Hostname: page-component-848d4c4894-v5vhk Total loading time: 0 Render date: 2024-06-25T15:39:11.819Z Has data issue: false hasContentIssue false
  • English
  • Français

Pharmacological and nonpharmacological approaches to reduce disinhibited behaviors in dementia: a systematic review

Published online by Cambridge University Press:  25 March 2022

Claire V. Burley Open the ORCID record for Claire V. Burley [Opens in a new window] ,
Kim Burns  and
Henry Brodaty Open the ORCID record for Henry Brodaty [Opens in a new window]
Claire V. Burley
Affiliation:
Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
Kim Burns
Affiliation:
Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
Henry Brodaty*
Affiliation:
Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
*
Correspondence should be addressed to: Henry Brodaty, Centre for Healthy Brain Ageing (CHeBA), Level 3, AGSM Building, School of Psychiatry, Faculty of Medicine and Health, University of New South Wales, Sydney NSW 2052, Australia. E-mail: h.brodaty@unsw.edu.au
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

Disinhibited behaviors in dementia are associated with multiple negative outcomes. However, effective interventions are under-researched. This systematic review aims to provide an overview of intervention studies that report outcome measures of disinhibited behaviors in dementia.

Design:

Systematic searches of the databases MEDLINE, EMBASE, and PsychINFO, Social Work Abstracts and Cochrane Central Register of Controlled Trial databases were conducted for publications published between 2002 and March 2020. We included hand-searched reviews, original articles, case reports, cohort studies, and randomized controlled trials (RCTs). All studies were rated for research quality. Statistical and clinical significance were considered for individual studies. Effect sizes were included where provided or calculated where possible. Mean effect sizes were calculated for RCTs only.

Participants:

The systematic review included studies involving people living with dementia.

Measurements:

The Neuropsychiatric Inventory disinhibition subscale was used most often.

Results:

Nine pharmacological and 21 nonpharmacological intervention studies utilized different theoretical/clinical approaches. These included pain management, antidepressants, models of care, education and/or training, music-based approaches, and physical activity. The quality of research in RCTs was strong with a greater effect size in nonpharmacological compared to pharmacological approaches (mean Cohen’s d = 0.49 and 0.27, respectively). Disinhibition was a secondary outcome in all studies.

Conclusion:

Pharmacological (including pain management and antidepressants) and, more so, nonpharmacological (models of care, education/training, physical activity, and music) approaches were effective in reducing disinhibition.

Keywords

BPSDdementiadisinhibited behaviorshypersexualitypharmacologicalbiopsychosocialnonpharmacological
Type
Review Article
Information
International Psychogeriatrics , Volume 34 , Issue 4: Issue Theme: Varied Facets of Dementia , April 2022 , pp. 335 - 351
Copyright
© International Psychogeriatric Association 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alagiakrishnan, K. et al. (2005). Sexually inappropriate behavior in demented elderly people. Postgraduate Medical Journal, 81, 463–466.CrossRefGoogle ScholarPubMed
Alagiakrishnan, K., Sclater, A. and Robertson, D. (2003). Role of cholinesterase inhibitor in the management of sexual aggression in an elderly demented woman. Journal of the American Geriatrics Society, 51, 1326–1326.Google Scholar
Alkhalil, C., Hahar, N., Alkhalil, B., Zavros, G. and Lowenthal, D. (2003). Can gabapentin be a safe alternative to hormonal therapy in the treatment of inappropriate sexual behavior in demented patients? International Urology and Nephrology, 35, 299–302.CrossRefGoogle ScholarPubMed
Alkhalil, C., Tanvir, F., Alkhalil, B. and Lowenthal, D. (2004). Treatment of sexual disinhibition in dementia: case reports and review of the literature. American Journal of Therapeutics, 11, 231–235.CrossRefGoogle ScholarPubMed
Baikie, E. (2002). The impact of dementia on marital relationships. Sexual and Relationship Therapy, 17, 289–299.CrossRefGoogle Scholar
Bakker, T. J. E. M., Duivenvoorden, H. J., Van Der Lee, J., Olde Rikkert, M. G. M., Beekman, A. T. F. and Ribbe, M. W. (2013). Benefit of an integrative psychotherapeutic nursing home program to reduce multiple psychiatric symptoms of psychogeriatric patients and caregiver burden after six months of follow-up: a re-analysis of a randomized controlled trial. International Psychogeriatrics, 25, 34–46.CrossRefGoogle ScholarPubMed
Brunelle-Hamann, L., Thivierge, S. and Simard, M. (2015). Impact of a cognitive rehabilitation intervention on neuropsychiatric symptoms in mild to moderate Alzheimer’s disease. Neuropsychological Rehabilitation, 25, 677–707.CrossRefGoogle ScholarPubMed
Burns, K., Jayasinha, R., Tsang, R. and Brodaty, H. (2012). Behavior management a guide to good practice: managing behavioral and psychological symptoms of dementia. DCRC, UNSW Sydney Australia. Available at: https://dementiaresearch.org.au/wp-content/uploads/2020/07/DCRC_BPSD_Guide_2012.pdf.Google Scholar
Canevelli, M., Talarico, G., Tosto, G., Troili, F., Lenzi, G. L. and Bruno, G. (2013). Rivastigmine in the treatment of hypersexuality in Alzheimer disease. Alzheimer Disease and Associated Disorders, 27, 287–288.CrossRefGoogle ScholarPubMed
Capotosto, E. et al. (2017). Cognitive stimulation therapy in the Italian context: its efficacy in cognitive and non-cognitive measures in older adults with dementia. International Journal of Geriatric Psychiatry, 32, 331–340.CrossRefGoogle ScholarPubMed
Chan, C., Chan, W. and Li, S. (2006). Efficacy and safety of rivastigmine in the treatment of behavioral and psychological symptoms in Chinese dementia patients: an open-label study. Hong Kong Journal of Psychiatry, 16, 101–108.Google Scholar
Chapman, K. R. and Spitznagel, M. B. (2019). Measurement of sexual disinhibition in dementia: a systematic review. International Journal of Geriatric Psychiatry, 34, 1747–1757.CrossRefGoogle ScholarPubMed
Chinn, S. (2000). A simple method for converting an odds ratio to effect size for use in meta-analysis. Statistics in Medicine, 19, 3127–3131.3.0.CO;2-M>CrossRefGoogle ScholarPubMed
Choi, A.-N., Lee, M. S., Cheong, K.-J. and Lee, J.-S. (2009). Effects of group music intervention on behavioral and psychological symptoms in patients with dementia: a pilot-controlled trial. International Journal of Neuroscience, 119, 471–481.CrossRefGoogle ScholarPubMed
Cipriani, G., Cammisuli, D., Danti, S. and Fiorino, M. (2016). Disordered gambling and dementia. European Geriatric Medicine, 7, 474–478.CrossRefGoogle Scholar
Clerici, F., et al. (2012). Memantine effects on behavior in moderately severe to severe Alzheimer’s disease: a post-marketing surveillance study. Neurological Sciences, 33, 23–31.CrossRefGoogle ScholarPubMed
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A. and Gornbein, J. (1994). The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 2308–2314.CrossRefGoogle ScholarPubMed
de Giorgi, R. and Series, H. (2016). Treatment of inappropriate sexual behavior in dementia. Current Treatment Options in Neurology, 18, 1–15.CrossRefGoogle ScholarPubMed
de Medeiros, K. et al. (2010). The neuropsychiatric inventory-clinician rating scale (NPI-C): reliability and validity of a revised assessment of neuropsychiatric symptoms in dementia. International Psychogeriatrics, 22, 984–994.CrossRefGoogle ScholarPubMed
Dementia Australia (2021). https://www.dementia.org.au/national/support-and-services/carers/behaviour-changes/disinhibited-behaviours; last accessed August 05 2021.Google Scholar
de Oliveira, A. M. et al. (2019). An intervention to reduce neuropsychiatric symptoms and caregiver burden in dementia: preliminary results from a randomized trial of the tailored activity program-outpatient version. International Journal of Geriatric Psychiatry, 34, 1301–1307.CrossRefGoogle ScholarPubMed
Dhikav, V., Anand, K. and Aggarwal, N. (2007). Grossly disinhibited sexual behavior in dementia of Alzheimerʼs type. Archives of Sexual Behavior, 36, 133–134. https://doi.org/10.1007/s10508-006-9144-1 CrossRefGoogle ScholarPubMed
Dichter, M. N. et al. (2015). Dementia care mapping: effects on residentsʼ quality of life and challenging behavior in German nursing homes. A quasi-experimental trial. International Psychogeriatrics, 27, 1875–1892.CrossRefGoogle ScholarPubMed
Forester, B. et al. (2007). Report on an open-label prospective study of divalproex sodium for the behavioral and psychological symptoms of dementia as monotherapy and in combination with second-generation antipsychotic medication. The American Journal of Geriatric Pharmacotherapy, 5, 209–217.CrossRefGoogle Scholar
Freymann, N., Michael, R., Dodel, R. and Jessen, F (2005). Successful treatment of sexual disinhibition in dementia with carbamazepine - a case report. Pharmacopsychiatry, 38(3),144–1445. https://doi.org/10.1055/s-2005-864127.CrossRefGoogle ScholarPubMed
Fu, C. Y., Moyle, W. and Cooke, M. (2013). A randomized controlled trial of the use of aromatherapy and hand massage to reduce disruptive behavior in people with dementia. BMC Complementary and Alternative Medicine, 13 (165),1–9.CrossRefGoogle ScholarPubMed
Giovagnoli, A. R., Manfredi, V., Schifano, L., Paterlini, C., Parente, A. and Tagliavini, F. (2018). Combining drug and music therapy in patients with moderate Alzheimer’s disease: a randomized study. Neurological Sciences, 39, 1021–1028.CrossRefGoogle ScholarPubMed
Habiger, T. F., Flo, E., Achterberg, W. P. and Husebo, B. S. (2016). The interactive relationship between pain, psychosis, and agitation in people with dementia: results from a cluster-randomised clinical trial. Behavioral Neurology, 2016, 7036415.Google ScholarPubMed
Harris, L. and Wier, M. (1998). Inappropriate sexual behavior in dementia: a review of the treatment literature. Sexuality and Disability, 16, 205–217.CrossRefGoogle Scholar
Hartmans, C., Comijs, H. and Jonker, C. (2014). Cognitive functioning and its influence on sexual behavior in normal aging and dementia. International Journal of Geriatric Psychiatry, 29, 441–446.CrossRefGoogle ScholarPubMed
Herrmann, N., Black, S. E., Chow, T., Cappell, J., Tang-Wai, D. F. and Lanctot, K. L. (2012). Serotonergic function and treatment of behavioral and psychological symptoms of frontotemporal dementia. The American Journal of Geriatric Psychiatry, 20, 789–797.CrossRefGoogle ScholarPubMed
Herrmann, N., Rabheru, K., Wang, J. and Binder, C. (2005). Galantamine treatment of problematic behavior in Alzheimer disease: post-hoc analysis of pooled data from three large trials. The American Journal of Geriatric Psychiatry, 13, 527–534.CrossRefGoogle ScholarPubMed
Hoffmann, K. et al. (2016). Moderate-to-high intensity physical exercise in patients with Alzheimer’s disease: a randomized controlled trial. Journal of Alzheimer’s Disease, 50, 443–453.CrossRefGoogle ScholarPubMed
Houser, W. S., George, D. R. and Chinchilli, V. M. (2014). Impact of TimeSlips creative expression program on behavioral symptoms and psychotropic medication use in persons with dementia in long-term care: a cluster-randomized pilot study. American Journal of Geriatric Psychiatry, 22, 337–340.CrossRefGoogle ScholarPubMed
Husebo, B. S., Ballard, C., Sandvik, R., Nilsen, O. B. and Aarsland, D. (2011). Efficacy of treating pain to reduce behavioral disturbances in residents of nursing homes with dementia: cluster randomised clinical trial. BMJ (Clinical Research Ed.), 343, d4065.CrossRefGoogle Scholar
Joller, P., Gupta, N., Seitz, D. P., Frank, C., Gibson, M. and Gill, S. S. (2013). Approach to inappropriate sexual behavior in people with dementia. [Approche pour les comportements sexuels inappropries chez des personnes atteintes de demence.]. Canadian Family Physician, 59, 255–260, e135-e140.Google Scholar
Keszycki, R. M., Fisher, D. W. and Dong, H. (2019). The hyperactivity-impulsivity-irritiability-disinhibition-aggression-agitation domain in Alzheimer’s disease: current management and future directions. Journal of Frontiers in Pharmacology, 10, 1109.CrossRefGoogle ScholarPubMed
Kimura, T., Hayashida, H., Furukawa, H., Miyauchi, D. and Takamatsu, J. (2009). Five cases of frontotemporal dementia with behavioral symptoms improved by yokukansan. Psychogeriatrics, 9, 38–43.CrossRefGoogle Scholar
Lai, C. K. Y. (2014). The merits and problems of Neuropsychiatric Inventory as an assessment tool in people with dementia and other neurological disorders. Clinical Interventions in Aging, 9, 1051.CrossRefGoogle ScholarPubMed
Leone, E. et al. (2013). Management of apathy in nursing homes using a teaching program for care staff: the STIM-EHPAD study. International Journal of Geriatric Psychiatry, 28, 383–392.CrossRefGoogle ScholarPubMed
Lichtwarck, B. et al. (2017). Targeted interdisciplinary model for evaluation and treatment of neuropsychiatric symptoms: a cluster randomized controlled trial. American Journal of Geriatric Psychiatry, 26, 25–38.CrossRefGoogle ScholarPubMed
Light, S. A. and Holroyd, S. (2006). The use of medroxyprogesterone acetate for the treatment of sexually inappropriate behavior in patients with dementia. Journal of Psychiatry & Neuroscience, 31, 132.Google ScholarPubMed
Manabe, Y., Ino, T., Yamanaka, K. and Kosaka, K. (2016). Increased dosage of donepezil for the management of behavioral and psychological symptoms of dementia in dementia with Lewy bodies. Psychogeriatrics: The Official Journal of the Japanese Psychogeriatric Society, 16, 202–208.CrossRefGoogle ScholarPubMed
Mendez, M. F., Shapira, J. S., McMurtray, A. and Licht, E. (2007). Preliminary findings: behavioral worsening on donepezil in patients with frontotemporal dementia. The American Journal of Geriatric Psychiatry, 15, 84–87.CrossRefGoogle ScholarPubMed
Mullins-Sweatt, S. N., DeShong, H. L., Lengel, G. J., Helle, A. C. and Krueger, R. F. (2019). Disinhibition as a unifying construct in understanding how personality dispositions undergird psychopathology. Journal of Research in Personality, 80, 55–61.CrossRefGoogle ScholarPubMed
Nagaratnam, N., Gayagay, G. Jr (2002). Hypersexuality in nursing care facilities: a descriptive study. Archives of Gerontology and Geriatrics, 35, 195–203.CrossRefGoogle ScholarPubMed
Nagata, K. et al. (2012). Effects of yokukansan on behavioral and psychological symptoms of vascular dementia: an open-label trial. Phytomedicine, 19, 524–528.CrossRefGoogle Scholar
O’Connor, C. M. et al. (2019). The tailored activity program (TAP) to address behavioral disturbances in frontotemporal dementia: a feasibility and pilot study. Disability and Rehabilitation, 41, 299–310.CrossRefGoogle ScholarPubMed
Öhman, H. et al. (2017). Effects of frequent and long-term exercise on neuropsychiatric symptoms in patients with Alzheimer’s disease-secondary analyses of a randomized, controlled trial (FINALEX). European Geriatric Medicine, 8, 153–157.CrossRefGoogle Scholar
Prakash, R., Pathak, A., Munda, S. and Bagati, D. (2009). Quetiapine effective in treatment of inappropriate sexual behavior of Lewy body disease with predominant frontal lobe signs. American Journal of Alzheimer’s Disease & Other Dementiasr, 24, 136–140.CrossRefGoogle ScholarPubMed
Sachdev, P. (2017). Inappropriate sexual behaviors in dementia. The American Journal of Geriatric Psychiatry, 25, 372–373.CrossRefGoogle ScholarPubMed
Saidlitz, P., Sourdet, S., Voisin, T. and Vellas, B. (2017). Management of behavioral symptoms of dementia in a specialized unit care. Psychogeriatrics, 17, 81–88.CrossRefGoogle Scholar
Segrec, N., Zaman, R. and Pregelj, P. (2016). Increased libido associated with donepezil treatment: a case report. Psychogeriatrics, 16, 70–72.CrossRefGoogle ScholarPubMed
Series, H. and Dégano, P. (2005). Hypersexuality in dementia. Advances in Psychiatric Treatment, 11, 424–431.CrossRefGoogle Scholar
Sprangers, S., Dijkstra, K. and Romijn-Luijten, A. (2015). Communication skills training in a nursing home: effects of a brief intervention on residents and nursing aides. Clinical Interventions in Aging, 10, 311–319.Google Scholar
Stewart, J. T. (2018). Carbamazepine treatment of hyperactivity and intrusiveness in dementia. Clinical Neuropharmacology, 41, 43–44.CrossRefGoogle ScholarPubMed
Taniguchi, S. et al. (2013). Treatment in a ward for elderly patients with dementia in Japan. Neuropsychiatric Disease and Treatment, 9, 357–363.CrossRefGoogle Scholar
Teranishi, M. et al. (2013). Efficacy and tolerability of risperidone, yokukansan, and fluvoxamine for the treatment of behavioral and psychological symptoms of dementia: a blinded, randomized trial. Journal of Clinical Psychopharmacology, 33, 600–607.CrossRefGoogle ScholarPubMed
Tosto, G., Talarico, G., Lenzi, G. L. and Bruno, G. (2008). Effect of citalopram in treating hypersexuality in an Alzheimer’s disease case. Neurological Sciences, 29, 269–270.CrossRefGoogle Scholar
Tournier, I., Vives, M. and Postal, V. (2017). Animal-assisted intervention in dementia: effects on neuropsychiatric symptoms and on caregiversʼ distress perceptions. Swiss Journal of Psychology, 76, 51–58.CrossRefGoogle Scholar
Tune, L. E. and Rosenberg, J. (2008). Nonpharmacological treatment of inappropriate sexual behavior in dementia: the case of the pink panther. The American Journal of Geriatric Psychiatry, 16, 612–613.CrossRefGoogle ScholarPubMed
Verbeek, H., Zwakhalen, S., van Rossum, E., Ambergen, T., Kempen, G. and Hamers, J. (2014). Effects of small-scale, home-like facilities in dementia care on residents’ behavior and use of physical restraints and psychotropic drugs: a quasi-experimental study. International Psychogeriatrics, 26, 657–668.CrossRefGoogle ScholarPubMed
Verhagen, A. P. et al. (1998). The delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by delphi consensus. Journal of Clinical Epidemiology, 51, 1235–1241.CrossRefGoogle ScholarPubMed
Villars, H. et al. (2013). A follow-up intervention in severely demented patients after discharge from a special Alzheimer acute care unit: impact on early emergency room re-hospitalization rate. International Journal of Geriatric Psychiatry, 28, 1131–1140.Google ScholarPubMed
Wan, X., Wang, W., Liu, J. and Tong, T. (2014). Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Medical Research Methodology, 14, 135.CrossRefGoogle ScholarPubMed
Zwijsen, S. et al. (2014). Coming to grips with challenging behavior: a cluster randomized controlled trial on the effects of a multidisciplinary care program for challenging behavior in Dementia. Journal of the American Medical Directors Association, 15, 531.e1–531.e10.CrossRefGoogle ScholarPubMed
Supplementary material: File

Burley et al. supplementary material

Burley et al. supplementary material

Download Burley et al. supplementary material(File)
File 18.3 KB