Cipriani Gabriele, Ulivi Martina, Danti Sabrina, Lucetti Claudio, Nuti Angelo
Neurology Unit, Versilia Hospital, Lido di Camaiore, Italy.
Psychogeriatrics. 2016 Mar;16(2):145-53. doi: 10.1111/psyg.12143. Epub 2015 Jul 28.
To describe inappropriate sexual behaviour (ISB) observed in patients with dementia, we conducted searches using the Cochrane Library, PubMed, and Web of Science to find relevant articles, chapters, and books published from 1950 to 2014. Search terms used included 'hypersexuality', 'inappropriate sexual behaviors', and 'dementia'. Publications found through this indexed search were reviewed for further relevant references. Sexuality is a human's need to express intimacy, but persons with dementia may not know how to appropriately meet their needs for closeness and intimacy due to their decline in cognition. Generally, the interaction among brain, physical, psychological, and environmental factors can create what we call ISB. The most likely change in the sexual behaviour of a person with dementia is indifference. However, ISB in dementia appear to be of two types--intimacy-seeking and disinhibited--that differ in their association with dementia type, dementia severity and, possibly, other concurrent behavioural disorder. Tensions develop from uncertainties regarding which, or when, behaviours are to be considered 'inappropriate' (i.e. improper) or abnormal. While most ISB occur in the moderate to severe stages of Alzheimer's dementia, they may also be seen in early stages of frontotemporal dementia because of the lack of insight and disinhibition. ISB are often better managed by non-pharmacological means, as patients may be less responsive to psychoactive therapies, but non-pharmacological interventions do not always stop the behaviour.
为了描述在痴呆症患者中观察到的不当性行为（ISB），我们利用考克兰图书馆、PubMed和科学网进行检索，以查找1950年至2014年发表的相关文章、章节和书籍。使用的检索词包括“性欲亢进”“不当性行为”和“痴呆症”。对通过此次索引检索找到的出版物进行了审查，以获取更多相关参考文献。性是人类表达亲密感的需求，但痴呆症患者由于认知能力下降，可能不知道如何恰当地满足他们对亲密和亲近的需求。一般来说，大脑、身体、心理和环境因素之间的相互作用会产生我们所说的不当性行为。痴呆症患者性行为最可能的变化是冷漠。然而，痴呆症中的不当性行为似乎有两种类型——寻求亲密型和脱抑制型——它们在与痴呆症类型、痴呆症严重程度以及可能的其他并发行为障碍的关联方面存在差异。对于哪些行为或何时的行为应被视为“不当”（即不适当）或异常存在不确定性，从而引发了紧张关系。虽然大多数不当性行为发生在阿尔茨海默病痴呆的中度至重度阶段，但由于缺乏洞察力和脱抑制，在额颞叶痴呆的早期阶段也可能出现。由于患者可能对精神活性疗法反应较小，不当性行为通常通过非药物手段能得到更好的管理，但非药物干预并不总能阻止这种行为。
