect of dementia.
• Approach care with compassion and dignity, recognizing that hypersexuality in dementia patients stems from brain changes affecting impulse control and social awareness rather than intentional misconduct.

Environmental Modifications

• Create a structured environment that minimizes triggers and provides appropriate stimulation through activities like music therapy, art, or physical exercise to channel energy constructively.
• Ensure the patient's basic needs are met, as discomfort or boredom can sometimes manifest as sexual behaviors.

From the Research

Management of Hypersexual Dementia Patients

To manage hypersexual dementia patients, the following approaches can be considered:

• Non-pharmacological interventions, such as behavioral techniques, education of the patient, their partner, and caregivers, are recommended as the first line of treatment 2, 3
• Pharmacological interventions, including antidepressants, antipsychotics, anticonvulsants, cholinesterase inhibitors, hormonal agents, and beta-blockers, can be used, but with caution due to the risk of adverse effects in elderly patients with dementia 4, 5, 2
• Identifying and monitoring target symptoms is essential in managing hypersexual behavior in dementia patients 5, 3
• A thorough patient history should be taken prior to starting any drug therapy to rule out possible behavioral changes due to an existing medication side effect, delirium, or past mental or sexual health history 3

Treatment Options

Some specific treatment options that have been reported to be effective in managing hypersexual behavior in dementia patients include:

• Risperidone, which was used to treat a patient with hypersexuality and hyperorality in the context of delirium induced by benzodiazepine withdrawal 2
• Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), which can be effective in reducing hypersexual behavior, but may also cause sexual dysfunction as a side effect 6
• Distraction/diversion of the patient when inappropriate sexual behaviors occur, which is a common non-pharmacological intervention 3

Considerations

When managing hypersexual dementia patients, it is essential to consider the following:

• The ethical implications of treating a patient for this condition, including issues of consent and the potential risks and benefits of treatment 5, 3
• The importance of educating the patient, their partner, and caregivers about the condition and its management 2, 3
• The need for careful monitoring of the patient's symptoms and response to treatment, and adjustment of the treatment plan as needed 4, 5, 3