Lane Natasha E, Ahuja Manan, Hatch Stacey, Seitz Dallas P, McGowan Jessie, Watt Jennifer A
Division of Geriatric Medicine, University of Toronto, Toronto, Ontario, Canada.
ICES, Toronto, Ontario, Canada.
J Am Geriatr Soc. 2025 Aug;73(8):2589-2597. doi: 10.1111/jgs.19489. Epub 2025 Apr 28.
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.
不适当性行为（ISB），如性触摸和性暴露，在高达25%的痴呆症患者中出现。本系统评价考察了药物和非药物干预措施在管理痴呆症患者ISB方面的有效性。
非Meta分析的系统评价（国际前瞻性系统评价注册库：CRD42023469625）。我们检索了MEDLINE、美国心理学会心理学文摘数据库、Embase、循证卫生保健数据库、考克兰系统评价数据库、疗效评价文摘库和老年学数据库，检索时间从建库至2023年9月8日，对研究日期和语言无限制。如果研究考察了任何药物或非药物干预措施对患有痴呆症和ISB的成年人的有效性，则所有研究设计均符合纳入标准。两名评价员独立完成所有研究筛选、数据提取和偏倚风险评估。使用循证卫生保健批判性评价清单来确定病例研究和病例系列的质量，并使用考克兰偏倚风险评估工具2来评价一项随机对照试验。根据效应方向，采用计数法对研究结果进行综合分析。
我们纳入了74项研究，其中60项为病例研究，13项为病例系列，1项为随机试验。大多数研究（64%）仅报告了药物干预措施。非药物干预措施（如分散注意力、环境改造）在33例（72%）中与ISB的改善或解决相关；然而，只有5例（21%）在未联合使用药物治疗的情况下得到改善或解决。在男性中，包括孕激素和抗雄激素在内的激素治疗比抗精神病药、抗抑郁药或抗惊厥药更频繁地导致ISB减少。
非药物干预措施在减少ISB方面可能有效，不过药物干预措施通常也有必要。需要进行非药物和药物干预有效性及安全性的随机试验以指导实践。
