The cognitive aspects of sexual intimacy in dementia patients: a neurophysiological review

ABSTRACT

Changes in higher-order cognitive behaviors such as reward recognition, salience processing, novelty perception, decision-making, emotional contagion, motivation, and empathy may contribute to intimacy dysfunction. Network circuitry underlying these cognitive functions is often activated in sexually intimate behavior. We propose that sexual dysfunction in AD and bvFTD is more nuanced than is commonly believed, and propose how AD and bvFTD atrophy may correlate neuroanatomically to brain regions and networks that contribute to the higher-order cognitive aspects of intimacy. The characterization of sexual intimacy in dementias must be expanded to meet the needs of our dementia patients and their romantic partners.

KEYWORDS:

• Sexual dysfunction
• cognitive
• intimacy
• dementia
• Alzheimer’s
• bvFTD
• hypersexuality
• disinhibition
• salience
• neurodegenerative

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. The core areas of the DMN are thought to be the vmPFC, dmPFC, PCC, hippocampal formation, inferior parietal lobule (IPL) and lateral temporal cortex (Enos, 1991). The ACC, the anterior temporal lobe, the parahippocampal gyrus (PHG), and the hypothalamus have also been implicated in the DMN (Grecius et.al., 2003; Fox, Spreng, Ellamil, Andrews-Hanna, & Christoff, 2015; Shimoda et al., 2015). The DMN is activated when subjects rest with their eyes closed with stimulus-independent thought (Greicius et al., 2003). It incorporates personal experience into planning, and helps with processing visual imagery and episodic memory retrieval (Zhou & Seeley, 2014). One study of the DMN in meditation described the DMN as “a source of internal noise affecting direct attention” (Pagnoni, 2012).