Still Lucy
Recognizing dementia in your pet—and how to deal with it
It's 4:30 am and my 15-year-old Maltese mix Lucy is barking incessantly. I stumble out of bed to find out what's wrong. There she is: lost in the jungle of the dining room table and chairs, which have been in the same place for five years. She repeatedly bumps into the furniture legs like a furry pinball, unable to find her way out.
Soon after, I speak with Dr. Christine Fletcher, an associate at North Portland Veterinary Hospital experienced in canine geriatric issues. She says Lucy's problems are fairly typical for dogs with cognitive dysfunction — aka senile dementia. "Many of these dogs get lost and confused really easily," Fletcher says. "And they will start to bark a lot, because they don't what else to do. This can be a distress behavior for them."
Lucy is not alone in her distress: in a recent study of 180 dogs age 11-16 years, 28% of those 11-12 had at least one sign of cognitive dysfunction, while 68% of those 15-16 had at least one symptom of the condition. For cats, more than half of those 15 or older were found to exhibit at least one symptom as well.
Mental decline in pets is becoming more prevalent, but it's for a happy reason: they’re receiving better care, so they're living longer and are therefore more prone to many of the same age-related conditions seen in humans.
People are also simply more aware. "When I was growing up we had a dog that lived until she was 17, and looking back she clearly had dementia, but we didn't know what it was," Dr. Fletcher remembers. "She lost her housebreaking, she was always wandering. Our vet didn't have a name for it. Now we actually have criteria we can apply."
Dr. Daniel Krull
Doing the DISHA
Dr. Dan Krull is a board-certified Veterinary Neurologist at Columbia River Veterinary Specialists in Vancouver, WA. He feels that increasing education of those criteria among both pet parents and animal care professionals is key as more pets live longer.
"There are still many veterinarians I speak to who aren't entirely aware of some of the symptoms that come along with this condition," he says, adding that the simple acronym — DISHA —can be used to describe the signs of cognitive decline.
"D" is for disorientation. In addition to seeming out of sorts, pets can become confused in familiar surroundings. "Wandering, getting lost in the house — this is something to keep an eye on," Fletcher advises.
That said, older pets are prone to physical conditions like sight and hearing loss, which can also lead to disorientation, so it's important to rule those out first.
"I" is for interactions. Is your pet suddenly more subdued or aggressive, or even more loving or needy? Fletcher says the latter happened with her own 14-year-old dog.
Dr. Christine Fletcher
"One thing we started noticing is that this dog who was never super affectionate — she liked people fine, but was definitely not cuddly — is now coming up and soliciting petting."
"S" stands for sleep. According to Krull, changes in a pet's sleep cycle often signal that something isn't right. "The pet is pacing or vocalizing; or 'my cat's walking around, he's louder than usual and won't let me sleep'. That's a common thing for owners to complain about."
"H" is for house soiling — urinating or even defecating in places they never have before. "We really try to distinguish this from urinary incontinence, which is much more common," says Fletcher. "That's where the animal is not aware that they're urinating, which is a medical issue, versus a dog that is just walking through the house and then squats or lifts his leg to pee, which can be cognitive dysfunction. We have to talk about what exactly the dog is doing."
"A" refers to both activity and anxiety. According to Dr. Krull, dogs usually have increased activity with cognitive dysfunction, especially at times when they previously were less active — like at night. Anxiety can also cause nervous pacing, or a personality change owners notice.
It is also urgent that pet parents don't just assume what they're seeing is the onset of age-related mental decline. "If you have a pet exhibiting a lot of these signs — the DISHA — it's really important for a veterinarian to do a full, thorough neurologic exam," cautions Dr. Krull. That's because if there are other symptoms present, like weakness, decreased sensation, or loss of vision on one side, it could be indicative of a brain tumor or other physical issues, and not cognitive dysfunction.
Wait to Redecorate
While there is no cure for cognitive dysfunction, owners can maintain their companion's quality of life, and possibly even slow the disease's progression.
"The one area over which pet owners have the most control is environmental modification and enrichment," says Krull. "Stimulating these pets mentally, continuing with training, exercise, introducing novel toys. Try anything that keeps them active, involved and alert." Physical and mental activity can also help with sleep issues.
Maintaining a consistent physical environment and a regular schedule is also a priority, according to Krull. "One of the worst things for these patients is changes in who or what is in the household."
Fletcher adds that it's also a good idea to check your home for hazards to help keep a symptomatic cat or dog safe. "Make sure the pet is not going to fall down stairs or get stuck somewhere. Use scents as cues — smell seems to hang on longer than many of the other senses. For stairs, putting a dab of scent in the middle of each tread is an idea."
Drug therapy is another tool pet parents may want to consider when cognitive symptoms and related stress become severe. Lucy is on a low-dose pain pill to help her sleep through the night. Xanax — given to the pet, not the owner — is often used to alleviate dementia-related anxiety.
Finally, while no conclusive evidence exists to suggest that nutrition or supplements can either prevent cognitive dysfunction or improve its symptoms, a diet rich in antioxidants and Omega-3s has been shown in some studies to be beneficial.
Here and Gone
On my desk there's a picture of Lucy that never fails to make me smile: she's perched on the edge of a moving fishing boat, gazing over Lake Merwin like it's her personal kingdom. A few minutes after that shot was taken, she scared the expletives out of us when she decided to jump into the water for a swim.
Eight years later, that same brave, impulsive little dog has trouble finding her water bowl and howls at the walls.
According to Dr. Krull, what's happening to Lucy is likely similar to what happens to humans diagnosed with Alzheimer's.
"There's what we call atrophy of the surrounding brain as dogs and cats age. Amaloid beta proteins — plaques — are absolutely found in Alzheimer's patients, and while it's not quite the same, we do feel that the more [of them] there are in the brains of dogs and cats, usually the more cognitively affected they are."
This condition can shorten a pet's life, though not for a physiological reason. Often a physically sound animal passes because their quality of life has declined to a point that the owner chooses to humanely euthanize the cat or dog.
According to both doctors Krull and Fletcher, it's an excruciating decision.
"Often it's easier if the animal has cancer or kidney failure [because] there are definite signs to look for," says Fletcher. "With cognitive dysfunction, it's hard because these animals are eating great, drinking, their bodies are going along pretty well. So one of the things I'll talk to people about is if this animal is still able to do any of its usual routine. How much of that animal is still there?"
Krull agrees. "There's so much gray area," he says. "I usually try to tell owners to think of four or five things their dog or cat loves to do. If they start to not do those things anymore, and you're crossing things off the list and you get down to that fourth or fifth thing, for some people, that's it."
Hearing this lifts my heart a little, because in addition to belly rubs, Lucy still very much enjoys a meander down the street. Yes, she tends to wrap her leash around trees and often finds a scent she likes so much she refuses to budge. But that's ok. All of a sudden I'm starting to appreciate the fact that she's still as stubborn as the day I adopted her.
Does My Pet Have Age-Related Dementia?
While there is no cure for senile dementia in pets, watching for signs in your senior pet can mean an earlier diagnosis, and possibly better adjustment.
Possible symptoms — DISHA
D — Disorientation: wandering, seeming out-of-sorts.
I — Interactions. Depression, fear, excessive neediness, or sudden uncharacteristic extreme affection/friendliness.
S — Stands for sleep. Night pacing or vocalizing. Can signal dementia, pain, anxiety, or illness.
H — House soiling. More often physical than cognitive; see your vet.
A — Activity and Anxiety. Newly active at night, wandering in circles, restless pacing, fear of previously familiar places and situations.
DISHA applies to both canines and felines, but symptoms are often more subtle in cats. That's because not only do we interact with cats differently than dogs, but also because cats are expert at hiding weakness, making problems more difficult to spot.
Michele Coppola is a veteran Portland radio personality, copywriter, and freelance writer who shares couch space with her three rescue pooches, Lucy, Bailey and Ginny, as well as Byron, the stray man she married six years ago.