Alzheimer's Patients and Intimacy Outside Marriage: Johns Hopkins Health After 50 Offers Guidance on This Emotional Health Challenge

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Alzheimer's patients developing intimate relationships outside marriage is becoming more common as our aging population lives longer than ever before, and the prevalance of Alzheimer's disease increases. Johns Hopkins' newsletter "Health After 50" offers guidance on this difficult emotional health challenge for people caring for a spouse with Alzheimer's disease

Forgetting about prior relationships can cause this symptom -- but that is not usually the case. Many people with Alzheimer's (and some patients recovering from stroke) develop a condition called prosopagnosia, which is an isolated inability to recognize familiar faces.

Many people with memory-robbing advanced Alzheimer's disease eventually become unable to recognize their spouses. A small number of these patients form new, intimate connections with other people living near them in long-term care facilities. While these extramarital relationships are rare, when they do occur, they can deeply upset families.

WHY IT HAPPENS
"If your husband or wife has been diagnosed with Alzheimer's and seems not to know who you are, it's important for you and your doctor to understand why this is happening," explains Peter Rabins, M.D., Professor, Psychiatry and Health Policy, and Director, Division of Geriatric Psychiatry and Neuropsychiatry at Johns Hopkins.

"Forgetting about prior relationships can cause this symptom -- but that is not usually the case. Many people with Alzheimer's (and some patients recovering from stroke) develop a condition called prosopagnosia, which is an isolated inability to recognize familiar faces."

These patients have normal vision, but they cannot connect what they see to individual identities. (Interestingly, many of these people can recognize familiar voices, including their husbands' or wives'.)
Another cause of these symptoms may be a false belief. For example, some patients think that their family members are "imposters"; they may also mistake other people they live with for their spouses.
These conditions can be fleeting or variable; occasionally, an individual will recognize some family members but not others. Eventually, however, most patients with Alzheimer's cannot identify even the most familiar people.

WHAT TO DO
Intimacy among Alzheimer's patients usually goes no further than holding hands. Nevertheless, these new connections can still distress husbands and wives who recall -- and treasure --life-long relationships.

"It's hard enough to watch your spouse lose the memories that you share," says Dr. Rabins. "To feel rejected or replaced on top of that is extremely difficult."

Complicated ethical questions arise if your spouse begins to have a physical relationship with another patient. Family members and the long-term care staff must determine if your loved one has the capacity to consent.

"It's really crucial for the facility to figure out whether or not patients really understand what they are doing, and their families need to be involved," Dr. Rabins stresses.
Have an expert psychologist or psychiatrist who is knowledgeable about assessing the capacity to consent evaluate both patients in the relationship. Your long-term care facility can (and legally should) help you locate such a professional.

A CHALLENGING PERSPECTIVE
Families should keep in mind that patients with advanced Alzheimer's disease are living in the moment; they cannot access the past, so they reach out to the people who are immediately around them.
Neurological impairments may make patients unable to maintain long-term relationships. They simply connect to people differently than we do.

As your marriage changes, it may help you to talk with a counselor. And remember: Even when people with Alzheimer's start spending time with new companions, they usually don't push their families away.

This article is taken from the March 2008 issue of the Johns Hopkins "Health After 50" Newsletter.

Copyright 2008
Johns Hopkins Health After 50

For over 20 years, Johns Hopkins Health After 50 newsletter has been publishing timely information on the health disorders that affect us in later life.

FOR MORE INFORMATION
For more information on Memory Loss and Alzheimer's, please visit our Memory topic page at Johns Hopkins Health Alerts:
Johns Hopkins Health Alerts Memory Topic

THE JOHNS HOPKINS GUIDE TO MEMORY LOSS AND AGING
Johns Hopkins Health Alerts has recently published a free special report, "The Johns Hopkins Guide to Memory Loss and Aging." It in you will learn more about the reasons for memory loss as we age, and how to distinguish between Alzheimer's disease and other forms of dementia, versus the normal changes in memory we can all expect as a result of the aging process. It also offers 8 Memory Preserving Tips.

For a free copy The Johns Hopkins Guide to Memory Loss and Aging, please visit:
Johns Hopkins Guide to Memory Loss and Aging

DR. PETER V. RABINS
Dr. Peter V. Rabins is the medical editor of The Johns Hopkins Memory Bulletin:
Johns Hopkins Memory Bulletin

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