sexual behavior ISB is a relatively common and potentially
Sexualized behaviors dementia form of behavior in people with dementia.
It can cause considerable distress and put placements and people at risk. Yet it is poorly researched and understood.
In addition to non-pharmacological approaches to management, a wide range of classes of medication has been used in ISB, and the results have been reported as single cases or short series, though none has been the subject of a randomized clinical trial, in part because of the lack of a well-defined method of observing and measuring ISB, as well as the significant ethical considerations. Pharmacological treatments for which there is low-level evidence of efficacy in the literature include antidepressants, antipsychotics, anticonvulsants, cholinesterase inhibitors, hormonal agents, and beta-blockers.
None of the drugs discussed here is licensed for use in ISB, and elderly people, particularly those with dementia, are at high risk of adverse effects. Caution is advised before using medication in this group of people.
It is important to consider alternative non-pharmacological treatments, as well as discussing issues of ethics and consent with those involved, before initiating treatment. It is helpful to identify and monitor target symptoms. Pharmacological treatments should be Sexualized behaviors dementia at low dose and titrated up slowly and carefully. Nevertheless, in some situations, medication may provide a useful part of a management plan for ISB.
Sexuality is one of the basic needs in human life. Although sexual activity often
Sexualized behaviors dementia in elderly people, sexual interest may not [ 1 ]. Despite this, sexual expression among older adults is often perceived as non-existent, humorous, grotesque, or even sordid and disgusting [ "Sexualized behaviors dementia" ]. However, as in younger people, not all sexual behavior in older people is inappropriate. In elderly patients with dementia, a combination of cognitive deterioration, worsening judgment, and personality changes probably contributes to changes in sexual attitude and behavior.
The most common alteration reported in people with dementia is apathy and indifference to sex [ 3 ]. Nevertheless, inappropriate sexual behavior ISB, also known as sexually disinhibited behavior, or hypersexuality has been consistently described in most dementia syndromes [ 4 ].
ISB should be seen as a part of the symptom cluster of behavioral and psychiatric disturbances associated with dementia, which
Sexualized behaviors dementia disruptive and distressing, and impairs the care of the patient [ 8 ]. ISB can include sex talk i. ISB can be divided in conventional and non-paraphilic i. In one observational study, sexual behavior was coded as follows: Despite its thoroughness, this classification has several flaws.
Firstly, the concept of appropriateness varies among individuals and can be affected by numerous elements, such as religious beliefs or prevailing societal views of elderly persons
Sexualized behaviors dementia 12 ]. Acts like public undressing or genital touching may be misinterpreted as sexual, when in fact they can result from pain, discomfort, hyperthermia, or attempts to be freed from a restrained environment [ 6 ]. Normal needs for sex and intimacy in older adults are frequently Sexualized behaviors dementia as an inappropriate increase in sexual drive [ 8 ].
Lastly, inappropriateness often stems from judgmental mind-sets and arbitrations of the observers clinical staff, family, and other residentsrather than the sexual activities themselves [ 13 ].
Physical manifestations appear to be more frequent in males [ 16 ], whereas women seem more verbal [ 17 ]. "Sexualized behaviors dementia" can be a threat to the mental and physical health of patients and others [ 18 ]; for example, repeated masturbation can cause genital trauma [ 19 ].
These activities can cause anxiety, distress, and embarrassment in caregivers, often disrupting the continuity of care at home and leading to confinement at home or institutionalization [ 20 ].
Finally, sexualized conducts may cause a conflict between ethical and legal responsibilities of clinicians, since hindering sexual expression can be seen as a violation of the principle of autonomy [ 18 ]; therefore, the capacity to consent needs to be assessed [ 21 ]. Many neurobiological and psychosocial factors can contribute to
Sexualized behaviors dementia onset and maintenance of ISB. The neurobiological basis of sexuality is likely founded on complex interactions between different brain systems, neuroendocrine factors, and neurotransmitters.
Four brain Sexualized behaviors dementia have been implicated in the neurobiology of ISB: Dysfunction of the frontal lobes, often seen in dementia, is known to trigger disinhibited behaviors [ 22 ], and it has been associated with ISB [ 23 ]. Lastly, lesions to the right hypothalamus and periventricular area can cause manic symptoms, including increased sexual drive [ 31 ]. Neuroendocrine factors affecting ISB include androgens, estrogens, progesterone, prolactin, oxytocin, cortisol, pheromones, and neurotransmitters and neuropeptides including nitric oxide, serotonin, dopamine, adrenaline, noradrenaline, opioids, acetylcholine, histamine, and gamma-aminobutyric acid [ 32 ].
Psychotropic drugs such as levodopa, benzodiazepines, and alcohol have all been linked with increased agitation and sexual disinhibition [ 33 ]. Psychosocial issues often contribute to the onset of ISB in predisposed demented patients; these factors include mood instability, premorbid patterns of sexual activity and interest, lack of habitual sexual partner or misidentification of someone else as usual partner, lack of privacy, understimulating or unfamiliar environment, misinterpretation of cues, and potentially many others [ 33 ].
If the patient is severely impaired, then a history should be obtained from the caregivers or family members [ 8 ]. Lawrie and Sexualized behaviors dementia emphasize the importance of considering the appropriateness or inappropriateness of a sexual behavior according to the larger context, and managing contributory factors such as boredom, loneliness, or misinterpreted gestures of communication [ 35 ].
Some behavior measurement tools for patients with dementia include items relating to ISB.
The Ryden Aggression Scale contains a section on sexually aggressive behavior including making obscene gestures, touching body parts of another person, hugging, intercourse, or kissing [ 36 ].
In the case of an abrupt onset of Sexualized behaviors dementia ISB, laboratory testing and neuroimaging studies to evaluate for delirium or a new structural lesion should be considered [ 8 ]. This study systematically reviews the published literature on the current treatment options for ISB in older adults with dementia in order to support the clinician in managing ISB. We eliminated 24 duplicate records.
We looked for original articles, namely case reports, case series, case-control and cohort studies, and randomized controlled trials; however, we also considered previous reviews and expert opinions published where evidence-based studies were lacking.
Finally, we selected 37
Sexualized behaviors dementia articles which contained information regarding treatment of ISB in dementia. We present the evidence divided into non-pharmacological and pharmacological treatments. Although there are few reports of non-pharmacological interventions and there is a lack of evidence for their efficacy, there is a general agreement that they should be the first-line treatment for ISB in elderly people with dementia [ 20 ], principally because of concerns about safety and ethics [ 38 ].
However, clinicians often manage problematic behavior with medication because of the ease of administration, perceived efficacy [ 39 ], and lack of trained staff members [ 40 ]. Non-pharmacological treatment can
Sexualized behaviors dementia divided into environmental, behavioral or cognitive-behavioraland educational.