Parkinson’s Sexually Inappropriate Behavior

Parkinsons Disease Sexual Issues For Couples

The demands and challenges of Parkinsons may derail a couples sexual dynamics. Issues may include:

• The person with Parkinsons has reduced mobility, which may force them to take a more passive role in lovemaking.
• Symptoms of Parkinsons tend to worsen at night, which may prompt the couple to sleep in separate bedrooms. This arrangement reduces opportunities for spontaneous sex.
• The couple may have firmly established roles. Parkinsons can dramatically change each persons role and this sudden unfamiliarity may stall aspects of the relationship, including sex.
• The way each person handles the diagnosis and daily demands of Parkinsons may cause friction. Communication problems can spill over into the bedroom.
• Parkinsons can disrupt a couples lovemaking routine in many ways. Further problems will arise if the couple are unable or unwilling to make changes to their sexual attitudes and habits.

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Nature Of Hypersexuality In Dementia

As with non-demented people, the range of sexual behaviours shown by people with dementia is very wide. In a study of 40 people with dementia living in a long-term care home, Reference Zeiss, Davies and TinklenbergZeiss et al systematically observed each of the residents on nine separate 5-minute occasions, coding for each minute of observation whether a sexual behaviour was present and if so whether it was appropriate, inappropriate or ambiguous. Examples of inappropriate behaviour were: making explicit sexual comments, touching someone other than a partner on the breast or genitals, touching a partner on the breast or genitals in public, exposing breasts or genitals in public. Many behaviours were coded as ambiguous, for example being undressed outside the bedroom or bathroom, or sitting with stilled hands cupped over genitals. Of the 1800 one-minute segments coded, inappropriate behaviour occurred in 27 and ambiguous behaviours in 67 . Only 18% of the individuals ever displayed inappropriate behaviour during observation, and a similar proportion, 20%, displayed appropriate sexual behaviour. A further 28% showed ambiguous behaviour.

Boxes 1 and 2 list major factors in the aetiology of changes in sexual behaviour in dementia.

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Box 3assessment Of Competency To Engage In A Sexual Relationship

Patients awareness of the relationship

Can the patient avoid exploitation?

Is the patient aware of potential risks?

For a competent patient, the situation is ethically clearer in that the choice is primarily for the patient to make. Staff may have a role in supporting this decision . Attitudes of staff are very variable, and teams will need to discuss these issues explicitly to ensure that staff are adequately trained and supported. Reference BarrettBarrett engagingly describes the difficulties that arose when an elderly non-demented man living in a residential home wished to pay for sexual services from female visitors.

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Physical Issues Of Your Sex Drive

Parkinsons affects ones autonomic nervous system, which controls sexual response and functioning. Parkinsons acts upon neurons in the brains substantia nigra, causing dopamine-producing nerve cells to die. Since dopamine is a chemical that transmits signals between parts of the brain that usually coordinate smooth muscle movement, this is critical to sexual function on two fronts.

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First, this dopamine drop may result in a decreased sex drive and sexual interest. Second, the lower levels of dopamine that result are believed to cause ones loss of balance, changes in walking pattern and posture, muscle rigidity, Bradykinesia , and tremors when resting. The symptoms of Parkinsons can also be seen in:

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Treatment For Parkinsons Disease Can Affect Sexuality

Parkinsons is incurable, but most of the symptoms are manageable with medication or surgery. However, medication can diminish sexual desire and reduce sexual response. Medication which improves motor or physical functions is mainly taken during the waking hours, lower levels at night may also affect sexual function. Some medications may cause an increase in desire , which is a rare side effect. Talk to your doctor about treatment side effects.

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Tips For A Better Sex Life With Parkinsons Disease

• Communicate: Be open with your partner about your feelings and discuss your physical needs. If the topic of sex causes upset or arguments, it might be worth seeing a sex therapist.
• Consider changing your medication: If your medication is having an impact on your sex life, talk to your doctor about an alternative treatment. Your sex life is important, so it should be given as much attention and care as your general health and wellbeing.
• Be open with your doctor: Dont be afraid to talk about sex with your doctor thats what your healthcare team is there for, and they will have dealt with these types of concerns before.
• Deal with fatigue and depression: Depression and fatigue can negatively impact your sex life, so look at ways of treating these symptoms. A combination of therapy and antidepressant medications may help, so talk to your doctor.

Parkinson’s And Male Sex Drive

Men with Parkinsons disease may experience difficulty obtaining/maintaining an erection or ejaculating during sexual intercourse.

Abnormalities in the function of the autonomic system may be one contributing cause of erectile dysfunction in men with PD. Erectile dysfunction in Parkinsons disease can also be directly related to the low dopamine levels of the brain.

Other common disorders related to aging, like diabetes, hypertension, and high cholesterol, can also contribute to erectile dysfunction.

Sildenafil can sometimes help with erectile dysfunction. Testosterone replacement therapy may also help with both erections and desire.

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Sex Drugs And Parkinson’s Disease

Mwiza Ushe Joel S. Perlmutter

Brain. 2013 136:371-373.

Dopaminergic therapy to relieve motor manifestations of idiopathic Parkinson’s disease may inadvertently cause inappropriate hypersexuality . Impulse control disorders that include gambling, eating and hypersexuality seem to occur more commonly with dopamine receptor agonist therapy than L-DOPA and can lead to substantial morbidity with social, psychological and legal consequences . The unregulated nature of direct dopamine receptor activation may provide potential clues to the underlying mechanisms. However, the pathophysiological basis for these behaviours remains unknown. Interestingly, dopaminergic pathways also play a key role in brain networks involved in the reward system, and pathological responses in this system may underlie addiction . Similarities between addictive behaviour and drug-induced hypersexuality in Parkinson’s disease suggest that they may share common pathological brain mechanisms. Thus investigations of brain regions and networks related to dopaminergic-induced hypersexuality in Parkinson’s disease could shed light on these potentially common underlying mechanisms and provide clues for rationale treatment. The study by Politis et al. in this issue of Brain takes an important step in this direction.

Tables

Bowel And Bladder Problems

Fear of incontinence during sexual activity may have a negative impact not only on self-esteem, but also on sexual arousal, especially in women with Parkinson’s or female partners.

If you experience urinary incontinence, certain drug treatments may be helpful. Emptying your bladder and avoiding drinks for two hours before intercourse may help with continence.

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The Motor And Autonomic Nervous System And Parkinsons Disease

Our sexual response and function are controlled by our motor and autonomic nervous systems. The loss of the brain chemical dopamine in people diagnosed with Parkinsons affects the motor and autonomic nervous systems.

This can directly cause a range of sexual problems . For example:

• motor or physical changes slowness of movement , tremor and rigidity may interfere with the practicalities of lovemaking
• both men and women may notice a reduced desire to participate in sexual activity
• fatigue associated with Parkinsons can reduce libido
• women may experience vaginal dryness

Examples Of Delusions In Pd

• Belief: Your partner is being unfaithful.
• Behavior: Paranoia, agitation, suspiciousness, aggression.

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How Parkinsons Affects The Libido

Parkinsons disease and the sex drive is a complicated issue. is a common complaint in patients with Parkinsons disease. However, certain PD medications particularly dopamine agonists can actually cause an increased sex drive in men and women, known as hypersexuality or sex addiction.

If this happens, and it is out of character for you, it is important to tell your doctor. Other side-effects of PD medications include psychosis and other impulsive behavior such as pathological gambling or heavy drinking. If you experience any of these symptoms, your doctor will most likely change your medication and monitor your mental health.

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Parkinsons And Female Sex Drive

Common sexual issues in women with Parkinsons disease include loss of lubrication and involuntary urination during sex. Sex can be uncomfortable because of a lack of lubrication and desire.

For women with PD who have experienced menopause, the decline in sexual interest may be due to both menopause and PD. Hormone replacement therapy may help the physical effects of menopause.

An added benefit is that such therapy can help keep bones strong and flexible. Never, however, take any hormonal supplements without consulting with your healthcare provider first.

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How Else Can I Help Myself

Parkinsons has an impact on sexual function and intimacy at many levels. Diagnosis may affect both partners emotionally, resulting in lack of desire. If you try to have sex or intimate relationships in this tense period, you will probably find it difficult because of anxiety and low mood. Fear of rejection, a lack of self-esteem and sexual difficulties can be upsetting and unsettling.

It is therefore very important to have plenty of supportive, intimate love during this period, and if you do encounter any sexual difficulties, talk to each other about them and dont give up. Dont be afraid to discuss your worries with your partner, your doctor or a therapist – communication is an important part of finding solutions. You may find books and website that give you good advice and enable you and your partner to discuss your sexuality more openly.

Motor symptoms, such as rigidity, tremor and bradykinesia may influence your flexibility and may mean that you need to take a more passive role. Some couples cope well with these role changes others need professional support to accommodate changes and physical limitations. Again, discussing the difficulties you experience is important in finding ways to overcome them.

Definition And Diagnostic Criteria

HS is defined by an abnormal, increased and recurrent sexual drive, which is associated with distress in personal and social life. Voon et al. proposed a list of diagnostic criteria, including: an excessive or atypical modification from baseline of the sexual thoughts and interests minimum duration of the behavior should

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On The Basis Of The Information So Far What Would You Expect The Mmse Score To Be

Your Colleagues Who Attended the Banner Alzheimers Institute Case Conference Answered as Follows:

Mr As MMSE score was 26/30. Mr As sentence and pentagon drawing from the MMSE are shown in Figure 1.The Montreal Cognitive Assessment is a 30-point test that assesses several cognitive domains. Because it is more challenging than the Mini-Mental State Examination, it has greater sensitivity for mild cognitive impairment and early stages of dementia. With a cutoff score < 26, the sensitivity for detecting mild cognitive impairment was 90% and the specificity was 87% . Research has demonstrated that MoCA scores are highly correlated with education. It is recommended that education be taken into account when interpreting MoCA performance, but there are no formal specific cutoff scores for lower education at this time . This test is available online at .

Personality Changes In The Elderly

Minor personality changes in older adults, such as becoming more irritable or agitated, are not unusual. Extreme personality changes, such as a passive person becoming very controlling, could be a sign of dementia due to changes in the brains frontal lobe.

A 2016 study suggests that older adults have different personality traits than those of younger people. For example, neuroticism tended to increase in adults in their 80s.

Some people may revert to a younger age as they grow older. This could be a sign of depression or a way to cope with aging.

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Causes Of Personality Changes

Grief, bad news, and disappointment can cause a normally happy person to become downtrodden. Sometimes, a persons mood can be altered for weeks or months after hearing devastating news. However, mood changes arent the same as personality changes.

However, some people experience unusual or strange behavior for years, which may occur due to an illness or injury. A person may experience a change in their demeanor after experiencing a traumatic situation or witnesses an unpleasant event.

These behavioral changes may be caused by a mental health condition, such as:

Medical conditions that cause a fluctuation in hormone levels can also cause strange or unusual behavior. These conditions include:

History Of Presenting Illness

At the time of the visit to Banner Alzheimers Institute, Mr A, who had now been on oral rivastigmine for several months, reported continued worsening of short-term memory. He was frequently disoriented to time and date. He was repetitive in conversations. He had difficulty maintaining a calendar and remembering appointments. Difficulty concentrating on tasks was also noted. Mr A was having more difficulty with reading and writing and misplacing items. He was able to remember peoples names and recognize familiar faces.

Most personal activities of daily living were maintained, but Mr A was experiencing greater difficulty performing instrumental activities of daily living. Although his Parkinsons disease had resulted in changes in fine motor movements, making it difficult for him to fasten buttons and tie shoelaces, Mr A could now no longer coordinate tasks such as putting on pants or T-shirts. For example, there was one incident in which Mr A put his clothes on backward. He also required prompting to remember to bathe and brush his teeth. Mr A could no longer shop by himself, manage finances, or calculate tips and handle cash.

Mr As appetite was poor, and he was losing weight. He also struggled with insomnia and was frequently using clonazepam as a sleep aid. No urinary or fecal incontinence had been reported.

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Uncontrolled Sexual Behaviour In Dementia

Submitted: September 25th, 2014Published: July 1st, 2015

DOI: 10.5772/59979

There are two ways to cite this chapter:

There are two ways to cite this chapter:

Total Chapter Downloads on intechopen.com

• Faculty of Psychology and Educational Sciences, Open University of the Netherlands, The Netherlands
• Zuyd University of Applied Sciences, Heerlen, The Netherlands

*Address all correspondence to: Susan.vanhooren@ou.nl or susan.vanhooren@zuyd.nl

What Are Parkinsons Delusions

Delusions are thoughts that arent grounded in reality. Theyre not as common as hallucinations, affecting only about 8 percent of people with Parkinsons disease. But they are harder to treat.

The most common delusions involve paranoia for example, the feeling that people are out to get you, or that your partner is cheating on you. Having these thoughts can lead to aggressive or even dangerous behavior.

Youll start with a visit to your doctor for an evaluation. Your doctor may diagnose you with this condition if you:

• have had symptoms like hallucinations and delusions for at least 1 month
• dont have another condition that could be causing these symptoms, like dementia, delirium, major depression, or schizophrenia

Not everyone with Parkinsons disease will develop psychosis. Youre more likely to have this if you:

There are two possible causes of Parkinsons psychosis:

• changes in levels of brain chemicals like serotonin and dopamine from the disease itself
• changes in levels of these chemicals from medications that treat Parkinsons disease

Dopamine is a chemical that helps your body move smoothly. People with Parkinsons disease have lower than normal levels of dopamine, which causes their body to move stiffly.

Drugs that treat Parkinsons improve movement by increasing dopamine levels. Yet they can sometimes cause psychosis as a side effect.

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Aggressive And Combative Behavior After Stroke

Some survivors can demonstrate aggressive and even combative behavior after stroke. When this happens, you must seek help and talk to both a doctor and, if you experience any harm, call the domestic abuse hotline. Usually aggressive and combative behavior is the result of damage to the frontal lobe and impaired impulse control. Medication may help, and its imperative to talk to your loved ones doctor while also protecting your safety.

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Actions For This Page

• A person who has Parkinsons disease faces many challenges, including the possibility of reduced sexual feeling and function.
• Parkinsons can affect the partners sexuality too.
• Communication is the best remedy for all types of relationship problems, including sexual problems.
• Always see your doctor if you are concerned about your medical condition, treatment, sexuality or sexual relationship.

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