Findings from a recent Alzheimer’s study show that sexual dysfunction is more common in men with dementia and may be related to medication side effects.1 The study, led by Dr. Roberta Butchers from the University of Warwick, U.K., is the first to investigate sexual dysfunction among people with Alzheimer’s disease (AD), and one of the largest studies of its kind, with data on more than 500 men and women with AD or mild cognitive impairment (MCI). The results suggest that sexual dysfunction is common in late-stage AD and may be underdiagnosed and undertreated, especially in men.1
Why Is Sildenafil (Viagra) Effective for Alzheimer’s Disease?
As a licensed healthcare professional in New York City, I often get questions about medications and health issues from my patients. One of the most common questions I receive is, “Is there a generic for Viagra?” When people with AD hear that Viagra is a generic medication, they sometimes think it will help them in their quest for more youthful looks. However, as Dr. Butchers and her team discussed in reference to their study, “Generic Viagra is not recommended for people with dementia and should be avoided altogether in those with low blood pressure or cardiovascular disease.”1 To understand why, let’s examine how Viagra works.
In the blood circulation system, nitric oxide (NO) is a chemical that acts as a messenger in the body. When a cell releases NO, it can enhance the function of other nearby cells. NO levels decrease with age, and there is some evidence that NO can improve cognition and reduce the need for daily medications in people with AD.1 When blood flows normally through the body, it transports nutrients and oxygen to the brain, which makes it function better. Medications that enhance blood flow to the brain, such as Viagra, can help maintain normal cognitive function in older adults with AD.
Sexual Dysfunction in Early-Stage Alzheimer’s
Although the participants in Dr. Butchers’ study were already in the later stages of AD, they found that sexual dysfunction was common even in those who were still experiencing relatively early symptoms. One in five of the men and women in the study had experienced at least one case of impotence or low sex drive (hypoactive sexual desire). Among the participants with mild AD, the rate was even higher, with one in three reporting impotence or low sex drive.1
Dr. Butchers and her team found that the severity of cognitive impairment and the presence of depressive symptoms were significantly correlated with sexual dysfunction, though not with the overall satisfaction of the men and women with regard to their sex lives.1 The researchers surmised that this could be because people with more severe dementia and depressive symptoms are either not interested in sex or cannot perform sexually due to the symptoms of their disease.
Risks of Taking Certain Medications for Alzheimer’s Disease
There are several medications that are commonly prescribed to people with AD, including acetylcholinesterase inhibitors (AChEIs) and memantine. Like many other medications, these can have various side effects and risks associated with them. One of the most significant side effects of AChEIs, for example, is hepatotoxicity, which can lead to liver damage. Like most medications, this can be potentially dangerous, especially for people with existing liver problems.2
The risks and side effects of medications for AD must be carefully considered, and physicians should have a good understanding of any potential interactions before starting a patient on a particular treatment. Sadly, many doctors do not discuss alternative treatment options with their patients, due to a lack of knowledge or a desire to avoid offending their patient. In some cases, doctors may be unaware of the risks and side effects of the medications they prescribe.
Treatments for Sexual Dysfunction in Later-Stage Alzheimer’s
For people with late-stage AD or MCI, the medications that can help with sexual dysfunction include:
- treatments for depression (such as an antidepressant)
- pDE-5 inhibitor (which can help improve erectile dysfunction in men)
- apomorphine (an intravenous medication used to treat erectile dysfunction in men)
- vasopressin (a hormone that helps regulate water balance in the body)
- sex therapy (counseling or a hypnosis session to help relieve sexual dysfunction)
Risk of Alzheimer’s Disease in Men With Sexual Dysfunction
The researchers found that the men in their study were twice as likely as the women to develop AD. They suggested that this could be because men are more likely to engage in activities that increase the risk of dementia. These activities include:
- chasing women
- high-risk behaviors
- alcohol abuse
- smoking
- poor diet
Men with AD may be more likely to experience impotence or low sex drive due to medication side effects or increased disease severity. However, as the disease progresses, psychological factors (such as depression and anxiety) can also contribute to sexual dysfunction in men.
Based on these findings, men with AD should be assessed for sexually-related problems early on, so that they can be treated effectively.
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