As with people, the incidence of medical and behavioral conditions affecting the quality of life, increases in older pets. It is important to note that “old age” is not a disease, just a time in life when, unfortunately, the incidence of disease is greater. It is common for people to just accept that their pet is “slowing down” because he/she is getting older. Conversely, some people will make changes to their pet’s food, or start adding supplements, solely based on the age of their pet. I do not agree with either of these approaches. With each patient I will always consider their age when making recommendations to my clients however, it is not the only factor. By considering the owner’s observations combined with findings on a physical exam, I am able to develop a diagnostic and treatment plan.
Because our pets don’t speak, we are dependent on our observations of their behavior at home. Any change in the normal routine of our pets may signify a problem. The challenge is to distinguish between medical and behavioral problems. To complicate things, some pets can have both.
Potential medical causes of behavioral changes include:
-Hormonal disturbances: Can result in changes in urination, increased incidence of infections, changes in appetite, aggression, lethargy, and (in cats) increased vocalization (seen with hyperthyroidism).
-Painful conditions: such as arthritis, cancer, and skin conditions (these can make an animal seem restless, irritated, or aggressive in some cases)
-Kidney dysfunction: Can cause an increase or decrease in urine production, poor appetite, and lethargy. In addition, many pets will start urinating in the house.
-Hypertension (high blood pressure): With the use of more accurate methods of blood pressure measurement, hypertension is being increasingly recognized as a problem in domestic animals. Signs can include restlessness, disorientation, and confusion.
-Sensory Loss: Loss of hearing or vision can lead to disorientation, changes in movement, irritability, and soiling in the house.
Clearly, there are many “medical” conditions that can cause behavioral changes. However, there are occasions when many of the signs noted above may be caused by a condition known as Cognitive Dysfunction Syndrome (CDS).
CDS is a chronic and progressive disease characterized by both loss and dysfunction of brain cells. It bears some similarities to human Alzheimer’s disease. The prevalence of CDS in dogs and cats over 11 and 15 years respectively, is fairly high. As the signs of CDS can overlap, or occur concurrently with some of the medical conditions noted above, it can be difficult to diagnose conclusively in some individuals. The most common signs noted in dogs are changes in social interaction (becoming more “needy” or the opposite – seeming disinterested in the owner), loss of housetraining, disorientation (wandering aimlessly around the house), reversal of the wake-sleep cycle (staying up all night and sleeping all day), and changes in activity levels. In cats the most common signs are excessive vocalization and housesoiling without a medical cause.
Diagnosis of CDS in our older patients involves screening for early signs at the annual examination by way of a properly obtained history from the owners and eliminating other (medical) causes of the behavior. In many cases there are concurrent medical problems. When this occurs, the approach I favor is to address the medical issues first and monitor for improvement, or lack thereof. If most, or all signs resolve with treatment of any medical conditions, no additional course of action may be needed at that time. If however, the signs persist I will initiate therapy for Cognitive Dysfunction Syndrome.
Treatment for Cognitive Dysfunction Syndrome will generally involve a combination of management changes at home, as well as medication. The changes made at home will be tailored to the specific patient, but will normally involve activities to stimulate interaction between your pet and the family, in an effort have the brain be more active. In addition, some changes to the home may need to be made to ensure the safety of your pet when he/she cannot be monitored. In early cases, these changes may be enough to effect an improvement, but in many pets require medication as well. It is important to note that the diagnosis of CDS is not “black and white”. In other words there is no one definitive test to make the diagnosis. As such, a portion of the diagnosis is made based on monitoring for a response to therapy. If there is dramatic improvement with therapy specific for CDS we can be confident in the diagnosis. Unfortunately there are occasions in which the diagnosis is correct, but the response to therapy is poor.
Being prepared to discuss your pet’s behavior each time you visit us will help us detect these changes early. In many cases, it is only after treatments have begun that we can see, in retrospect, that our pets were displaying signs of a problem.