Management of inappropriate sexual behaviour in frontotemporal dementia: a case study

ObjectiveTo present a case of a 79-year-old male with frontal lobe dementia (following a cerebral abscess) who was referred due to inappropriate sexualised behaviour (ISB) in a care home setting.To discuss the evidence base for the management of ISB in frontotemporal dementia.Case report79-year-old male patient who was diagnosed with frontal lobe dementia, following a craniotomy to aspirate and evacuate a cerebral abscess which affected the left frontal, parietal and temporal lobes. He then started to exhibit sexualised behaviour; he was using sexualised language towards female residents and care workers in the residential home, and was inviting residents to his room and asking them to touch him. This behaviour was felt to be due to inappropriate sexual behaviour which forms part of the spectrum of behavioural and psychological symptoms of dementia. Non-pharmacological interventions were tried but failed to manage his symptoms. He was started on Paroxetine which treated the symptoms for approximately 12 months. The symptoms reocurred and he was switched to Amisulpride which had a positive effect on his symptoms.DiscussionISB is a behavioural and psychological symptom of dementia and may be seen in 7% to 25% of patients with dementia. ISB is distressing for the caregivers and also presents considerable challenges for the treating clinician. ISB presents with behaviour such as sexual language, implied sexual acts, and overt sexual acts. A differentiation should be made between whether the act was one of intimacy-seeking or disinhibition. However, there is a need to intervene when there are risks to the wellbeing and safeguards of the patient and also caregivers and residents. ISB can be difficult to treat, and there is limited evidence on the subject. It is often better managed by non-pharmacological interventions if possible, due to patients often being less responsive to psychoactive therapies and the risks involved with using medication. Non-pharmacological interventions include environmental, behavioural and educational approaches, and examples of these are discussed. Pharmacological interventions are also discussed, but there is a lack of evidence in this area; currently the evidence is from case series and case reports. The variety of drug classes illustrate the non specific nature of drug therapy.ConclusionManaging and treating ISB is difficult and complex.The evidence suggests using non-pharmacological approaches as first line before considering pharmacological interventions.However, there is a need for further research to develop robust non-pharmacological and pharmacological interventions in the treatment of ISB.

Neurologic Wilson Disease Presenting with Acute Delirium And Automatic Writing Behaviour: A Case Report

Introduction: Wilson’s disease (WD) is a rare autosomal recessive disorder which leads to abnormal copper deposition in multiple tissues. Due to extensive deposition of copper in the liver and brain, WD primarily manifests with a wide range of symptoms as well as psychiatric symptoms. Method: We report a 15-year-old boy presenting with automatic writing behavior and acute neuropsychiatric symptoms; splenomegaly and elevated transaminase levels. Result: A diagnosis of WD was later made, following liver biopsy. Previously, increased writing activity has been reported in cerebrovascular disease, frontal lobe dementia, temporal lobe epilepsy, Parkinson disease and multiple sclerosis but not in WD. Conclusion: This is the first report of increased writing behavior in WD.

Cognitive Enhancement in Non-Alzheimer’s Dementias

Cognitive enhancement in non-Alzheimer’s dementias has not been studied as extensively as that in Alzheimer’s dementia. This chapter reviews the research on cognitive enhancement for three types of dementia: vascular dementia, dementia with Lewy bodies, and frontal lobe dementia. The chapter reviews both pharmacological and nonpharmacological approaches for treatment of dementia. The focus is on randomized controlled trials for currently available medications, specifically cholinesterase inhibitors and memantine. Major advances in physical and cognitive rehabilitation during the past decade have inspired clinicians and researchers to explore the role of potential cognitive enhancers in different types of dementias. This chapter also examines the effects of therapeutic interventions such as exercise, physical rehabilitation, cognitive rehabilitation, and electrical stimulation of the brain on cognition in non-Alzheimer’s dementias.

The planning of appropriate medical and social care in dementia

This chapter discusses how medical practices can plan appropriately for future management of Alzheimer’s disease. The complexity and heterogeneity of the clinical and social problems in dementia requires a multifaceted approach in clinical practice. With regard to the aetiology of dementia, we are currently moving from the classical hypothesis that dementia is caused by a few distinct and well-defined disease entities (such as Alzheimer’s disease, frontal lobe dementia, vascular dementia) to a pathogenetic hypothesis, in which each patient’s dementia is caused by a combination of slowly progressing, pathophysiologic processes such as Alzheimer-type pathology (i.e. neurofibrillary (β‎-amyloid) plaques and tangles), taupathies, synucleinopathies, and vascular lesions. The diagnostic process in dementia first consists of diagnosing which disease processes caused the cognitive decline and next what problems in care delivery are present and have to be solved.