After several strokes, my uncle's behavior is inappropriate -- what can we do?

A fellow caregiver asked...

My uncle has suffered several strokes in the last six years. Physically, he has recovered and is fairly independent. However, he has gone from a charming intelligent man who was always very respectful of women to constantly leering and making sexually inappropriate conversation. It's bad enough at home, but a family outing with him to a restaurant, bank or grocery store is mortifying for all, especially my poor aunt. He will openly turn to stare at women as they walk by and flirts constantly expressing specifics (without profanity). We are not prudes, but his behavior and commentary is extremely offensive. Young female relatives are starting to avoid him,and no one brings a future in-law around. He would be mortified to know he's behaving this way, but it's getting worse, not better. It's like there are no controls in place, and he seems bewildered when we try to discuss it. Is anyone else dealing with this, and how are you handling it? I am also starting to worry about legal consequences.

Expert Answer

James Castle, M.D. is a neurologist at NorthShore University HealthSystem (affiliated with The University of Chicago) and an expert on strokes.

Sorry to hear about this.

It sounds like he might be suffering from "Frontal Lobe" dysfunction, most likely from all the strokes. This causes people to be disinhibited and inappropriate in social settings.

I would first start by having him evaluated by a Neurologist and getting an MRI of the brain. A Neuropsychologist may also be helpful in sorting out if there is a dementia co-existing that can be treated with medications.

For symptoms such as this, I commonly prescribe extended release valproic acid once a day. It is used as a "mood stabilizer" and often deals with the problem in a healthier way then would be accomplished with the use of "anti-psychotic" medications. Please ask your doctor/Neurologist about the use of this medicine, or others like it, to help regain some control of his behavior.

Good luck!