Managing Your Patient’s Libido

Medications May be of Limited Use for Treatment of Sexual Aggression in Dementia

Kiran Rabheru, MD, CCFP, FRCP(C)
Active Staff, Geriatrics
Psychiatry, London Psychiatric Hospital, London, ON

Until recently, most studies in dementia have focussed almost exclusively on cognitive dysfunction, rather than on the behavioural and psychological disturbances that occur in dementia (BPSD), which are often far more disturbing to the patient's caregivers. Specifically, there is very little published literature on inappropriate sexual behaviour in dementia (ISBsD). A stereotypic view of older adults as sexless, as well as relative disinterest in studying their patterns of sexual behaviour, have probably contributed to this lack of research into this important area.

From the neurologic viewpoint, the limbic system is the source of libido. Illnesses that damage the limbic system, with few exceptions, reduce the libido. Hence, in up to one third of patients with dementia, the change in sexual behaviour is one of sexual apathy. However, in patients with Alzheimer's dementia, hypersexuality and inappropriate sexual expression can also occur, and has been reported in 2 to 7% of these patients. Changes in the frontal lobe can cause alterations in personality such as disinhibition. Damage to the bilateral temporal lobe as a result of trauma, Herpes simplex, encephalitis, infarctions, and rarely, Alzheimer's or frontal lobe dementia (FLD) (e.g.