Risk management and treatment of sexual disinhibition in geriatric patients

Upwards of 7% of cognitively impaired elderly are reported to exhibit sexually disinhibited behaviors. These behaviors may be the result of either a chronic history of sexual disinhibition, regression, or sequel to a stroke, surgical intervention, vascular insult, blow to the head, or cardiac event in which observed cognitive deterioration is the acute symptom. Elderly patients who are sexually disinhibited may exhibit a behavior that makes it difficult to manage them at home or in a nursing home.

A review of the treatment of sexual disinhibition with neurohormones is presented; guidelines for assessing risk and risk management are proposed; and a five-year study with 39 geriatric out patients with cognitive impairment and sexual disinhibitions reviewed. Case examples of sexual aggressives are followed by treatment recommendations in which an algorithm is presented.

The treatment algorithm recommends beginning selective serotonin reuptake inhibitors medication before considering estrogen (preferably a patch) or antiandrogen therapy. The estrogen patch led to excellent treatment results in elderly demented men with sexual disinhibition.

Elderly demented patients who are sexually disinhibited may be managed successfully with neurohormones if SSRI medication proves unsuccessful.