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Alzheimer's Disease and Sexuality

Maintaining Intimacy, Managing Difficult Behavior

By James Clyde Sellman, Ph.D.

Updated July 24, 2008

(LifeWire) -- Besides memory loss and impaired thinking, Alzheimer's disease can produce daunting changes in behavior and personality. It is impossible to say how the disease will unfold for a given individual, but in some cases, it brings about unwelcome sexual -- or seemingly sexual -- behaviors.

For spouses and loved ones, such changes underscore the impact of the disease on even the most intimate of relationships. It is vital, though, to remember that this behavior is a result of the disease -- or possibly other health issues or medications -- not an intentional choice of the individual.

Diminished Inhibitions, Disconcerting Behavior

Individuals with Alzheimer's may experience reduced sexual interest or -- less often -- sharply increased sexual interest or acting out, known as hypersexuality. Problem behavior can include jealous accusations that a spouse is having an affair, sexual overtures to a nonspouse or masturbation in public.

Other inappropriate behaviors, such as use of vulgar or obscene language, exposing oneself or undressing in public (collectively termed "disinhibition"), may not be sexual at all but can be construed as such by others.

Managing Behavior Without Drugs

In a 2007 article in Geriatric Nursing, Ethel Mitty and Sandi Flores noted that people with Alzheimer's increasingly communicate through behavior instead of speech, and as the disease deprives them of cultural norms and personal history, their behavior can become jarringly uncharacteristic.

The Alzheimer's Association advises family and friends of individuals with Alzheimer's to:

  • Avoid becoming angry at, arguing with or embarrassing the person; try to be gentle and patient.
  • Seek a reason for the behavior; for example, someone who disrobes in public may simply be hot or tired or may find their clothing uncomfortable.
  • Gently but firmly remind the individual that the behavior is inappropriate.
  • Try distracting or redirecting the person's attention, or, if necessary, take him or her someplace private.
  • Try increasing the level of appropriate physical attention, hugs, stroking the hair, massage, etc.; sexual advances may reflect a need for reassuring contact.
  • Consider practical solutions; for inappropriate disrobing, try putting trousers or dresses on backward or carrying extra (more comfortable) clothing with you during outings.
  • Keep in mind the possibility of depression, medication side effects or interactions, which can reduce interest in sex or trigger inappropriate behavior.
  • Consult a specialist in Alzheimer's or dementia or a geriatric psychologist.

Urgent intervention is needed if the person becomes physically aggressive or violent. Have a plan of action in place, whether it be calling on family members, friends or the police for help. It may also become necessary to move the individual to a care facility better equipped to handle such behavior.

Medications

As all medications have side effects -- and the potential for interacting with other medications -- nonmedication strategies are preferable. If these strategies do not resolve matters, though, here are some medication options for various underlying or accompanying issues:

  • Aggression, agitation and delusions. So-called atypical antipsychotics, such as Risperdal (risperidone) or Zyprexa (olanzapine), or older medications, such as Haldol (haloperidol), have been used to address these behaviors. However, it should be noted that in a recent study, short-term use of antipsychotics among people with dementia was associated with an increased risk of hospitalization or death. Anticonvulsants, such as Depakene (sodium valproate) or Tegretol (carbamazepine), originally used in treating epileptic seizures, are sometimes employed as well to treat difficult behaviors.
  • Depression, irritability and apathy. Antidepressants, such as Selective Serotonin Reuptake Inhibitors (SSRIs) and Celexa (citalopram) or Zoloft (sertraline), have been described for depression. Cholinesterase inhibitors, such as Aricept (donepezil), slow Alzheimer's progression and help with various behavioral issues.
  • Fearfulness, anxiety and sleep disturbances.Tranquilizers, such as the benzodiazepines Ativan (lorazepam) or Serax (oxazepam), are best as a short-term solution. They can cause dizziness, impair balance and worsen cognitive symptoms; they can also result in physical dependence.
  • Drug side effects or interactions. To minimize such problems, your doctor may suggest switching drugs or changing the dosages or schedule by which medications are administered.

Balancing the Sexual Rights of People with Alzheimer's and Their Partners

Sexuality is a fundamental part of human existence, and sex is an important way of sharing closeness and expressing love. Many people, though, have difficulty accepting that older adults or those who have serious illnesses still have sexual needs and the right to express them.

In long-term care facilities, sexual needs can endure even after people no longer recognize their spouses or remember that they are married. Occasionally, this results in extramarital nursing home relationships, which can raise awkward issues.

Most long-term care facilities have established policies regarding relationships and sexual behavior. Major concerns include avoiding any sexual exploitation, abuse or assault and determining the individuals' ability to give meaningful consent.

The impact of Alzheimer's on awareness and rational thinking ultimately destroys the ability to consent. A partner seeking sexual intimacy with someone at this stage of dementia can face difficult ethical questions and may decide to forgo sex altogether -- or seek it outside the relationship.

On the other hand, caregivers may experience a loss of desire. It is hard to feel attractive or aroused when providing day-in, day-out care for someone with dementia. Guilt about placing one's spouse in a nursing home can also dampen sexual desire.

Therapists, particularly geriatric psychologists, can help make sense of these issues and how to resolve them. Religious or spiritual advisers may be another source of counsel. The Alzheimer's Discussion Forum can be a solid source of support and suggestions in these situations. In addition, the Family Caregiver Alliance offers valuable resources, and the Alzheimer's Association has local chapters and more than 1,500 support groups nationwide.

For more information, see:

Sources:

"Alzheimer's Disease." About.com. 31 Jul 2007. About.com, Inc., A part of The New York Times Company. 12 Jun 2008. <http://adam.about.net/reports/Alzheimer-s-disease.htm#adamHeading_3>.

"Behavioral Symptoms." Alz.org. 20 Mar 2008. Alzheimer's Association. 7 Jun 2008. <http://www.alz.org/professionals_and_researchers_behavioral_symptoms_pr.asp>.

"Dementia: Drugs Used to Relieve Behavioural Symptoms." Alzheimers.org. Mar 2004. Alzheimer's Society [U.K.]. 20 Jun 2008. <http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=110>.

"Inappropriate Sexual Behaviors." ADEAR: Alzheimer's Disease Education and Referral Center. 26 Oct 2007. National Institute on Aging. 11 Jun 2008. <http://www.nia.nih.gov/nia.nih.gov/Templates/ADEARCommon/ADEARCommonPage.aspx?NRMODE=Published&NRNODEGUID=%7b0498243A-C02B-432F-AE2F-AF9A46B5856D%7d&NRORIGINALURL=%2fAlzheimers%2fPublications%2fchallenging%2ehtm&NRCACHEHINT=Guest#sexual>.

"Inappropriate Sexual Behavior and Alzheimer's Disease." About.com. 17 Sep. 2006. About.com, Inc., A part of The New York Times Company. 20 Jun. 2008 <http://alzheimers.about.com/od/challengingbehavior/a/alz_inapp_behav.htm>.

Miller, Lisa J. "The Use of Cognitive Enhancers in Behavioral Disturbances of Alzheimer's Disease." The Consultant Pharmacist. 22:9(2007): 754-62. <http://www.seniorcarepharmacy.org/publications/tcp/.> (subscription)

Mitty, Ethel, and Sandi Flores. "Assisted Living Nursing Practice: The Language of Dementia: Theories and Interventions." Geriatric Nursing. 28:5(2007): 283-88. <http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WG2-4PV1MCH-9&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=ea115c376524b07807ea0fe44df77f2a>. (subscription)

"Sexual Health: Working Definitions, 2003." WHO.int. 2003. World Health Organization. 15 Jun 2008. <http://www.who.int/reproductive-health/gender/sexual_health.html.>

"Sexuality [Alzheimer's Association Topic Sheet]." Alz.org. Oct 2004. Alzheimer's Association. 15 Jun 2008. <http://www.alz.org/national/documents/topicsheet_sexuality.pdf>.

"Sexuality and Dementia Coping with Changes in Your Intimate Relationship." Caregiver.org. 2001. Family Caregiver Alliance/National Center on Caregiving. 21 Jun 2008. <http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=782.>

"Sexuality and Dementia Information Sheet." Alzscot.org. Oct 2003. Alzheimer Scotland. 21 Jun 2008. http://www.alzscot.org/downloads/sexuality.pdf


"The Changing Brain in Alzheimer's Disease." National Institute on Aging. 29 Aug 2006. National Institute on Aging, National Institutes of Health. 9 Jun 2008. <http://www.nia.nih.gov/Alzheimers/Publications/UnravelingTheMystery/Part1/ChangingBrainInAlzheimer.htm>.

LifeWire, a part of The New York Times Company, provides original and syndicated online lifestyle content. James Clyde Sellman is a freelance writer and editor in Newton, Mass., who specializes in a broad range of consumer health topics. His work has appeared in the Harvard Health Letter, Harvard Women's Health Watch, Revolution Health (www.revolutionhealth.com), Infertility Source (www.infertilitysource.com) and My Student Body.com (www.mystudentbody.com).

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