INAPPROPRIATE SEXUAL BEHAVIOR IN THE CONTEXT OF DEMENTIA AND NEURODEGENERATIVE DISORDERS: A REVIEW OF THE LITERATURE.

Abstract

Background: The increasing prevalence of neurodegenerative disorders in the context of global population aging, has led to a growing incidence of Behavioral and Psychological Symptoms in Dementia (BPSD). Among these, Inappropriate Sexual Behavior (ISB) constitutes a particularly challenging and underrecognized issue for healthcare providers, patient and their family. Despite its clinical, ethical, and institutional implications, ISB remains insufficiently studied and poorly understood in the field of geriatric psychiatry.

Subjects and methods: A literature review was conducted using publications from 2004 to 2024, identified across multiple databases (PubMed, Cochrane, Scopus, Cairn, Psychinfo). Search terms included: "sexuality in older adults," "dementia and sexuality," "sexual behavior disorders," and "affective, cognitive needs in geriatric psychiatry."

Results: Sexual expression persists as a fundamental human need in older adults, including those with dementia, yet it is frequently misinterpreted or pathologised. ISB in dementia may stem from multifactorial etiologies, including neuroanatomical changes, unmet emotional, relational needs, medication side effects, comorbid conditions, or pre-existing personality traits. Distinguishing ISB from paraphilic or deviant sexual behaviours necessitates a nuanced, individualised, and contextually informed assessment. Structured tools can aid in the systematic evaluation and monitoring of ISB. Management strategies should prioritise non-pharmacological interventions as first-line approaches. Pharmacological treatments are considered only in refractory cases.

Conclusion: ISB in dementia demands a comprehensive, interdisciplinary, and person-centered approach. Greater clinical awareness, standardized diagnostic frameworks, and robust empirical research are urgently needed to inform effective and ethically sound interventions, ultimately improving patient and caregiver outcomes.