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Approach to inappropriate sexual behaviour in people with dementia.

OBJECTIVE
To provide family physicians with an update on the approach to diagnosis and management of inappropriate sexual behaviour (ISB) in persons with dementia.


SOURCES OF INFORMATION
MEDLINE and EMBASE were searched for relevant articles published before June 2012. No level I studies were identified; most articles provided level III evidence.


MAIN MESSAGE
Inappropriate sexual behaviour is common in people with dementia. A variety of factors (eg, cultural, religious, societal views of geriatric sexuality, medicolegal issues) might complicate evaluation of this behaviour, and must be considered to allow suitable management of individual patients. Tools to assist in documenting ISB are available. Creative nonpharmacologic interventions for ISB might be effective when tailored to individual patients. A number of drug treatments (eg, antidepressant, antiandrogen, antipsychotic, and anticonvulsant medications) have been proposed for symptoms that do not adequately respond to nonpharmacologic interventions. However, evidence to support drug treatments is limited, adverse effects remain an important consideration, and it is unclear which should be used as first-line versus second-line treatments.


CONCLUSION
Although there is no empirically established treatment algorithm for dementia-related ISB, existing literature provides some evidence for various nonpharmacologic and pharmacologic treatments. Further high-quality research is urgently needed to guide family physicians who manage patients with dementia-related ISB.