Cognitive Dysfunction in the older dog and cat: Treatment Part I
In my previous blog “The Cognitive Dysfunction (CDS) in dogs and cats” we discussed the clinical behavioral signs associated with this disease. The acronym DISHAAL was used to help us remember these changes in behavior. Disorientation, Interactions between owner and pet are altered, sleep-wake cycle disturbances,house soiling, activity changes- Increased/ Repetitive, Activity- Decreased/ apathy, depressed, learning and Memory are decreased. The most common signs in the dog are anxiety, night waking and vocalization and in the cat vocalization (especially at night) and soiling.
There are three major treatment goals in CDS
Management of concurrent medical issues
Concurrent medical conditions can present as signs of CDS as well as compound problems with CDS and anxiety. In fact the majority of senior animals are presented for veterinary evaluation because of changes in behavior. I would suspect that the majority of these behaviors have a medical cause. Therefore the first approach to treatment must be to evaluate for other medical conditions and medications they may be currently taking.
For example, if a pet has a urinary tract infections or a medical problem which results in the increased consumption of water, one may be dealing with increased problems with night walking, restless ness and soiling in inappropriate areas. Treating a urinary problem medically can lessen or eliminate some of these behavioral changes.
The pain associated with arthritis, may manifest as an increase in aggressive behavior. The older dog or cat may anticipate pain if they anticipate being handled or moved. Pain can also manifest itself as decrease in activity, vocalization, house -soiling and self- trauma. Diagnosis of the source of pain and then pain management may decrease aggressive behavior and increase activity.
Cats with hyperthyroidism may show behavioral signs such as increased vocalization, aggression, urine marking increased or decreased activity and night walking. Feline hyperthyroidism is one of the most common endocrine diseases seen in the older cat. If behavioral alterations are due to this disease treatment will eliminate them.
Dogs with hypothyroidism show signs of lethargy, irritability and decrease response to stimuli. Simple replacement therapy significantly changes these signs.
Obvious it is impossible to list and explain all of the medical problems which can results in behavioral signs of CDS or compound CDS. It is the role of your veterinarian to help in the diagnosis and treatment of these medical problems. The most important take away concept is that medical diseases must be diagnosed and treated for before one can evaluate the significance of CDS in the dog and cat.
Anxiety creates a stress response in the pet. Stress results in physiologic changes in the body the response of which is beyond the scope of this blog. Suffice it to say, chronic stress can worsen the clinical signs of CDS.
The following are a list of actions which can help decrease anxiety in your older pet.
Drug therapy to decrease anxiety
There are several classes of drugs which can be used to decrease anxiety in the pet. Drug selection is based on the situation causing the anxiety. For example, in senior pets with generalized anxiety, noise phobias, or separation anxiety, buspirone or selective serotonin reuptake inhibitors like fluoxetine (Reconcile; Elanco, Greenfield, IN, USA) and sertraline may be considered because of their low risk of side effects. Consultation with a veterinarian will help determine if your pet would benefit from one of these drugs.
There are some natural compounds which may help reduce anxiety.
Continued enrichment and mental stimulation
Studies in animals and humans have shown that mental stimulation can delay the onset of dementia. In addition for our pets mental stimulation is an essential component in maintaining quality of life. Continued enrichment can take the form of positive social interactions, continued training, play, exploration and hunting games, searching and retrieving.
In my next blog I will review current drug therapy and dietary products used for CDS. In addition I will discuss a common problem in dogs, night walking.
A home Veterinary visit helps in the evaluation and recommendations for CDS treatment.
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