Dementia in Pets: What You Need to Know
How to recognize it in your beloved four-legged family member, and what can help
It is a gift that our companion animals are living longer than at any time in the past, thanks to advances in veterinary medicine, better nutrition and our understanding of how to care for them. But with longevity has come a host of ailments once thought exclusive to humans. I have had 10 dogs over the course of my life and have seen them through diabetes, lung cancer, breast cancer, heart disease and, most recently, cognitive dysfunction syndrome (CDS) — better known as dementia.
I didn't know dogs and cats could suffer from dementia until my 12-year-old cocker spaniel, Theo, was diagnosed.
But it was clear something was happening to him. He had begun pacing aimlessly through the house. He forgot how to use his doggie door. Once a reliable and boisterous announcer of mealtime, cyclers and the UPS truck, he went suddenly silent. Food fell from his mouth; he was startled by the same fire hydrant on our walk every day and he started to walk in circles. A trip to the vet confirmed that Theo was suffering from canine cognitive dysfunction syndrome.
Cognitive dysfunction syndrome affects approximately 28% of 11- to 12-year-old dogs and 68% of dogs aged 15 to 16. It affects 36% of cats aged 11 to 21. Fifty percent of cats aged 15 and older show behavior changes consistent with CDS.
Making the Diagnosis
If you suspect your dog or cat might have CDS — or are concerned about any behavioral changes, no matter how slight — a visit to your veterinarian is essential. You'll be asked which behaviors you've noticed, so it's a good idea to make a list to take with you.
He forgot how to use his doggie door. Once a reliable and boisterous announcer of mealtimes, cyclers and the UPS truck, he went suddenly silent.
Some medical conditions or medication reactions can mimic cognitive dysfunction, so your vet will want to rule those out. For example, dogs with chronic pain, anxiety or who are sight- or hearing-impaired may exhibit signs of CDS but not otherwise fit the criteria.
Dr. Marcia Toumayan, who heads up the Cat Clinic of Chattanooga (Tenn.), a veterinary practice, advises that kidney disease, diabetes, osteoarthritis and hyperthyroidism should all be investigated before a diagnosis of feline CDS is made. As with most ailments, early detection and treatment will lead to better outcomes.
Signs and Symptoms of CDS in Dogs and Cats
Many vets use the acronym DISHAAL to assess for cognitive dysfunction. DISHAAL stands for disorientation; alterations in interactions with owners, other pets and the environment; sleep-wake cycle disturbances; house soiling; changes in activity; anxiety and learning and memory impairment.
It's helpful to go through each of these one by one and talk about how they can manifest. You'll notice it's possible to have a great deal of crossover between symptoms and that the presence of some symptoms can lead to other symptoms, such as disorientation leading to anxiety.
Dogs and cats with CDS will often begin to wander, pace purposelessly or seem not to know where they are. It is not unusual for animals with CDS to get "stuck" in corners. Some animals will drop their food or be unable to find their bowl or litter box.
Altered Interactions (with owners, other animals and the environment)
Like humans with various forms of dementia, animals with CDS may no longer recognize family members. They may become less playful or display increased aggression or timidity. They may stop engaging with their toys and treats or display unusual reactions to common things in their environment. Dogs and cats with CDS may also avoid being petted or no longer greet their owner upon their return. They may stop responding to sights and sounds in their environment (though this can also be the result of changes in sensory acuity due to aging) or may have increased reactivity to sight or sounds that previously did not provoke a response.
Theo was an example of this, since he lost interest in bicyclers and the UPS truck and was increasingly startled by the fire hydrant we passed every day on our walk.
Dogs and cats with CDS may also avoid being petted, or may no longer greet their owner upon their return.
Sleep/wake cycle disturbances
Animals with CDS often suffer disrupted sleep habits, which can contribute to disorientation and confusion. Sleeping significantly more or less than usual may be cause for concern. Some dogs with CDS pace and howl at night.
Animals previously fastidious about their elimination habits or who reliably took themselves outside (or asked to go out) may begin to have accidents indoors or soil their crate or bedding. There can be a number of reasons for this: it's possible they no longer interpret the signals from their body telling them they need to eliminate; they may have lost their ability to communicate their need to go out or they may not be able to find the litter box or, as in Theo's case, the doggie door. Some also simply lose their training, and no longer understand where to potty.
Dogs and cats with CDS may become lethargic or overly active. Spinning in circles — either while standing in one place or while walking — is one disturbing symptom of canine CDS. Other symptoms include pacing or wandering, snapping at or licking the air or walls and changes in appetite.
Dogs and cats may appear depressed or apathetic, and may lose interest in play, treats or self-care.
In cats aged 15 and older, the most common signs of CDS are aimless activity and excess vocalization. According to Toumayan, if hyperthyroidism is not diagnosed and treated, it can also cause a cat to become restless and increasingly vocal, so it's important to rule that out before a diagnosis of feline CDS is made.
Just as people with various forms of cognitive decline often experience anxiety, so do some dogs and cats. Signs of anxiety in animals include panting, lip-licking, whining (or mewing), pacing, restlessness, clinging, furniture scratching and compulsive behaviors like repetitive self-grooming.
Some animals may develop fears and phobias to places, surfaces, things or people, or develop separation anxiety.
Learning and memory deficits
Animals with CDS may forget their previous learning. Dogs may no longer sit or lie down on command, respond to their name or ask to go outside to potty. Dogs may no longer understand how to walk properly on a leash and cats may forget how to use a litter box.
It is important to recognize when an animal's failure to obey previously learned rules is a symptom of CDS. Behavioral correction or, worse, punishment can escalate anxiety in an already confused animal.
Treatment Options for CDS
Treatment of cognitive dysfunction syndrome is aimed at slowing the advancement of neuronal damage and improving clinical signs. Dr. Stacy Choczynski Johnson, a vet expert at Pumpkin Pet Insurance, suggests pet owners talk to their vet about a combination of the following interventions:
Selegeline is a monoamine oxidase inhibitor (antidepressant) that can reduce clinical signs of CDS in dogs. It has also been used off-label in cats, and according to the American Association of Feline Practitioners, has shown some promise. Some owners report substantial improvements in their pet's cognitive functioning with Anipryl, while others report little if any. It is important to begin treatment as soon as symptoms of CDS are noticed.
CBD (Cannabidiol) oil, essential oils
CBD and lavender oil will not restore your dog or cat to his previous level of cognitive functioning, but they can ease the anxiety related to CDS and help your pet stay calm.
Certain senior pet foods supplemented with antioxidants, vitamins and omega-3 fatty acids have been shown to improve signs of CDS and to slow the progress of cognitive decline. Your vet can recommend one or more of these to try.
SAM-e is an over-the-counter supplement which aids in detoxification of the liver. It is often recommended for dogs and cats with CDS and can also help with osteoarthritis.
Environmental control ("Don't move the coffee table")
There are a number of ways you can help your pet adjust to changes in their cognitive functioning. Dogs may need more frequent trips outdoors or even the addition of an indoor toilet area. Cats may need more litter boxes (one on each floor of the home, for example) or litter boxes with lower sides.
If your pet can no longer hop up onto the bed or other favorite perches, consider providing non-slip ramps.
You can help your pet regulate their sleep/wake cycle by opening blinds and providing outdoor activities during daylight and reducing exposure to artificial light at night. Choczynski Johnson says it's important to keep your pet's environment as stable and consistent as possible.
Hearing a diagnosis of CDS is never easy.
Mental stimulation and enrichment
Mental stimulation is key to our pets' quality of life, says Toumayan, and helps maintain cognitive function. Interact positively and often with your pet. Introduce new and varied opportunities for exploration.
Most cats love climbing, perching and hunt-and-chase games; combining these with novel ways for them to obtain food and treats — for example, giving them toys that require pushing, lifting, dropping, batting, pawing or rolling to release food — will help keep them interested.
For dogs and cats alike, scattering favored food or treats (or catnip) in different locations around the house encourages pets to hunt, search and retrieve, and, most of all, to stay active and engaged. Interspersing enrichment activities throughout the day, and having a final play session just before bedtime may lead to better sleep.
Toumayan advises owners provide their cats with plenty of food puzzles, petting and grooming time. "Even something as simple as a cardboard box to hide and play in can keep cats entertained," she explains.
When It's Time to Say Goodbye
It's not something any of us want to think about, but euthanasia is the last, most loving gift we can offer our pets. But how do we know when it's time?
Choczynski Johnson says that when she consults with her patients about their pets' quality of life, she asks them, "What are three things your pet 'lives for?" And, she adds, "Maybe it's a special treat, a walk, snuggling or a game of fetch. Once they stop doing those things as a result of illness, life might not be worth living. That's when it is time to start thinking about humane euthanasia."
She says: "Personally, I believe that it is better to say 'goodbye' before the human-animal bond is completely severed."
My husband and I said goodbye to Theo in November, 2019, roughly two years after he was diagnosed. He was 14.
Hearing a diagnosis of CDS is never easy. But knowing what is happening with our pets is the only way we can help them cope and try to maintain their quality of life. The best approach is a combination of medication, diet, supplements and environmental enrichment. And, of course, love.
Says Choczynski Johnson: "Managing a pet at home with dementia is a true testament to the human-animal bond."