Love Endures

In a word, yes. As many family members and nursing home administrators are discovering, this growing segment of society is capable of romantic attachments and sexual feelings. Patients with dementia may not fit the popular view of who gets to fall in love, but fall they do, exercising that universal human impulse against loneliness and depression. But whether it takes place at home or in a communal living setting, intimacy on such terms can raise complex personal and ethical questions, pit individual rights against family wishes and even compromise a patient's physical and emotional well-being.

A perhaps extreme case in point: The alleged sexual assault last year of six elderly residents of a 40-bed facility in Ohio that cares for people with dementia. The attacker, according to families who filed a police report: a male resident in his eighties. State health inspectors, who found the home had failed to ensure residents' protection, threatened to revoke its license, then settled for a $10,000 fine and temporary restrictions. The man was moved to another facility and has since died. A local prosecutor is still considering criminal charges against the home, according to local police. But could the sex that health authorities say took place have been consensual? "If they were in a home like this, I don't think they can give you consent," said Detective Captain Mike Goodwin, with the New Philadelphia, Ohio, police. Others might disagree.

Love in dementia land, however, is rarely the topic of discussion by nursing home administrators or family support groups, social workers say. Few facilities have policies on the topic. "There was a phenomenal interest on the part of our members after Reingold's presentation at their annual meeting in October," said Bruce Rosenthal, a spokesman for the American Association of Homes and Services for the Aging (AAHSA) in Washington. The group gave Reingold and his colleagues its Excellence in Practice award October for their "progressiveness in addressing challenging subjects." Said Rosenthal, "Administrators were saying, 'This is going on and we don't have a solution.' "

Sex on the Declining Brain

Not all patients with dementia are on the prowl. Those with advanced illness usually lose interest, and some people with earlier-stage dementia have their appetites prematurely dampened by antipsychotic or antidepressant medications. So why do others have a fully functioning sex drive when they can't even find the bedroom?

While Alzheimer's disease and its cousin vascular dementia gradually destroy the brain, they often leave functional for quite a while the part of the brain that hollers at us to reproduce or at least get cozy with another human, says neuropsychologist David Zald, assistant professor at Vanderbilt University. Sexual desire may survive, he says, because we tend to remember emotional experiences -- including sex -- more clearly and for a longer time than more mundane events. How long the drive survives may depend on both a patient's condition and the importance he or she placed on physical intimacy before the onset of dementia, says Jerrold Pollak, a neuropsychologist at the Seacoast Mental Health Center in Portsmouth, N.H.

One 94-year-old Washingtonian could be a case in point. Dementia hasn't stopped her lifelong pursuit of men, her daughter explained. The daughter recently pushed the two beds in her mother's bedroom together, so her mom and the mom's boyfriend, who both use walkers, don't fall out. That would be the local boyfriend, who, by the way, doesn't know about her Florida beau.

Then again, social workers say, dementia patients sometimes behave in ways that others misread as sexual. They may, for example, suddenly undress if they are warm or itchy. People with dementia also misread cues, so when a caretaker says, "Let's go to bed," the patient may read that as a welcome invitation for companionship.

About 10 percent of dementia patients have fronto-temporal dementia, characterized by a loss of impulse control, said Pollak. Instead of the typical first symptoms of dementia -- memory loss and confusion -- you get "isolated weird sexual behavior," such as being lewd in public, he said.

Spouse/Diaper Changer

Loss of impulse control causes some of the biggest problems for any caretaker, particularly the unsuspecting spouse or partner. Dementia can cause disinhibition, which means your partner may be making the moves on you (or others) all the time or at the wrong times. People with dementia may forget that they just had sex, and want it again. And again.

Some caretaker spouses describe their problems as exaggerated versions of marital angst. Men with dementia may feel bad or angry if they can't perform, and their partners may feel guilty or disappointed. Or amorous patients may feel hurt if their loved one isn't in the mood after having changed their diapers or wiped their drooly chins one time too many. For couples who are relatively young when dementia upends their lives, the issue of intimacy is even more poignant.