Sexual Problems of Healthy and Dementic Elderly in Korea / 신경정신의학

OBJECTIVES: The aging process can influence sexual functions by physiological, pathological, behavioral and psychosocial changes. Studies on sex among elderly are scarce. However, sexual activities remain throughout life in different forms. The aim of this study was to identify sexual problems and dysfunctions among dementia patients and compare with healthy aged persons. METHODS: The sexual problems and affecting factors were evaluated by structured interview and sexual problem screening instruments for 46 dementia patients according to DSM-IV and 60 healthy Koreans aged over 60. RESULTS: 1) Frequency of erection was less than once a day in 68.0% of controls, while more than once a day in 47.6% of dementia. Trouble in attaining erection was found in 50.0% of dementia as compared with 65.4% of controls. Awake with erection was less than once a week in 37.8% of controls, while less than once a week in 22.2% and more than once a week in 10.0% of dementia. Maintaining erection was better in controls (92.0%) as compared with dementia (55.0%)(pactivity). Satisfaction in sex life (41.7%), partner's satisfaction (31.8%), satisfaction with partner (45.5%) and men's interest in sex decline with age (54.5%) were higher in dementia (p<0.001, respectively). 2) The recognition of sexual problems was higher in healthy elderly (74.1%). Most of sexual dysfunctions except sexual desire disorder (83.3% in controls vs 40.0% in dementia) was higher in demetia, that is, erectile disorder (30.0%), premature ejaculation (20.0%), and orgasmic disorder (10.0%). The duration over 5 years of sexual problems was the most in both (46.7% in controls vs 53.3% in dementia). 3) Problematic sexual behaviors seen among dementia patients were obscene remarks/sexual hallucination (30.8%, respectively), public exposure (15.4%), inappropriate contact/physical contact with others/sexual seduction toward other patients (1.7%, respectively) in that order. Appea-rance time of sexual problems was over 1 year of dementia (50.0%), within 1 year of dementia (32.4%), and with the initiation of dementia (17.6%). The frequency was more than once a week in 60.0% and less than once a week in 40.0% of dementia. Place of sexual misbehavior was one's own room (68.6%), other place (22.9%), toilet (5.7%), activity therapy room (2.9%) in that order. Targets of sexual misbehavior were other patients (40.0%), caregivers (31.4%), medical personnel/others (14.3%, respectively) in that order. For the management of sexual misbehavior, most of the doctors chose non-pharmacological methods (83.9%). CONCLUSION: The sexual activity among Korean elderly with age over 60 was more active in healty controls than dementic patients, while sexual dysfunction except sexual desire disorder was more in dementic patients than healthy controls. Therefore, special interest and proper management was needed toward hypersexuality as well as sexual hypoactivity, and most of all, conceptual changes of doctors and caregivers toward sexual problems in the elderly must be preceded.

A Case of Probable Diffuse Lewy Body Dementia

A case of Lewy body dementia in a 71 year-old male patient was reported and related articles were also reviewed. He has been ill with Parkinsonism since 1988, and referred to the neuropsychiatrist because of depression since 1989. Episodically he has experienced dizziness, falls and low blood pressure. Mild cognitive decline including memory, attention, language, and visuospatial ability accompanied by occasional fluctuation of consciousness, confusion, visual hallucination and disorientation was developed on February 9th in 2000. Such symptoms were repeated thereafter, and responded on donepezil in addition to the antiparkinsonian drugs.