Sexual Acting Out

One behavior that Alzheimer's patients may exhibit, and which is very common in those with Frontotemporal Lobe dementia, is a lack of inhibition. This can manifest verbally - calling someone inappropriate names in public - or physically.

Certain parts of a dementia patient's body become more sensitive, said Teepa Snow, a dementia care specialist and trainer based in North Carolina who travels the country giving presentations about the disease. One "hot spot" is the mouth and they may begin humming or grinding their teeth. They also may resist a caregiver trying to shave them or touch their mouth. Genitalia also become more sensitive and patients may wince at being cleaned. Those with Alzheimer's tend to savor their sense of touch, leading to clapping, grabbing and even pushing.

This heightened sense of touch can also lead to one of the least-discussed Alzheimer's behaviors: sexual acting out. This is made worse by older patients with macular degeneration.

"You're looking at somebody who's gonna be using their hands a lot to explore the environment because they lack their central field of vision and they have no sense of what's the language processing that's going on so they're going [to] be touching and feeling," Snow said. "They're also going to do a lot more self-stimulation . . . . because they can't pay attention to the environment for stimulation so they're going to be focusing on their own bodies. And they aren't going to know where they are."

This can lead to stripping and masturbation in public, as well as inappropriate touching. Sometimes, the object of affection may be a stranger or even a son or daughter caregiver. "They can't figure out who you are to them; they think they're younger than they are and they don't realize you're the daughter, they think you're the spouse," Snow said. "So they're treating you like that because you're giving care like that and you don't realize that's the role you've taken over."

A heterosexual patient may even initiate a same-sex relationship. "Does it mean I've developed homosexual tendencies? No," Snow said. "What it means is I have my sensory needs and I want to be close to somebody. I'm lonely, I'm lost, I don't know where I am, I don't know why I am and I'm looking for comfort. . . it's being human and having this disease."

Sexual acting out can trigger some of the more visceral responses from caregivers, Snow said, and as with all Alzheimer's behaviors, reaction is everything.

"It is incredibly tough because this has all kinds of emotional registers that it hits with us and it makes us uncomfortable, it makes us nervous," she said. "We get angry, we get upset, we get vindictive, we get mean, we get vicious. We just overreact because it scares us."

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