Inappropriate Sexual Behaviors in Dementia

Ana Verdelho and Manuel Gon^alves-Pereira

Abstract Among behavioral changes in the context of cognitive decline and dementia, those related to sexual behavior may be the most disturbing. Their management is a challenge for caregivers (either informal or formal), general staff, and clinicians. The aim of this chapter is to provide a brief overview of inappropriate sexual behaviors in the context of dementia. These behaviors may not only be symptoms of the neurodegenerative disorder but also of medical comorbidities. Psychosocial factors (including previous personality and the environment) must also be considered. Clinical examples are given to illustrate some of the issues raised in this chapter.

Keywords Alzheimer’s disease • Behavioral disturbances in dementia • Caregivers • Frontotemporal lobar degeneration • Hypersexuality • Sexual behavior • Sexual disinhibition

List of Abbreviations

AD Alzheimer’s disease

FTD Frontotemporal dementia

IPA International Psychogeriatric Association

ISB Inappropriate sexual behaviors

MRI Magnetic resonance imaging

A. Verdelho (*)

Department of Neurosciences and Mental Health, Centro Hospitalar Lisboa Norte-Hospital de Santa Maria, Instituto de Medicina Molecular (IMM) and Instituto de Saude Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it

M. Gonfalves-Pereira

CEDOC, Chronic Diseases Research Center, Nova Medical School, Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Campo Martires da Patria 130,

1169-056 Lisboa, Portugal e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it

© Springer International Publishing Switzerland 2017 251

A. Verdelho, M. Gonfalves-Pereira (eds.), Neuropsychiatric Symptoms of Cognitive Impairment and Dementia, Neuropsychiatric Symptoms of Neurological Disease, DOI 10.1007/978-3-319-39138-0_11

SSRI Selective serotonin reuptake inhibitors

VD Vascular dementia

Clinical Example 1

Graga is 82 years old. Alzheimer’s disease was diagnosed 5years ago. She has been living in a nursing home for 3 years, initially seeming very well adapted to the place and interacting with the staff in positive ways. There were no relevant behavioral changes, and her participation in basic activities of daily living was overall adequate. One day, she suddenly started manipulating her genitals, no matter where she was in the nursing home or with whom. When asked about what she was doing, she seemed not to realize that this looked inappropriate. She would interrupt for a few minutes only to restart again. The staff repeatedly asked her to stop, which Graga was momentarily able to do, although eventually restarting over and over. During the weekly visits of the family, she exhibited the same behavior in front of even her grandsons, which was difficult to explain and embarrassed everyone. Graga was not aware of the impact of all this for other residents and for her own family. The neurologist was asked to medicate her, as “things are getting worse with her dementia, she is now completely out of her mind"

After a neurological observation, there was no relevant deterioration in cognitive and overall behavioral symptoms (compared to before the “sexual” behaviors began) and no recent neurological changes. Urinary samples were collected and a urinary tract infection was diagnosed. Appropriate antibiotic treatment was started and the symptoms disappeared in 48 h. This happened 1 year ago and she remains asymptomatic.

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