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    Dementia Symptoms & Caregiver Strategies: Managing Disinhibition in Cognitively Impaired Adults

    What Are Disinhibited Behaviors?
    Disinhibited behaviors are impulsive actions which seem tactless, rude or even offensive. They occur when people don’t follow the usual social rules about what or where to say or do something.

    Disinhibited behaviors can place enormous strain on families and caregivers. They can be particularly upsetting when someone, who has previously been private and sensitive, behaves in a disinhibited way.

    Disinhibited Behaviors May Include:

    • Tactless or rude remarks
      A person who is cognitively impaired may comment tactlessly about another person’s appearance for instance. It can sometimes look as if they are trying to deliberately embarrass or harass the other person.
    • Bold behavior
      A person with cognitive challenges may inappropriately flirt with someone or make sexual comments.
    • Exposure
      A person who is cognitively impaired may take some or all of their clothes off at inappropriate times or in inappropriate settings.
    • Fondling
      Forgetting social rules, a person may publicly fondle themselves or masturbate in front of others.
    What Causes These Behaviors?
    Every person with cognitive impairment is an individual who will react to circumstances in their own way. Sometimes the behavior may be related to changes taking place in the brain. In other instances, there may be events or factors in the environment triggering the disinhibition (a task may be too complex; the person may not be feeling well, etc.).

    Understanding The Behaviors
    It is important to try to understand why the person is behaving in a particular way. If family members and caregivers can determine what may be triggering the behavior, it may be easier to figure out ways to prevent it from happening again.

    Some Frequent Causes Of Disinhibited Behaviors Are:
    • Confusion
      Some behaviors occur because the person with cognitive impairment confuses the identity of people. The individual may believe that a care worker, or daughter, is actually their wife and behave in a way that is inappropriate as a result.
    • Discomfort
      Some of these behaviors, such as undressing or fondling themselves in public, may be the result of discomfort. For instance, feeling too hot or cold, or that clothes are too tight, may mean that clothing is removed in order to feel more comfortable. Urinary tract infections and itching can also lead to handling of the genital area. 
    • Forgetting and the loss of skills
      Sometimes these behaviors occur because the person with cognitive impairment has forgotten where he or she is, the appropriateness of being discreet, how to dress, or even the importance of dressing. The person may need to urinate, but has forgotten where the bathroom is, or how to use it. Remember that the lack of judgment that leads to the inappropriate and impulsive behavior could be the result of brain changes that are part of the cognitive impairment. 
    • Disorientation
      The individual may be confused about the time of day and believe that he or she should be getting ready for a bath or for bed. Or the person may believe that they are in the bathroom or bedroom.
    As mentioned earlier, some behaviors occur because the person with cognitive impairment confuses the identity of people and behaves in a way that is inappropriate as a result. Some of these behaviors, such as undressing or fondling themselves in public, may be due to discomfort. Sometimes these behaviors occur because the person has forgotten where they are, and they may believe that they are in the bathroom or bedroom.

    What To Try
    • Look for a reason behind the behavior. Understanding why someone is behaving in a particular way will help you respond to it.
    • The person’s doctor may be able to check whether there is a physical illness, undesirable side effects of medication or discomfort and provide some advice.
    • React with patience and gentleness. Try not to over-react, even though the behaviors may be very embarrassing. Remember that the behaviors are most likely part of an illness.
    • Give your loved one plenty of appropriate physical contact such as stroking and hugging. Often the person is anxious and needs reassurance through touch and gentle loving communication.
    • If the individual is engaging in inappropriate sexual behaviors gently remind him or her that their behavior is inappropriate. Lead them to a private place or try distraction by giving them something else to do, or something else to concentrate on.
    • Adjust clothing. Consider buying pants without zippers if public fondling is a problem.
    Disinhibited behaviors can be very difficult for families and caregivers. These behaviors are symptoms of cognitive impairment and it is important to remember that your loved one does not mean to upset you. To reduce your own stress make sure to look after yourself and take regular breaks.

    Cognitive Impairment can have many causes. The patient’s doctor should be consulted to determine a specific diagnosis and treatment options. But whatever the cause, the symptoms are often alike, and the Caregiver Strategies are often similar.

    The information in the resources listed above was compiled by the Ray Dolby Brain Health Center through clinical experience and commonly available published materials. For information on additional Caregiver Strategies, go to: cpmc.org/brainhealth.