Sunday, February 17, 2013

Alzheimer’s Disease and Inappropriate Sexual Behavior

Is it normal for my grandfather, who has Alzheimer's and dementia, to be acting inappropriately towards other people?

Q: My grandfather has mild to moderate Alzheimer's and dementia. Is it normal for him to be acting inappropriately around other people and making sexual advances towards his caregiver? What can we do to make this stop? Any suggestions?

A: One of the things that happens sometimes in people with dementia is that they lose some of their social inhibitions, due to some of the changes in their brains.

Sometimes a person who is making sexual advances is simply lonely or in need of affection. Also, he may think his caregiver is someone else, such as a spouse or someone from his past. And if the person who is making the sexual advances had boundary issues throughout his life the behavior often becomes worse with the onset of the disease.

It's usually not possible to reteach appropriate behaviors, but there are some other things that you might try:

  • Make sure that your grandfather’s caregiver does nothing to tempt him, that she dresses and behaves modestly. Sometimes the person with Alzheimer’s is misinterpreting cues.
  • Help her come up with some firm responses to your grandfather, such as, 'Mr. Smith, do not say that to me please” or “Mr. Jones, that is inappropriate, please do not say that to me! Teach her to walk away from him when he behaves this way”. It's important not to reinforce the behavior with attention.
  • Is there a particular time or place it is happening? During dressing or bathing, for example? If so, help the caregiver think about how to do these tasks in a very matter of fact way.
  • Switching to a male caregiver may make this problem disappear.
  • If all else fails, ask his doctor about medications that may dampen his sexual ardor. This should be a last resort, however. It does not always work, can have unwanted side effects, and physicians are often reluctant to try this.


I would suggest a behavioral neurologist evaluation, as they will know the best medications to use. I have used Tegretol with some success. Others have used Depakote and other medications. I recall someone reported on a novel medication to suppress sexual desire in demented patients. I think it was Cimetadine, but You should do a search and talk to a behavioral neurologist.

It can be very embarrassing for a spouse or family member but it is very common. My husband has been in a nursing home and now in an Alzheimer's unit for the last two and a half years. I like the Alzheimer's unit better because they know how to deal with behaviors better than a regular nursing home. They aren't shocked by their behavior and that helps me! It takes a special kind of nurse to work with dementia patients. I think they deserve more than they get for doing what they do.  Good Luck

My father was prone to making sexually suggestive comments to caregivers at an Assisted Living facility after his Alzheimer’s had progressed - and that was definitely not his normal behavior. Generally I just told him that it was inappropriate to behave that way. One time I told him that his behavior embarrassed me - he apologized the following day. But an apology is as temporary as the moments they recognize people or have moments of clarity.  Hopefully the staff is familiar with Alzheimer’s patients such that they have ways to address with such behaviors.

If the person make the sexual advances is doing so at home to caregivers that are family or friends, it is time to consider an assisted living facility. It is also important that everyone around him, at home, is firm that this behavior is inappropriate, even if you have to repeat it often.  If you cannot move the patient to an assisted facility or hire a professional male caregiver, ask his doctor about medications that may dampen his sexual ardor.

The families of Alzheimer’s sufferers must come to grips that as the disease progresses their loved ones come to a point that they are no longer the person they knew or were in love with.

Presentation of sexually inappropriate behavior

Table 1

Patient characteristics with sexually inappropriate behavior in demented elderly patients

  Figure 1

Figure 1

Twenty six (63.4%) had behavioral treatment, 18 (43.8%) were taking antipsychotics, three (7.3%) were receiving hormonal therapy, and six (14.6%) were taking cholinesterase inhibitors. Behavioral treatment was more commonly seen in the community sample (81%) than in NH sample (45%) (p = 0.01) (fig 2).

  Figure 2

According to the Alzheimer’s Association, about 50 percent+ of men with Alzheimer’s experience erectile dysfunction.

Most people with Alzheimer's disease lose sexual drive as well as their ability to function, but many, especially male patients exhibit behaviors including: inappropriate sexual advances, lewd remarks, telling sexually related stories, touching, or public masturbation. Sometimes inappropriate sexual behavior combines with aggression and this is obviously a much more serious problem that can be very difficult to manage, especially when the caregiver is an older spouse.

Tips for Coping with Sexually Inappropriate Behavior

Coping is often a matter of trial and error. First, it may be best to monitor the behavior and keep a diary. Record what is happening, at what time, where the behavior is occurring, and the antecedents (anything that occurs before the behavior). Take notes about who is present, what are they saying or doing, in fact anything that helps put together a profile. If you can manage do this for a few days with minimal intervention it may help when you analyze the information. The information may also help a doctor or psychologist should the behavior be serious enough to seek their help.

Sometimes this information can help you rearrange a persons' day, or avoid contact with a person that may be the target of the behavior. Maybe change the time of day a visit takes place, getting someone else to take over an activity, and so on.

Here are a few more general caregiving tips you can try:

* Use a kind instruction to stop the behavior. Humorous sentences can be good. Try not to sound demanding or angry as this generally has the opposite effect to the one you want. Some people do however require firmer instructions than others.

* Try redirecting the person to another activity.

* Try different approaches, and just because an approach did not work once, does not mean it will not work again.

* Try using different instructions, saying it in a different way, if they do not respond to being asked to stop. Use simple, short sentences as complexity generally adds to confusion.

* Stop any access of patient to pornography on the Internet, magazines, videos, etc.

This See also:
How can I keep my father, who has dementia, from losing things?
See all 691 questions about Alzheimer's and Other Dementias means that their ability to distinguish what is or is not socially appropriate is no longer working right. This can manifest itself in different ways: saying embarrassing things to people, picking up a plate and licking it, or making sexual advances, for example.


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