ISSN: 2690-0807
Archive of Gerontology and Geriatrics Research
Opinion       Open Access      Peer-Reviewed

Intimacy, parkinson’s disease and dementia in the time of the coronavirus

Gila Bronner1,2*, Tanya Gurevich3-5 and Amos D Korczyn4,5

1Sexual Medicine Center, Department of Urology, Sheba Medical Center, Israel
2Movement Disorders Institute, Department of Neurology, Sheba Medical Center, Israel
3Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Tel Aviv, Israel
4Sackler Faculty of Medicine, Tel Aviv University, Israel
5Sagol School of Neuroscience, Tel Aviv University, Israel
*Corresponding author: Gila Bronner, MPH, MSW, CST, Senior Sex Therapist and Supervisor, Sex Therapy Service, Sexual Medicine Center, Department of Urology, Sheba Medical Center, Tel-Hashomer 52621, Israel, Tel: + 972-52-2590161; Fax: 972-3-5302990; E-mail: gila@gilabronner.com
Received: 23 June, 2020 | Accepted: 29 June, 2020 | Published: 30 June, 2020

Cite this as

Bronner G, Gurevich T, Korczyn AD (2020) Intimacy, parkinson’s disease and dementia in the time of the coronavirus. Arch Gerontol Geriatr Res 5(1): 029-030. DOI: 10.17352/aggr.000022

While the corona virus does not seem to invade the brain, patients with neurodegenerative diseases do not suffer from specific deficits in their immune system which could put them at increased risk of SARS-CoV-2 infection. So far, experience from the affected regions does not show an apparent increased risk, although there are no systematic data yet available [1].

People with PD (pwPD) may suffer because of the imposed restriction of free ambulation, limited social interaction, as well as less access to essential therapies (e.g., physiotherapy). All these may increase stress, cause or exacerbate depression, and unfavorably affect parkinsonian symptoms. Impulse control disorders, such as online gambling, may be increased because of the imposed isolation.

If affected by COVID-19, pwPD may be more likely to suffer from severe manifestations while perhaps be less likely to be admitted to intensive care if the number of beds is limited. Even the fear of such eventuality might be stressogenic to these patients, enhancing tremor, and other parkinsonian features.

PD is an age-related progressive disorder with well-known motor symptoms, and various non-motor symptoms such as pain, depression, anxiety, sleep disturbances, cognitive deterioration, sexual dysfunction (SD). Deterioration in sexual functioning was reported by men (77%), and women (78%) with PD [2]. Three types of problems were described [3]: (1) SD associated directly with PD. Decreased dopamine activity induces dysphoria and decreased motivation for sexual response [4]. In addition, the expectation of sexual reward diminishes due to inability to maintain arousal (e.g., erectile dysfunction) and to achieve satisfying orgasm. (2) Sexual preoccupation behaviors (SPBs) [3], where pwPD seem preoccupied by sex and present heightened interest (in 8.8%) [5] and hypersexual behavior (in 3.5%) [6] and (3) SD as a side effect of medical treatments for PD itself (e.g., antidepressants, dopamine agonists), and for other comorbidities (cardiovascular, diabetes, etc.) [3,5,7,8]. The most common and bothering SPB is sexual desire discrepancy, expressed by excessive demands for sex by patients (mainly men)

The stress associated with COVID-19 may increase anxiety, depression, and motor symptoms. Consequently, patients may be treated with additional antidepressants (causing more SD), and/or with dopaminergic treatment (increasing desire discrepancy).

Cognitive impairment is a frequent manifestation of PD with a yearly incidence of around 10% of patients [9]. The COVID-19 lockdown, the loss of daily routine and face-to-face encounters may lead to increased stress and behavioral problems in demented patients [10]. Inappropriate sexual behavior is one of the challenging neuropsychiatric problems in dementia. Due to confusion and misidentification, patients may touch a wrong person, or exhibit a disinhibited behavior (e.g. lewd language, exhibitionism, aggressive sexual demands) [11]. Possible cognitive deterioration including sexual manifestations in these patients should be assessed by Health Care Providers (HCPs). Management of these embarrassing symptoms is usually more effective by non-pharmacological interventions [11]. Considering that the period of COVID-19 pandemic may be stressful for the care-partners as well, this non-pharmacological interventions (such as therapeutic touch) may be impossible.

HCPs have many options for meaningful interventions without being experts in sexual medicine [12]. They can provide explanations to reduce anxiety (“During COVID-19 people experience deterioration in their sexual function”), inquire (“Have you noticed any changes with your sexual function/behavior?”), or refer to specialists (“I can refer you to our specialist”, “There are online guidelines for safe sex”), or prescribe an appropriate medication (antidepressants, phosphodiesterase type 5 inhibitors). When a sexual problem is brought up, the HCP may listen, acknowledge the importance of their sexual complaints, and evaluate their specific needs.

In this complicated period of social isolation, anxiety and uncertainty, empathic and careful attention to the patients’ sexual life (which is one of the most important aspects of the daily life) [13], may contribute significantly to the quality of life of the pwPD, with no need for additional funding.

  1. Antonini A, Colosimo C, Pecurariu CF, Moro E, Trenkwalder C (2020) EAN Movement Disorders Scientific Panel recommendations for COVID-19 pandemic. Link: https://bit.ly/2ZhqWjC
  2. Bronner G, Royter V, Korczyn AD, Giladi N (2004) Sexual dysfunction in Parkinson's disease. J Sex Marital Ther 30: 95-105. Link: https://bit.ly/31qbfcj   
  3. Bronner G, Hassin-Baer S, Gurevich T (2017) Sexual Preoccupation Behavior in Parkinson's Disease. J Parkinsons Dis 7: 175-182. Link: https://bit.ly/31t3Fhm
  4. Ikemoto S, Yang C, Tan A (2015) Basal ganglia circuit loops, dopamine and motivation: A review and enquiry. Behav Brain Res 290: 17-31. Link: https://bit.ly/31tBzT8
  5. Giladi N, Weitzman N, Schreiber S, Shabtai H, Peretz C (2007) New onset heightened interest or drive for gambling, shopping, eating or sexual activity in patients with Parkinson's disease: the role of dopamine agonist treatment and age at motor symptoms onset.  J Psychopharmacol 2: 501-506. Link: https://bit.ly/2YFmg7Q
  6. Weintraub D, Koester J, Potenza MN, Siderowf AD, Stacy M, et al. (2010) Impulse control disorders in Parkinson disease: A cross-sectional study of 3090 patients. Arch Neurol 67: 589-595. Link: https://bit.ly/31qQ4a5
  7. Barbosa P, Lees AJ, Magee C, Djamshidian D, Warner TT (2016) A Retrospective Evaluation of the Frequency of Impulsive Compulsive Behaviors in Parkinson's Disease Patients Treated with Continuous Waking Day Apomorphine Pumps. Mov Disord Clin Pract 4: 323-328. Link: https://bit.ly/388oXCa
  8. Weintraub D, Siderowf AD, Potenza MN (2006) Association of dopamine agonist use with impulse control disorders in Parkinson disease. Arch Neurol 63: 969-973. Link: https://bit.ly/2CScQxv
  9. Garcia-Ptacek S, Kramberger MG (2016) Parkinson Disease and Dementia. Geriatr Psychiatry Neurol  29: 261-270.  Link: https://bit.ly/2YIQcQt
  10. Wang H, Li T, Barbarino P, Gauthier S, Brodaty H, et al. (2020) Dementia care during COVID-19. Lancet 395: 1190-1191. Link: https://bit.ly/31qczMj
  11. Bronner G, Aharon-Peretz J, Hassin-Baer S (2015) Sexuality in patients with Parkinson's disease, Alzheimer's disease, and other dementias. Handb Clin Neurol 130: 297-323. Link: https://bit.ly/3i8N605
  12. Bronner G, Korczyn AD (2018) The role of sex therapy in the management of Parkinson's disease patients. Mov Disord Clin Practice  5: 6-13. Link: https://bit.ly/3dJ8i9o
  13. Moore O, Gurevich T, Korczyn AD, Anca M, Shabtai H, et al. (2002) Quality of sexual life in Parkinson's disease. Parkinsonism Relat Disord 8: 243-246. Link: https://bit.ly/2AdbufI
© 2020 Bronner G, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.