This is a very personal, complex process including many factors not within the couples control, such as personality changes created by dementia. Couples who have been able to maintain a physical relationship, report that this adds significantly to a sense of well-being for both the patient and the caregiver. Other caregivers, however, grieve for the companionship and emotional fulfillment which is no longer possible with a person whose condition precludes rational and emotional involvement. As a caregiver, your need for affection and sexual intimacy does not end because your spouse can no longer respond to your needs. Each caregiver must decide how to meet intimacy needs, whether choosing celibacy or becoming involved in other things or with other people who provide nurturance and fulfillment.
Sexual attraction depends on many things, including the physical attributes of one's partner.
When the person with Alzheimer's begins to be lax in hygiene, the caregiver may react with strong emotions which preclude sexual feelings for the AD person. The caregiver should not feel guilty about the lack of sexual attraction for a partner who may have changed greatly in personality or behavior. The first step is to understand the reason behind the behavior. It is important not to over-react. Over-reacting may reinforce the behavior we are trying to avoid.