A husband in his seventies is on trial for sexual abuse and could face up to 10 years in jail for having sexual intercourse with his wife, who suffered from Alzheimer's disease.

A US jury will have to decide whether Donna Lou Rayhons, who died last year, was mentally capable of consenting to sex with her husband, Henry, in a case being closely watched by doctors and dementia charities.

Mr Rayhons, 78, a farmer and prominent Iowa state politician, met his wife singing in a church choir after both had been widowed. They married in 2007; she joined him while he conducted business at the state capitol and they spent their time off beekeeping.

A few years into the marriage, Mrs Rayhons was diagnosed with Alzheimer's disease and her condition deteriorated rapidly, but the couple continued to have conjugal relations.

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Early last year, at the age of 78, she was moved into the Concord Care Center, a nursing home two miles from where she lived with her husband in Garner, Iowa. In May, her husband was told that the nursing home had concluded that Mrs Rayhons was not able to consent to sex.

At the behest of one of her daughters from a previous marriage, who had concerns, Mrs Rayhons was moved from a private room to a shared one on May 23. That night her room-mate pressed an alarm and told staff that Mr Rayhons had entered the room and pulled over a curtain, and she heard suspicious noises. The woman said: "I'm not stupid. I know what was going on."

Nursing home staff called police and Mrs Rayhons was taken to hospital but no signs of abuse were found. Prosecutors said they later found DNA evidence that sex had taken place.

Mr Rayhons's visits to his wife were limited and he last saw her on August 7. His final words to her were: "Love you honey." She died the following day and he was arrested a week later.

The Republican withdrew from a re-election race for the Iowa House of representatives. As the trial opened last week, prosecutors outlined how bad Mrs Rayhons's condition had become. She had been found washing her hands in dirty lavatory water, could not remember how to eat a sandwich and believed her first husband was still alive.

Dr John Brady, medical director of the nursing home, told the jury that if she responded positively to hugs and affection from her husband, it was a "primal response" not an "informed decision". He said Mrs Rayhons had scored zero on a standard test for Alzheimer's when a score below eight counted as severe impairment. Other staff described her as being "in her own little world".

Joel Yunek, defending, told the court Mr Rayhons had engaged in intercourse with his wife, but not on May 23. He said on that night Mr Rayhons had prayed with his wife. Mr Yunek said: "She was the love of his life. For him, it was kind of an Indian summer."

Henry Rayhons (left) in court. Photo / AP
Henry Rayhons (left) in court. Photo / AP

In an interview last year, Mr Rayhons told Bloomberg: "We just loved being together. She was always a very well-dressed lady, which I admired. She liked high-heeled shoes." He added: "My wife just died and you're charged with something like this because you prayed by her bed. It hurts. It really hurts."

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His family called the sex abuse charges "illogical and unnatural". Elizabeth Edgerly, a clinical psychologist with the Alzheimer's Association, said: "Is the person capable of saying no if they don't want to do something? That's one of the biggest pieces. For most people with dementia, even long into the disease, they take comfort in being with people who love them."