19: Early Stages: Intimacy & Sexuality

This program will:

  • Present an overview of the various stages and changes related to Alzheimer’s disease
  • Discuss intimacy and sexual issues as relationships change during the early stages
  • There are no easy answers when it comes to the care of another
  • Our hope is to offer you useful information and guidelines for caring for someone with dementia
  • These guidelines will need to be adjusted to suit your own individual needs
  • Progressive dementia
  • Later years of life
  • Changes in brain
  • Chemistry
  • Structure
  • Processing
  • Loss of brain cells and pathways
  • Hippocampus damage affects new information processing and storage
  • Results are changes in behavior and functioning
  • Suspiciousness
  • Paranoia and negativity
  • Restlessness/wandering
  • Rummaging
  • Depression
  • Aggression
  • Catastrophic reactions
  • Agitation
  • Verbal abuse
  • Combativeness
  • Apathy and depression
  • Caregiver stress
  • Anxiety
  • Depression
  • Sleep disruption
  • Care recipient abuse


  • Strongly held ideas or beliefs that have no basis in reality


  • Misperceptions or misinterpretations of real objects


  • Perceptions of things that are not there
  • Forgetting things
  • Neglecting hygiene
  • Dressing and grooming poorly
  • Communication difficulties


  • Loss of memory


  • Inability to speak or understand language


  • Inability to recognition people, objects and places


  • Inability to perform routine, over-learned activities
  • Changes occur in stages over many years
  • Early, middle, late and end-stage

Early stages

  • Forgetful
  • Suspicious, obsessed
  • Restless, apathetic
  • Sleep changes may begin
  • Aware, concern

Middle stages

  • Difficulty functioning at home and at work
  • Personality changes and difficult behaviors
  • Sleep pattern changes more common

Late stages

  • Greater difficulty with activities of daily living
  • Reduced mobility
  • More difficult behaviors
  • Worsening of sleep pattern disturbances


  • Unable to walk
  • Unable to recognize familiar people
  • Weight loss
  • Incontinence
  • Needs complete care
  • May have moments of lucidity
  • Change with aging
  • Important for self-esteem and gender identity

What are some of the possible factors at play in this situation?

  • A. Robert has a medical condition that affects his sexual desires .
  • B. Robert is losing his inhibitions about sex .
  • C. Mary is too stressed and tired from caregiving .
  • D. Age-related changes are affecting Mary’s sexual response .
  • E. All of the above.

Choice A: Robert has a medical condition that affects his sexual desires, is a possibility.

Choice B: Robert is losing his inhibitions about sex, is also a possibility.

  • Alzheimer’s disease results in lowered inhibitions, which can lead to inappropriate sexual behavior.

Choice C: Mary is too stressed and tired from caregiving, is another possibility.

  • Caregiver stress and fatigue can reduce sexual interest.

Choice D: Age-related changes are affecting Mary’s sexual response, is also a possibility. CHANGES OF AGING CAN CAUSE

  • Painful intercourse
  • Decreased vaginal lubrication
  • Erectile dysfunction
  • Choice E: All of the above, is the best answer.
  • Reduction in female hormonal levels
  • Vagina
  • Wall thins
  • Lubrication decreases
  • Space shortens and narrows
  • Cervix can descend
  • Body becomes less sensitive to arousal
  • Reduction in testosterone levels
  • Degree of erection lessens
  • Orgasmic contractions fewer and weaker
  • Refractory period lengthens
  • Physical and mental health can affect sex life
  • Societal views about older people and sex
  • Strategies
  • Create romantic atmosphere
  • Plan for more time
  • External aids
  • Cardiovascular disease
  • Hypo and hyper thyroid
  • Chronic obstructive pulmonary disease
  • Arthritis
  • Medications can contribute to sexual dysfunction
  • Medical interventions can change self-image
  • Needs continue throughout the illness
  • Caregiving demands increase
  • Partner may be uncomfortable with sex
  • Fear of inappropriate sexual behavior
  • Changes in the relationship
  • Memory issues may affect quality of sex
  • Caregiver issues
  • Multiple requests for sex
  • Not aroused by someone who forgets their name
  • Consent
  • Lowered inhibitions
  • Public sexual behavior (groping, masturbating)
  • Increased frequency of sex
  • Suggestive talk
  • The frontal lobe of the brain, which controls our “executive functions,” such as impulses,judgement,reasoning, and decision-making abilities,gets damaged
  • Understanding
  • Unique solutions

Click here to learn more about Sexuality and Alzheimer’s

What could Mary do to resolve the situation?

  • A. Gently take his hand and leave the church
  • B. Hand him a hymnal to hold
  • C. Take his hand, squeeze it, and hold it

Choice A: Gently take his hand and leave the church, is a possible solution.

Choice B: Hand him a hymnal to hold, is another possible solution.

Choice C: Take his hand, squeeze it, and hold it, is a good choice.

  • Use discrete distraction
  • Refrain from scolding or showing disapproval
  • Normalize the behavior
  • Sexual problems are rare
  • Understand that the disease is the cause
  • Respond in a matter-of-fact way
  • Remind when behavior is inappropriate
  • Orient the person who is confused
  • Find out the reason for the behavior
  • Remove the person from the situation
  • Reassure and honor dignity
  • Be cautious when showing affection
  • Alternative ways to be intimate
  • Redirecting to self-stimulation
  • There is no right or wrong
  • Should not feel guilty
  • Changes in sexuality due to Alzheimer’s disease
  • Changes associated with aging
  • Effects of medical illnesses and medications
  • Strategies include:
  • Remind the person about appropriate behavior
  • Reorient the person to the situation
  • Use distraction or redirection
  • Provide privacy for sexual expression
  • Respect dignity and autonomy
  • Consider caregiver needs

Written by:
Catherine M. Harris, PhD, RNCS.
Mindy J. Kim-Miller, MD, PhD

Edited by:
Sasha Asdourian


18: Early Stages: Family Involvement & Planning

Select the best answers from the list of choices following each question.

Click here to open Certificate of Completion

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