The Complex Nature of Inappropriate Sexual Behaviors in Patients with Dementia: Can We Put it into a Frame?

Abstract

Sexuality constitutes an inseparable aspect of human life, strongly influenced and affected by the social environment. Similarly, it plays a crucial role on how people assess themselves and relate to others. Elderly sexual needs are similar to those of younger people, but may vary in frequency, intensity and expression. Sexual activity may show fluctuations across lifespan, gradually declining with age; however, it is not uncommon for a significant percent of elderly to remain sexually active. As for patients with dementia, there is either an increase or even a decline in sexual desire, which means less sexual activity especially in cases of severe cognitive dysfunction. Often sexuality in patients with dementia may arise as Inappropriate Sexual Behavior (ISB) due to behavioral disinhibition which is a common pattern of the disease. The present review examines sexual function and behavior in patients with dementia considering a number of aspects including but not limited to possible causes and interpretations, its associated anatomy, neurochemistry, pathophysiology and treatment.