Dementia in Cats
Is it old age or is it dementia?
Did you know that older cats, just like elderly people, can suffer from dementia? Also known as cognitive dysfunction syndrome, it’s thought to affect nearly a third of 11 to 14 year-old cats. So, how do you tell the difference between dementia and simply slowing down with old age, and what can you do about it?
Advances in veterinary medicine and a better understanding of all aspects of cat care, mean that today’s cats are living longer than ever. The average life expectancy of a cat is now 14 years, with many far exceeding that and some living into their 20's. In the UK, it’s thought that there are around 2.5 million ‘senior’ cats – which is about a third of the pet cat population! While this is great news, it does mean that we now see more cats developing diseases associated with old age.
It can be quite normal to become a bit forgetful as we age but, in some cases, this is more severe and is associated with a disease process affecting the brain. Similar changes are seen in the brains of older cats. Many people don’t realise that behaviour changes developing in their older cats, such as becoming more vocal, losing their toilet training and being awake more at night aren’t just a normal sign of ‘getting older’; they’re actually signs of a degenerative brain condition.
Dementia can affect all breeds of cat and, typically, it’s seen in cats over 8 to 10 years old. About a third of cats aged between 11 and 14 are thought to show at least one behavioural problem related to dementia, and this increases to half of all cats aged 15 or over. In this older age group, the most commonly reported behaviour concerns are increased vocalisation and aimless wandering.
There are many similarities between dementia in cats and Alzheimer’s disease in humans. In both cases, once cognitive decline begins, it is always progressive, although cats tend to retain their ability to eat. Both conditions begin without symptoms being obvious, however, it is possible to see changes taking place in the brains of cats as young as seven years old. In humans, as symptoms emerge, mild cognitive impairment may eventually become severe and a clinical diagnosis of Alzheimer’s disease is made. By the time we see overt signs of dementia in cats, they are already at an advanced stage of disease and are comparable with a person suffering from Alzheimer’s.
Dementia in cats isn’t curable, but there is some good news: You can slow its progression and the earlier you start interventions, the more effective they can be. Also, by promoting good brain health in younger cats, you can help to prevent it from developing in the beginning.
No tests are available for dementia in cats. A diagnosis is made by ruling out other possible causes for the symptoms. Typical changes in the behaviour of a cat developing dementia include altered social interactions and loss of learned behaviour. Most of the behavioural symptoms of dementia can be caused by other conditions that are common in older cats. For this reason, it’s important to look for and to rule out or treat other possible conditions that may be causing the behavioural changes, before we can diagnose dementia.
Cat owners know what is normal for their own cats, so they can usually spot gradual changes in their cat’s behaviour over time. When a cat seems to be doing something out of the ordinary, it’s time to investigate. With some medical conditions, behavioural changes often appear before other symptoms. It’s vital that these are spotted and addressed as soon as possible, so that the most effective intervention can begin, whether the cat is developing dementia or something different.
Taking a closer look at the cat’s behaviour is the first step towards a diagnosis. Individual behavioural changes, such as reduced self-grooming, could be caused by one of several medical conditions, such as feline hyperthyroidism (an over-active thyroid gland). If, however, a number of behavioural changes are identified, we might become much more suspicious that cognitive decline is behind them.
If you’re concerned about your cat’s behaviour, you can complete a simple behaviour screening questionnaire that may help to identify a decline in your cat’s cognitive function. Using your answers, points are awarded according to how often your cat displays certain types of behaviour. The points are added up to suggest the likelihood of cognitive decline or dementia being present. Depending on the result of the questionnaire, one of several next steps is then possible:
- If your cat doesn’t display any of the behaviour listed in the questionnaire, it’s unlikely that there is currently significant cognitive impairment. Your cat should be able to continue with their preventative healthcare routine and the questionnaire can be repeated in three to six months. By completing the questionnaire every few months (which is a long time in an older cat’s life), you’ll ensure that, should your cat begin to develop behavioural changes, you’ll know exactly when they began. If your cat’s score on the questionnaire isn’t suggestive of dementia, but you feel that something is not quite right, discuss your concerns with your vet team.
- If the results of the questionnaire suggest possible cognitive impairment, the next step is to make an appointment with your cat’s vet. Your vet will ask you in detail about your cat’s recent management and they’ll go through your answers to the screening questionnaire. They’ll examine your cat thoroughly and, depending on their findings, they might suggest further investigations. These could include urine analysis or blood tests. Together, your cat’s history, clinical examination and any further tests, will provide a fuller picture of your cat’s health.
- The results of your vet’s investigations may uncover medical conditions or disease processes that explain the changes in your cat’s behaviour. If this is the case, they’ll be able to recommend options for treatment. Osteoarthritis, for instance, is common in older cats and can lead to changes such as aggression, restlessness and crying. Getting the osteoarthritis under control would be expected to improve the behavioural symptoms.
- The results of your vet’s investigations might provide no evidence of other medical conditions and they might now be able to diagnose cognitive decline or dementia. Sometimes, more information may still be required to enable them to rule out other conditions with more certainty. It’s also possible that they may suspect an unrelated behavioural problem and wish to help you to address this.
- Of course, a diagnosis of cognitive decline or dementia isn’t welcome news, but there is much you can do to slow its progression and to improve your cat’s life quality.
A cat developing dementia displays one or more typical behaviours. Vets commonly use a checklist of these behaviours, which are usually given the acronym DISHAAL.
D = Spatial or temporal Disorientation
A cat with spatial disorientation might forget where the litter tray is or they may be unable to find their way out of a familiar room. Temporal disorientation means things like forgetting they’ve just been fed or that they’ve just been let outside.
I = Social Interactions
Altered relationships with people or other animals. Many cats become very clingy and affectionate, while others may seem disinterested in interacting with anyone. Attention-seeking behaviour has been found in one study to be the commonest behaviour change in cats of 11-14 years old.
S = Sleep-wake cycle
Cats are normally quite active at night, and often like to have little sleeps during the day, but this may become quite extreme in cats with dementia. Living with a cat who is awake and vocal at night can become exhausting.
H = House-soiling
Forgetting how to use the litter tray, for instance, going to the toilet next to it, or going on other surfaces, such as furniture and bedding.
A = Alterations in Activity levels
Aimless wandering is one of two behaviour problems most often reported in cats of 15 and over.
A = Anxiety
Cats with dementia can’t make sense of their world as they used to, and this makes them anxious. This may lead to attention seeking and crying.
L = Learning and memory
Cats may forget previously learned behaviour, such as how to use their cat-flap, or they may forget that they’ve just been let out and ask to go again. They may also be frightened by common noises, as changes within a certain area of their brain prevent them from being able to get used to new things.
The checklist was originally developed for dogs. Recently, it has been suggested that, in cats, increased vocalisation should be included in the checklist and awarded high significance. Since cats tend to vocalise when they are experiencing many of the other problems on the checklist, increased vocalisation could signify the occurrence of these. For instance, increased vocalisation might indicate anxiety, the need for attention, disorientation, or the need to be fed or let out shortly after having been fed or coming indoors.
In a large study, 60% of cats of 11 years and over were reported by their owners to show increased vocalisation, especially at night. Owners were asked what they believed to be the reason behind their cats’ crying and just over 40% felt it was disorientation. The same number interpreted it as the need for attention, while 16% thought their cat was trying to let them know they needed a resource. Under 5% believed their cat might be in pain.
A separate study found that, along with aimless wandering, increased vocalisation was the most commonly reported behaviour problem in cats aged 15 and over. Increased vocalisation is therefore an important behaviour to investigate in an older cat.
Although there is no cure for dementia, steps can be taken to slow its progression and improve a cat’s quality of life. Caring for a cat who is disorientated, who can be at times demanding and who may be active and loud during the night can be exhausting. Improving the cat’s symptoms and putting into place some management strategies to help them can also make life easier for their owner and can help to protect the bond between the cat and their family.
Every cat is an individual, so their management plan must be tailor-made. A multi-faceted approach that aims to protect and nourish the remaining functional brain tissue, improve the sleep-wake pattern and reduce confusion and disorientation, is usually taken to help cats with declining cognitive function. Other medical conditions are also addressed, to reduce their impact on the cat’s wellbeing.
With a few minor adaptations, the cat’s environment can be made easier to negotiate and more predictable, or more stimulating, depending on the cat’s needs. Environmental enrichment, which means providing opportunities for play, climbing, exploring and hunting behaviour, increases activity levels (which can help with disturbed sleep-wake cycles). It provides mental stimulation and promotes the growth and survival of neurons, especially if it’s implemented alongside a diet enriched with antioxidants. In younger cats, especially those who don’t go outdoors, environmental enrichment reduces the risk of them developing dementia in later life. In those cats who are already showing signs of cognitive decline, it can help to reduce frustration levels.
In practical terms, environmental enrichment involves things like offering puzzle feeders and providing interactive games that mimic hunting. Playing with your cat, whether you’re wiggling a fishing toy for them to bat or rolling a ball of silver foil to encourage them to stalk and pounce, is fun and worthwhile. Scratching posts or boards, and climbing platforms or perches also encourage exploration and activity.
Spending time with your cat and interacting in ways that make them happy can help them to feel less anxious. Even if your cat doesn’t want to play with toys, cuddling them (if they like to be held – not all cats do), stroking, fussing and grooming them, or flicking small nuggets of food or treats for them to chase and eat, can all be good ways to get your cat responding and moving around.
In some older cats who already have advanced dementia, environmental changes can lead to confusion and anxiety so, in these cats, it is often better not to try to impose change. For cats living with dementia, they can sometimes benefit from their world being condensed down to something much simpler, for instance, by keeping them in one room where everything is familiar and as predictable as possible. All their resources can be put within easy access, including comfortable beds and hiding places, low-sided litter trays and food and water. Low-sided litter trays are useful for cats who are finding it difficult to get in and out, either because of osteoarthritis, or because they struggle for a while and then give up or forget what they were trying to do. Similarly, raising food and water bowls might make these easier for an older cat to access. Even if a cat is still able to have the freedom of the whole home, it helps them if resources are provided on each floor.
Pheromone products, available as plug-in diffusers and sprays, may help to reduce anxiety in older cats and they could help to settle tension in multi-cat households. These are used in areas where the cat is likely to spend a greater proportion of their time.
Night-time crying is a common problem in cats suffering from dementia so, if you can work out and address the reasons behind the crying, you can improve both your cat’s and your own life quality. If you think your older cat is crying for attention, you can try letting them in to sleep with you, so that the warmth and contact reassures them and helps them to settle. If this isn’t possible or doesn’t help, you could consider setting up a regular bedtime routine for them, making sure they’ve eaten, settling them in a warm, comfortable bed in a room where they have everything they need, and possibly with a night light on and even a talk radio station to keep them company, and closing the door until morning. Some cats find it stressful to be separated from their families, so monitoring your cat if you do try giving them their own sleeping arrangements, should help to ensure that things aren’t being made worse. Baby monitors and cameras designed to send images back to your phone allow you to keep an eye on what your cat is doing without disturbing them.
If your cat cries for food, you could use an automatic feeder that delivers little meals throughout the night, or you could introduce feeding balls that spill food as they are rolled. Since it can be difficult for cats with a significant degree of cognitive decline to learn how to use new things, cats need to be helped to work them out. For cats who struggle with this, an alternative is to place lots of small stashes of food around or scatter it for them to find as they wander about. Breaking the association between asking owners for food and being fed is helpful in most cases, however, again, some cats will find it difficult to adapt to new ‘rules’.
Although diets to promote brain health in dogs have been available for some time, currently, no diets are designed specifically for cats with dementia. Some of the ingredients used successfully in diets formulated for dogs are either toxic or unpalatable to cats. However, some widely available feline diets have been associated with increased longevity or improved brain function. One study has shown that a diet designed to help cats with osteoarthritis improved dementia symptoms in 70% of cats. Some of the ingredients with which these diets are supplemented, including antioxidants and specific amino acids, have been demonstrated to reduce oxidative damage (damage that occurs during metabolism) to the brain tissue, and to improve the health of the nerve cells.
At least two diets are available that are formulated to reduce anxiety in cats. They contain, among other things, L-tryptophan and a digested protein isolated from milk (whole milk is not recommended to be given to adult cats). A study into one of the diets showed that cats receiving it were less fearful when introduced to unfamiliar surroundings. This might be helpful to cats with declining cognitive function. The second diet is designed to provide support to cats with urinary tract conditions, such as cystitis. We know that stress contributes significantly to the development of cystitis in cats, so this diet might be helpful in an older cat whose cognitive decline causes anxiety, leading to cystitis.
Your vet is the best person to offer recommendations on suitable diets for your cat. If you decide to introduce a new food, do it over about 10 days and offer the new diet in a separate bowl to the original one, gradually reducing the amount fed of the old diet and increasing the new. Cats, especially older ones, are often suspicious of change and it can be stressful for them if they’re hungry but aren’t ready to eat a full meal of a new diet. Keeping the two foods separate enables the cat to make a choice about which food to eat. If the old and new diets have been mixed together, it can put the cat off eating as they may find the new diet ‘contaminates’ the old one.
Certain proprietary supplements have been shown to improve symptoms of dementia in dogs, but more trials are needed to show whether they also work in cats. Additionally, one widely available supplement for dogs contains an ingredient – alpha-lipoic acid – that is toxic to cats.
Free radicals are chemical products of metabolism. Normally, the body uses its own antioxidants to remove them as they’re produced. With age, this process becomes less efficient and free radicals react with their surroundings, leading to oxidative damage to cells, including those in the brain. Providing supplementary antioxidants helps to counteract oxidative damage. A supplement that enhances the production of the body’s own antioxidant glutathione, known as S-adenosylmethionine (SAMe), has been shown to improve cognitive function in elderly cats. The effect was greatest on the cats who showed relatively mild symptoms, and who were probably at an early stage in the disease process.
Supplements and complementary remedies that might help to improve the sleep-wake cycle or reduce anxiety include milk protein hydrolysate (digested milk protein – remember, whole milk isn’t recommended in adult cats), suntheanine, melatonin and certain herbal or amino acid preparations.
The two main drugs used to help dogs with dementia by protecting nerve cells from free radical damage and improving the blood flow to the brain haven’t been extensively trialled in cats. Although there are anecdotal reports that they might improve symptoms in cats, they are not licenced for use in this species. Cats and dogs metabolise drugs very differently and what is safe for use in dogs is sometimes very toxic in cats.
Other drugs can be used successfully in cats to treat anxiety, so these may be helpful. Again, they are not licenced for use in cats, so their use depends on certain criteria, one being that there are no licenced alternatives. Your vet can advise you on the potential risks and benefits of medical intervention and they will need to ask you to sign a form to show that you have given informed consent to use an off-licence medication.
Stress and anxiety tend to worsen symptoms for cats suffering from dementia. These cats struggle with change, so try to establish some routine for them. If you need to go away, arrange for someone to take care of them in their own home. Taking them to a new environment, such as a boarding cattery, would be stressful for them. If you have visitors, consider settling your cat in a familiar room away from the gathering and ensure everything they need is easily accessible.
From time to time, other illnesses, especially those common in older cats, may lead to a blip in your cat’s wellbeing. If you see new symptoms, or if the existing ones suddenly seem worse, have a chat with your vet. It’s important to keep in touch so that any new problems can be addressed as soon as possible. Ultimately, this is a progressive disease, but the combination of environmental management with dietary and perhaps supplementary or medical therapy, can help to slow its development and improve your cat’s and your own quality of life.
Because the exact cause of dementia hasn’t yet been established, it’s difficult to know how to prevent it. However, we do know that poor environmental stimulation is associated with increased risk of developing dementia in later life. Environmental enrichment, for instance, providing opportunities for hunting, exploring and climbing behaviour, and using puzzle feeders, together with a diet rich in antioxidants, promotes neuron growth and survival and improves mental function. It’s particularly important to provide environmental enrichment for young cats who don’t go outdoors.