Sexuality and couple intimacy in dementia.
OBJECTIVE
The review assesses recent research and its impact on understanding of intimacy and sexuality in older adults with dementia.


RESULTS
There is no universally accepted definition of inappropriate sexual behaviors (ISBs), but they have been divided into overt acts associated with increased libido and uninhibited sexual behaviors directed at oneself or other people. Couples affected by dementia frequently maintain physical intimacy. Nonintercourse intimate activities may be preferred over intercourse. Early therapeutic interventions may assist partners in modifying activities, behaviors, and expectations about the future of the relationship. Inappropriate sexual behaviors are commonly due to the disruption of interconnected brain structures. Trauma to the temporal lobes may lead to hypersexuality and ISB. Trauma to the limbic system can produce changes in sexual preference. Both temporal and frontotemporal dementias, or either of them, often present with socially and sexually inappropriate behaviors. Huntington's disease can exhibit hypersexuality, pedophilia, promiscuity, and marital infidelity. The involvement of the medial striatum of the basal ganglia in this disease explains the prevalence of ISB. There is no consensus regarding first-line pharmacotherapy for ISB. Little information is known about the adverse effects.


CONCLUSIONS
Clinicians and society need to consider how dementia might affect physical intimacy.
Program of Studies in Sexuality, Department and Institute of Psychiatry, Medical School, University of São Paulo (FMUSP), São Paulo, Brazil.
Carmita H N
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Abdo
D000368:Aged; D026688:Bioethical Issues; D003704:Dementia / Q000523:psychology*; D006801:Humans; D007398:Interpersonal Relations; D008875:Middle Aged; D012725:Sexual Behavior; D012747:Sexual Partners / Q000523:psychology; D019529:Sexuality