Treatment of Inappropriate Sexual Behavior in Persons With Dementia: A Systematic Review

Inappropriate sexual behavior (ISB), such as sexual touching and sexual exposure, occurs in up to 25% of people with dementia. This systematic review examines the effectiveness of pharmacologic and non-pharmacologic interventions to manage ISB in persons with dementia.

Systematic review without meta-analysis (PROSPERO: CRD42023469625). We searched MEDLINE, APA PsycInfo, Embase, JBI EBP Database, CENTRAL, CDSR, and Ageline databases, with no limits on study date or language, from inception until September 8, 2023. All study designs were eligible for inclusion if they examined the effectiveness of any pharmacologic or non-pharmacologic intervention in adults with dementia and ISB. Two reviewers independently completed all study screening, data abstraction, and risk of bias assessments. The JBI Critical Appraisal Checklist was used to determine the quality of case studies and case series, and the Cochrane RoB 2 was used to appraise the one randomized controlled trial. Findings were synthesized using vote counting based on the direction of effect.

We included 74 studies, of which 60 were case studies, 13 were case series, and one was a randomized trial. Most studies (64%) reported exclusively pharmacologic interventions. Non-pharmacologic interventions (e.g., distraction, environmental modification) were associated with improvement or resolution of ISB in 33 (72%) instances; however, only five (21%) cases improved or resolved without co-prescribed pharmacotherapy. Among men, hormonal treatments, including progestins and anti-androgens, led to a reduction in ISBs more frequently than antipsychotics, antidepressants, or anticonvulsants.

Nonpharmacologic interventions can be effective at reducing ISB, though pharmacologic interventions are also frequently needed. Randomized trials of nonpharmacologic and pharmacologic intervention effectiveness and safety are needed to guide practice.