Hypersexuality in Dementia

Many behavioral and psychological symptoms of dementia can be hard to manage. These symptoms can cause a decline in the quality of life for the person with dementia and their caregivers. They can lead to a higher healthcare burden, more hospitalizations, and a worse overall outcome.^1,2

Hypersexuality, or sexual disinhibition, is a possible symptom of dementia that is especially hard to deal with. It can make spouses and other loved ones feel embarrassed, anxious, and scared. This affects both their physical and mental health.^1-3

What causes hypersexuality in patients with dementia?

There is little research into neurocognitive disorders and hypersexuality. Some people who have damage to the frontal and temporal regions of the brain have hypersexual behavior. But their condition, known as behavioral variant frontotemporal dementia (bvFTD), is different from Alzheimer's disease.¹

For people with Alzheimer's disease, a deficiency in gamma-aminobutyric acid (GABA) may play a part in behavioral problems. GABA is a chemical messenger in the brain called a neurotransmitter. GABA helps control nerve cell hyperactivity.^1,4

Having less GABA lowers nerve cell hyperactivity, which can lessen stress, fear, and anxiety. This means that inhibitions decrease. While there are GABA supplements that may help, it is not clear how effective they may be.^1,4

In some cases, there may be other medical causes of hypersexual behavior. Delirium that looks like neurocognitive disease can be caused by:¹

• Metabolic disturbances
• Electrolyte imbalances
• Infections
• Seizures or strokes

What are the signs of hypersexuality?

According to a 2022 review of studies, between 1.8 and 25 percent of people with dementia have sexually inappropriate behaviors. These behaviors may include:^1-3

1. Using sexual language they did not use before having dementia
2. Reading pornographic material
3. Asking for genital care from caregivers when there is no apparent need
4. Groping, public masturbation, or exposing themselves to family or caregivers

What are the treatments for hypersexuality in dementia?

There is no specific treatment for dementia-related hypersexuality. But the person's doctor will do a thorough review of their medical, social, and sexual history. All of their medicines should also be reviewed. This is because some medicines are known to lower sexual inhibitions or increase impulsivity in some people.^1,2

The person's doctor needs to know whether they have any history of mental illness or hypersexual behavior. Having a detailed timeline of symptoms is key to understanding this behavior.^1,2

Behavior interventions should be the first course of action. This type of treatment can include:¹

• Distracting the person by offering continual indoor and outdoor activities
• Limiting access to sexually stimulating material in magazines or on television
• Creating intimacy in nonsexual ways like sharing a meal or taking a walk together
• Patient and caregiver education
• Cognitive behavioral therapy (CBT) with a professional therapist

Healthcare workers and other caregivers must maintain a difficult balance, respecting the autonomy of the person with dementia while working to stop the inappropriate behavior. If the sexually inappropriate behavior is not stopped, the safety of others may be at risk. Protecting children and other vulnerable people is a major concern.^1-3

What if behavioral treatments do not work?

If behavioral treatments do not work, doctors may consider prescribing medicine. The first step is to make sure a drug fits the needs of the person with dementia.¹

Selective serotonin reuptake inhibitors (SSRIs) often are the first class of drug that doctors prescribe in cases of hypersexual behavior. SSRIs are chosen because they have relatively few side effects. SSRIs can reduce sex drive and obsessive behaviors.¹

Men with dementia and hypersexual behavior may benefit from hormone therapy that reduces their testosterone level. But there is not enough research on using drug therapy to treat women with hypersexual behavior to know its effect.¹

If the person with dementia is irritable with an unstable mood, antipsychotic drugs may be prescribed. But no antipsychotic has been approved by the US Food and Drug Administration (FDA) to treat behavior problems in people with dementia. And these drugs can cause harm. Hallucinations, stroke, and even death are possible.¹

Anticonvulsant drugs, which have been shown to be effective in small studies, may be another option. But no matter the drug, treatment should begin with the lowest possible dose.¹

Many of the drugs used to treat hypersexuality have troubling side effects. These side effects can lead to more rapid cognitive decline. If you have a loved one with persistent dementia-related hypersexual behavior, talk to their doctor about which medicine might be right for them.¹

Other things to consider

Consent is an issue when deciding on treatment for someone with dementia. The person may not be able to agree to treatment, so it is often up to family members to make treatment decisions.¹

It is important to address hypersexual behavior. If the behavior continues, the person with dementia may face negative consequences. For example, they could be refused housing at nursing homes or other inpatient facilities.¹

Caring for someone with hypersexual behavior can feel overwhelming. But try to remember that the illness is causing the person to act this way. It is not their fault. Though it may be hard to give at certain times, they always deserve compassion and support.⁵