Sexuality and Intimacy in Alzheimer’s Disease: A Systematic Review of Spouse-Caregivers’ Perspectives

Abstract Introduction The onset of Alzheimer’s disease (AD) reshapes multiple aspects of couples’ lives, particularly when one partner assumes the role of primary caregiver. Sexuality is often affected by caregiving burden, concerns about consent, and ageist beliefs; however, caregivers’ perspectives remain insufficiently explored. Objective This study examines how couples, particularly spouse-caregivers, experience and interpret sexuality and intimacy following an AD diagnosis. Methods A systematic review was conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD42023444035). Searches were performed in Web of Science, PubMed, PsycINFO, and Scopus. Eleven studies met the inclusion criteria. Across the studies, 309 heterosexual couples in which one partner had been diagnosed with AD were represented. Results Three themes were identified: (1) Evolution of Sexual Expression , including both the cessation of sexual intercourse and the adoption of alternative forms of closeness; (2) Impact of AD on Sexual Intimacy , encompassing changes in communication, role dynamics, and caregiver burden; and (3) Gender Differences , with women more often reporting reduced desire and greater caregiving burden, whereas men more often maintained spousal identity and sexual interest. Conclusions Spouse-caregivers experience complex and evolving intimate dynamics following an AD diagnosis. These experiences highlight unmet relational and sexual health needs within dementia care. Policy Implications Dementia-related policies should explicitly integrate sexuality into care services, mandate accessible psychoeducation for couples, provide gender-sensitive caregiver support, and train health professionals to address intimacy using a sex-positive, stigma-free framework.