Displays of inappropriate sexual behaviour by patients with progressive cognitive impairment: the forgotten form of challenging behaviour?

Abstract

Persons with progressive cognitive impairment such as dementia or Alzheimer's disease may display an array of challenging behaviours. For instance, levels of agitation and aggression have been reported as high as 33% in home-dwelling individuals and 80% in those residing in institutions. One form of challenging behaviour that may be displayed by this group is inappropriate sexual behaviour (ISB), but it is often overshadowed by other behaviours such as aggression. Inappropriate sexual behaviour involves any verbal of physical action of a sexual nature which is displayed in an inappropriate social context. Examples of ISB include: exposure of genitals in public/ward environments, 'groping' of nurses and masturbation in public areas. It has been estimated that the prevalence of ISB ranges from 2% to 17% of individuals with progressive cognitive impairment. Although it is less frequent than other challenging behaviours, it still may have significant deleterious effects on the victim's health. This paper is a review of the available literature on the nature, effects and management of ISB in persons with progressive cognitive impairment. Possible avenues for future research are also explored.