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Dementia can dramatically change sexual relationships for both the person with the illness and their partner. (Note that Alzheimer’s disease is the most common cause of dementia.)

Both partners may still have sexual desire. But changes in the brain can prevent people with dementia from being sexual the way they used to. And partners, especially if they are taking on a caregiving role, may mourn the loss of intimacy they shared with someone who once played an equal role.

However, dementia does not have to signal the end of intimacy altogether. Some couples continue to have sex when a partner is in the early stages of dementia. Others explore other ways to be intimate.

People with dementia might experience the following changes:

Changes in sexual interest. Some people find themselves less interested in sex. . On the other hand, people may find themselves more interested in sex (hypersexuality). These changes may be side effects of medications.)
Acting out sexually / loss of inhibition. Because of frontal lobe lesions, some people make advances toward strangers or mistake another person for their partner. Others undress or masturbate in public.
Changes in sexual response. Delayed or decreased arousal (erection, lubrication) and delayed or absent orgasms are most commonly due to medication side effects. (Patients are often given antidepressants.)

To cope with these changes, caregiving partners are often advised to:

Stay calm, and don’t act harshly. Remember that these changes are the result of a disease or its treatment and do not reflect the person inside.
Redirect your loved one’s attention. If your partner is being inappropriate or aggressive, have them focus on something else, like an object or a favorite activity.
Try to figure out what might be driving the behavior. For example, if your loved one undresses publicly, their clothing might be uncomfortable or too warm for the setting. If they are touching inappropriately, they might be seeking more physical connections.
Find other ways to be intimate. Stay close by cuddling, snuggling, and holding hands. Your loved one may feel reassured and safe with this type of physical contact.
Recognize the need for privacy. Your partner might wish to masturbate as a form of sexual release.

Other tips for caregiving partners:

Remember that your needs are important, too. Your sexual relationship may change, but it’s still okay to consider your own sexual needs. If possible, find some private time to enjoy sexual fantasies or masturbation. Some caregiving partners seek sex outside their relationship, although not all are comfortable with that.
Ask for professional help. Changes in sexual behaviors are quite common in dementia patients, and your loved one’s doctors, social workers, and therapists are likely familiar with various scenarios. They can offer tips for coping. In some cases, medications might be necessary.
Seek other support. Dementia caregiving groups are a great place to share your questions and frustrations as you make adjustments in your relationships. It may help to open up to others in similar situations. You might also consider therapy for yourself.
Stay safe. Sometimes, people with dementia become aggressive or even violent. If you feel that your loved one’s behavior has become difficult to handle, call emergency services for help.

Resources

Alzheimer’s Society

“Sex, intimacy and dementia”

https://www.alzheimers.org.uk/get-support/daily-living/sex-intimacy-dementia#content-start

National Institute on Aging

“Changes in Intimacy and Sexuality in Alzheimer’s Disease”

(Content reviewed: May 17, 2017)

https://www.nia.nih.gov/health/changes-intimacy-and-sexuality-alzheimers-disease

VeryWellHealth.com

Sellman, James Clyde, PhD

“Alzheimer’s and Changes in Sexual Behavior”

(Updated: January 27, 2020)