Skip to main content
American Journal of Alzheimer's Disease and Other Dementias logoLink to American Journal of Alzheimer's Disease and Other Dementias
. 2008 Aug-Sep;23(4):344–354. doi: 10.1177/1533317508318369

Pharmacotherapy for Inappropriate Sexual Behaviors in Dementia: A Systematic Review of Literature

Banu Ozkan 1, Kirsten Wilkins 2, Sunanda Muralee 3, Rajesh R Tampi 4
PMCID: PMC10697387  PMID: 18509106

Abstract

The aim of this study is to systematically review the published literature on pharmacotherapy for inappropriate sexual behaviors in dementia. Literature search of the 5 databases (PubMed, MEDLINE, EMBASE, PsychINFO, and COCHRANE collaboration) and the analysis of the data available for the pharmacotherapeutic treatments of inappropriate sexual behaviors in dementia were carried out.There are no published randomized controlled trials of pharmacotherapy for inappropriate sexual behaviors in dementia, but available data from uncontrolled trials, case series, and individual case reports suggest efficacy for antidepressants, antipsychotics, mood stabilizers, hormonal agents, cimetidine, and pindolol for the treatment of these behaviors. Although there are no controlled data for the treatment of inappropriate sexual behaviors in dementia, available data suggest efficacy for some commonly used pharmacotherapeutic agents.

Keywords: inappropriate sexual behaviors, hypersexuality, behavioral disturbances in dementia, neuropsychiatric symptoms of dementia

Full Text

The Full Text of this article is available as a PDF (130.5 KB).

Contributor Information

Banu Ozkan, Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.

Kirsten Wilkins, Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.

Sunanda Muralee, Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.

Rajesh R. Tampi, Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, rajesh.tampi@yale.edu .

References

  1. Mortimer JA Alzheimer's disease and senile dementia: prevalence and incidence . In: Reisberg B, ed. Alzheimer's Disease: The Standard Reference. New York, NY: Free Press; 1983:141-148. [Google Scholar]
  2. Aggarwal NT, Decarli C. Vascular dementia: emerging trends. Semin Neurol. 2007;27:66-77. [DOI] [PubMed] [Google Scholar]
  3. Bharucha AJ, Rosen J., Mulsant BH, Pollock BG Assessment of behavioral and psychological symptoms of dementia. CNS Spectr. 2002;7:797-802. [DOI] [PubMed] [Google Scholar]
  4. Black B., Muralee S., Tampi RR Inappropriate sexual behaviors in dementia. J Geriatr Psychiatry Neurol. 2005; 18:155-162. [DOI] [PubMed] [Google Scholar]
  5. Kamel HK, Hajjar RR Sexuality in the nursing home, part 2: managing abnormal behavior-legal and ethical issues. J Am Med Dir Assoc. 2004. ;5(suppl 2):S48-S52. [DOI] [PubMed] [Google Scholar]
  6. Burns A., Jacoby R., Levy R. Psychiatric phenomena in Alzheimer's disease. IV: disorders of behaviour. Br J Psychiatry. 1990;157:86-94. [DOI] [PubMed] [Google Scholar]
  7. Szasz G. Sexual incidents in an extended care unit for aged men. J Am Geriatr Soc. 1983;31:407-411. [DOI] [PubMed] [Google Scholar]
  8. Levitsky AM, Owens NJ Pharmacologic treatment of hypersexuality and paraphilias in nursing home residents. J Am Geriatr Soc. 1999;47:231-234. [DOI] [PubMed] [Google Scholar]
  9. Tsai SJ, Hwang JP, Yang CH, et al . Inappropriate sexual behaviors in dementia: a preliminary report . Alzheimer Dis Assoc Disord. 1999;13:60-62. [DOI] [PubMed] [Google Scholar]
  10. Alagiakrishnan K., Lim D., Brahim A., et al. Sexually inappropriate behaviour in demented elderly people. Postgrad Med J. 2005. ;81:463-466. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Bradford JM The neurobiology, neuropharmacology, and pharmacological treatment of the paraphilias and compulsive sexual behaviour. Can J Psychiatry . 2001;46:26-34. [DOI] [PubMed] [Google Scholar]
  12. Meston CM, Frohlich PF The neurobiology of sexual function. Arch Gen Psychiatry . 2000;57:1012-1030. [DOI] [PubMed] [Google Scholar]
  13. Bradford JM The paraphilias, obsessive compulsive spectrum disorder, and the treatment of sexually deviant behaviour. Psychiatr Q. 1999;70:209-219. [DOI] [PubMed] [Google Scholar]
  14. Potocnik F. Successful treatment of hypersexuality in AIDS dementia with cyproterone acetate. S Afr Med J. 1992;81:433-434. [PubMed] [Google Scholar]
  15. Huws R., Shubsachs AP, Taylor PJ Hypersexuality, fetishism and multiple sclerosis. Br J Psychiatry . 1991;158: 280-281. [DOI] [PubMed] [Google Scholar]
  16. Cooper AJ Medroxyprogesterone acetate (MPA) treatment of sexual acting out in men suffering from dementia. J Clin Psychiatry. 1987;48:368-370. [PubMed] [Google Scholar]
  17. Persinger MA Maintained hypersexuality between male rats following chronically induced limbic seizures: implications for bisexuality in complex partial epileptic seizures. Psychol Rep. 1994;74:647-652. [DOI] [PubMed] [Google Scholar]
  18. Lilly R., Cummings JL, Benson DF, Frankle M. The human Kluver-Bucy syndrome. Neurology. 1983;33:1141-1145. [DOI] [PubMed] [Google Scholar]
  19. Monga TN, Monga M., Raina MS, et al. Hypersexuality in stroke. Arch Phys Med Rehabil . 1986;67:415-417. [PubMed] [Google Scholar]
  20. Blustein J. , Seeman MV Brain tumors presenting as functional psychiatric disturbances. Can Psychiatr Assoc J. 1972;17(suppl 2):SS59-SS63. [DOI] [PubMed] [Google Scholar]
  21. Bear DM, Fedio P. Quantitative analysis of interictal behavior in temporal lobe epilepsy . Arch Neurol. 1977; 34:454-467. [DOI] [PubMed] [Google Scholar]
  22. Miller BL, Cummings JL, McIntyre H., et al. Hypersexuality or altered sexual preference following brain injury. J Neurol Neurosurg Psychiatry. 1986. ;49: 867-873. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Mendez MF, Chow T., Ringman J., et al. Pedophilia and temporal lobe disturbances. J Neuropsychiatry Clin Neurosci. 2000;12:71-76. [DOI] [PubMed] [Google Scholar]
  24. Chae BJ, Kang BJ Quetiapine for hypersexuality and delusional jealousy after stroke. J Clin Psychopharmacol. 2006;26:331-332. [DOI] [PubMed] [Google Scholar]
  25. Kerbeshian J., Burd L. Tourette syndrome and recurrent paraphilic masturbatory fantasy. Can J Psychiatry. 1991. ; 36:155-157. [DOI] [PubMed] [Google Scholar]
  26. Janati A. Kluver-Bucy syndrome in Huntington's chorea. J Nerv Ment Dis . 1985;173:632-635. [DOI] [PubMed] [Google Scholar]
  27. Comings DE, Comings BG A case of familial exhibitionism in Tourette's syndrome successfully treated with haloperidol. Am J Psychiatry. 1982;139:913-915. [DOI] [PubMed] [Google Scholar]
  28. Akil M., Brewer GJ Psychiatric and behavioral abnormalities in Wilson's disease. Adv Neurol. 1995;65:171-178. [PubMed] [Google Scholar]
  29. Bowers MB Jr, Van Woert M., Davis L. Sexual behaviors during L-dopa treatment for Parkinsonism. Am J Psychiatry. 1971;127:1691-1693. [DOI] [PubMed] [Google Scholar]
  30. Brown E., Brown GM, Kofman O., Quarrington B. Sexual function and affect in parkinsonian men treated with L-dopa . Am J Psychiatry. 1978;135:1552-1555. [DOI] [PubMed] [Google Scholar]
  31. Mc Lean PD Special award lecture: new findings on brain function and sociosexual behavior . In: Zubin J, Money J, eds. Contemporary Sexual Behaviors: Critical Issues in the 1970s. Baltimore, MD: Johns Hopkins University Press; 1973:53-74. [Google Scholar]
  32. Huang YS, Guilleminault C., Kao PF, et al. SPECT findings in the Kleine-Levin syndrome. Sleep. 2005;28:955-960. [DOI] [PubMed] [Google Scholar]
  33. Hashmi FH, Krady AL, Qayum F., Grossberg GT Sexually disinhibited behavior in the cognitively impaired elderly . Clin Geriatr. 2000;8:631-637. [Google Scholar]
  34. Aja A., Self D. Alternate methods of changing nursing home staff attitudes towards sexual behavior in the aged. J Sex Educ Ther. 1986. ;12:37-41. [Google Scholar]
  35. Young RC, Gyulai L., Mulsant BH, et al. Pharmacotherapy of bipolar disorder: review and recommendations . Am J Geriatr Psychiatry. 2001;12:342-357. [DOI] [PubMed] [Google Scholar]
  36. Lonergan ET , Cameron M., Luxenberg J. Valproate preparation for agitation in dementia [review]. Cochrane Database Syst Rev. 2004. ;(4):CD003945. 10.1002/14651858 .CD003945.pub2. [DOI] [PubMed] [Google Scholar]
  37. Sheldon LJ, Ancill RJ, Holliday SG Gabapentin in geriatric psychiatry patients. Can J Psychiatry . 1998;43:422-423. [PubMed] [Google Scholar]
  38. Alkhalil C. , Tanvir F., Alkhalil B., Lowenthal DT Treatment of sexual disinhibition in dementia: case reports and review of the literature . Am J Ther. 2004;11:231-235. [DOI] [PubMed] [Google Scholar]
  39. Miller LJ Gabapentin for treatment of behavioral and psychological symptoms of dementia . Ann Pharmacother. 2001;35:427-431. [DOI] [PubMed] [Google Scholar]
  40. Alkhalil C. , Hahar N., Alkhalil B., Zavros G., Lowenthal DT Can gabapentin be a safe alternative to hormonal therapy in the treatment of inappropriate sexual behavior in demented patients ? Int Urol Nephrol. 2003;35: 299-302. [DOI] [PubMed] [Google Scholar]
  41. Freymann N. , Michael R., Dodel R., Jessen F. Successful treatment of sexual disinhibition in dementia with carbamazepine-a case report. Pharmacopsychiatry . 2005; 38:144-145. [DOI] [PubMed] [Google Scholar]
  42. Aziz R., Lorberg B., Tampi RR Treatments for late-life bipolar disorder. Am J Geriatr Pharmacother . 2006;4: 347-364. [DOI] [PubMed] [Google Scholar]
  43. Tampi RR, van Dyck CH In: Miao-Kun Sun, ed. Chapter 11; Behavioral and Psychological Symptoms of Alzheimer's Disease. Research Progress in Alzheimer's Disease and Dementia. Hauppauge, NY: Blanchette Rockefeller Neuro-sciences Institute, Nova Publishers; ; 2006:251-272. [Google Scholar]
  44. Konovalov S. , Muralee S., Tampi RR Anticonvulsants for the treatment of behavioral and psychological symptoms of dementia: a literature review. Int Psychogeriatr. 2008; 20:293-308. [DOI] [PubMed] [Google Scholar]
  45. Death AK, McGrath KC, Handelsman DJ Valproate is an anti-androgen and anti-progestin. Steroids . 2005;70: 946-953. [DOI] [PubMed] [Google Scholar]
  46. Cummings JL Use of cholinesterase inhibitors in clinical practice: evidence-based recommendations . Am J Geriatr Psychiatry. 2002;11:131-145. [PubMed] [Google Scholar]
  47. Alagiakrishnan K., Sclater A., Robertson D. Role of cholinesterase inhibitor in the management of sexual aggression in an elderly demented woman . J Am Geriatr Soc. 2003;51:1326. [DOI] [PubMed] [Google Scholar]
  48. Chemali Z. Donepezil and hypersexuality: a report of two cases. Prim Psychiatry. 2003;10:78-79. [Google Scholar]
  49. Areosa SA, Sherriff F., McShane R. Memantine for dementia [review]. Cochrane Database Syst Rev. 2005;(18): CD003154. 10.1002/14651858.CD003154.pub5. [Google Scholar]
  50. Simpson DM, Foster D. Improvement in organically disturbed behavior with trazodone treatment . J Clin Psychiatry. 1986;47:191-193. [PubMed] [Google Scholar]
  51. Leo RJ, Kim KY Clomipramine treatment of paraphilias in elderly demented patients . J Geriatr Psychiatry Neurol. 1995;8:123-124. [DOI] [PubMed] [Google Scholar]
  52. Perilstein RD, Lipper S., Friedman LJ Three cases of paraphilias responsive to fluoxetine treatment. J Clin Psychiatry. 1991;52:169-170. [PubMed] [Google Scholar]
  53. McElroy SL, Phillip KA, Keck PE Obsessive compulsive spectrum disorder J Clin Psychiatry. 1994;55(suppl):33-53. [PubMed] [Google Scholar]
  54. Guidotti A. , Costa E. Can the antidysphoric and anxiolytic profiles of selective serotonin reuptake inhibitors be related to their ability to increase brain 3-alfa and 5-alfa-tetrahydroprogesterone (allopregnelone) availability ? Biol Psychiatry. 1998:44:865-873. [DOI] [PubMed] [Google Scholar]
  55. Stewart JT, Shin KJ Paroxetine treatment of sexual disinhibition in dementia. Am J Psychiatry. 1997;154:1474. [DOI] [PubMed] [Google Scholar]
  56. Raji M., Dongjie L., Wallace D. Sexual aggressiveness in a patient with dementia: sustained clinical response to citalopram. Ann Long Term Care. 2000;8:81-83. [Google Scholar]
  57. Mania I., Evcimen H., Mathews M. Citalopram treatment for inappropriate sexual behavior in a cognitively impaired patient. Prim Care Companion J Clin Psychiatry. 2006; 8:106. [DOI] [PMC free article] [PubMed] [Google Scholar]
  58. Nagaratnam N., Gayagay G. Hypersexuality in nursing care facilities-a descriptive study. Arch Gerontol Geriatr. 2002;35:195-203. [DOI] [PubMed] [Google Scholar]
  59. Maixner SM, Mellow AM, Tandon R. The efficacy, safety, and tolerability of antipsychotics in the elderly . J Clin Psychiatry. 1999;60(suppl 8):29-41. [PubMed] [Google Scholar]
  60. Macknight C. , Rojas-Fernandez C. Quetiapine for sexually inappropriate behavior in dementia. J Am Geriatr Soc. 2000;48:707. [DOI] [PubMed] [Google Scholar]
  61. Kobayashi T. Effect of haloperidol on a patient with hypersexuality following frontal lobe injury. Psychogeriatrics. 2004;4:49-52. [Google Scholar]
  62. Cooper AJ Progestogens in the treatment of male sex offenders: a review. Can J Psychiatry. 1986;31:73-79. [DOI] [PubMed] [Google Scholar]
  63. Mellor CS, Farid NR, Craig DF Female hypersexuality treated with cyproterone acetate. Am J Psychiatry. 1988; 145:1037. [DOI] [PubMed] [Google Scholar]
  64. Light SA, Holroyd S. The use of medroxyprogesterone acetate for the treatment of sexually inappropriate behaviour in patients with dementia. J Psychiatry Neurosci . 2006;31:132-134. [PMC free article] [PubMed] [Google Scholar]
  65. Weiner MF, Denke M., Williams K., Guzman R. Intramuscular medroxyprogesterone acetate for sexual aggression in elderly men. Lancet. 1992;339:1121-1122. [DOI] [PubMed] [Google Scholar]
  66. Lothstein LM , Fogg-Waberski J., Reynolds P. Risk management and treatment of sexual disinhibition in geriatric patients. Conn Med. 1997;612:609-618. [PubMed] [Google Scholar]
  67. Kyomen HH, Noble KW, Wei JY The use of estrogen to decrease aggressive physical behavior in elderly men with dementia. J Am Geriatr Soc. 1991;39:1110-1112. [DOI] [PubMed] [Google Scholar]
  68. Ott BR Leuprolide treatment of sexual aggression in a patient with dementia and Kluver-Bucy syndrome. Clin Neuropharmacol. 1995;18:443-447. [DOI] [PubMed] [Google Scholar]
  69. Rich SS, Ovsiew F. Leuprolide acetate for exhibitionism in Huntington's disease. Mov Disord. 1994;9:353-357. [DOI] [PubMed] [Google Scholar]
  70. Wiseman SV, McAuley JW, Freidenberg GR, Freidenberg DL Hypersexuality in patients with dementia: possible response to cimetidine . Neurology. 2000;54:2024. [DOI] [PubMed] [Google Scholar]
  71. Brunton LL, Lazo JS, Parker KL Goodman & Gilman's Pharmacological Basis of Therapeutics. http://www.accessmedicine.com/content.aspx?aID=946438. Accessed February 2, 2008. [Google Scholar]
  72. Jensen CF Hypersexual agitation in Alzheimer's disease. J Am Geriatr Soc. 1989;37:917. [DOI] [PubMed] [Google Scholar]
  73. Cohen RF, Swanwick GR, O'Boyle CA, Coakley D. Behaviour disturbance and other predictors of carer burden in Alzheimer's disease. Int J Geriatr Psychiatry. 1997;12:331-336. [PubMed] [Google Scholar]
  74. O'Donnell BF , Drachman DA, Barnes HJ, et al. Incontinence and troublesome behaviors predict institutionalization in dementia. J Geriatr Psychiatry Neurol. 1992;5:45-52. [DOI] [PubMed] [Google Scholar]

Articles from American Journal of Alzheimer's Disease and Other Dementias are provided here courtesy of SAGE Publications

RESOURCES