Dementia in Dogs
Is it old age or is it dementia?
Did you know that older dogs, just like elderly people, can suffer from dementia? Also known as canine cognitive dysfunction syndrome, it’s thought to affect nearly a third of 11- to 12- year-old dogs and well over two-thirds of dogs aged 15 to 16 years. So, how do you tell the difference between dog dementia and simply slowing down with old age, and what can you do about it?
Thanks to advances in veterinary medicine and to a better understanding of their care and nutrition, our dogs are living longer than ever before. It’s now common for dogs of many breeds to live well into their teens and sometimes beyond. This is great news, but it does mean that we’re now seeing a higher incidence of conditions associated with old age.
One such condition is canine dementia, which has some similarities to the condition we see in humans. As people age, they are likely to become a little more forgetful, and perhaps not as ‘sharp’ as in their youth. This can be perfectly normal, but we know that in some people this is severe and associated with disease – we call this dementia. Older dogs developing dementia gradually begin to behave differently. For instance, some of the signs of dementia in dogs include forgetting commands they’ve been taught, or they may seem to sleep more in the day, while being restless and sometimes vocal during the night. Many people don’t realise that the changes they’re seeing in their older dogs aren’t just a normal sign of ‘getting older’ – they’re actually signs of a degenerative condition of the brain. This is part of the reason dog dementia often goes underdiagnosed. The chances of a dog having dementia increase with age, and all breeds may be affected equally.
Just as in human Alzheimer’s disease, sadly, once cognitive decline begins, it is always progressive. Both conditions begin without obvious symptoms. Gradually, symptoms emerge which, in humans, are considered mild cognitive impairment. More severe symptoms develop, at which point a clinical diagnosis of Alzheimer’s disease is made. By the time we see overt signs of dementia in our pets, they are already at this late stage of disease and are comparable with a person suffering from Alzheimer’s.
The good news is that, although dementia isn’t curable, there are things you can do to slow down its progression and the earlier you catch it, the more effective those interventions can be.
There is no definitive test for dementia in dogs. It’s diagnosed by looking for typical behaviour changes, such as loss of learned behaviour and altered sociability, and ruling out other medical reasons for the changes we’re seeing. It’s important to determine and address the underlying cause, because older dogs often have more than one condition going on simultaneously, and all of the behaviour changes we see with canine dementia can also be signs of other diseases.
Dog owners tend to know their own pets well and are usually the first to notice subtle changes in the way their dog behaves. So, when an owner reports that their dog seems to be doing something more or less frequently, or even something new altogether, it can be a sign that it’s time to investigate. Behavioural changes often appear before other, more classical symptoms of some medical conditions. It’s vital that changes are spotted early to provide the most effective intervention, whether a dog is developing dementia or something different.
The first step in diagnosis is to look in more detail at the dog’s behaviour. Individual behavioural changes, such as not getting up to greet you when you come home, could be caused by one of several medical conditions, such as osteoarthritis. However, if we see a collection of behavioural changes emerging, we may become much more suspicious that the cause could be canine cognitive dysfunction.
Questionnaires are often used to screen dogs for behavioural changes that might suggest a decline in cognitive function. The levels at which dogs display different behaviours are awarded points and, together, they add up to indicate the likelihood of cognitive decline or dog dementia. If you’re concerned about your dog’s behaviour and you’d like to check their symptoms, you can find a screening questionnaire here.
Once you’ve completed a dementia-screening questionnaire for your dog, one of several outcomes is then possible:
- If your dog is displaying none of the listed behaviours, they should be fine to continue with their usual preventative healthcare and the questionnaire can be taken again in three to six months. Repeating the screening questionnaire every few months ensures that if your dog begins to display any of the behaviours, everyone has an accurate idea of when this began. Investigations and, if necessary, interventions can then be introduced for maximum benefit. If you’re worried about your dog, even though their score on the questionnaire isn’t suggestive of dementia, you can always discuss your concerns with your vet team.
- If the questionnaire has identified behaviour that could suggest cognitive problems, the next step is an appointment with your dog’s vet. Your vet will take a full history, which means they’ll ask you about your dog’s recent life and management and discuss your answers to the questionnaire. They’ll then perform a full physical examination. Depending upon their findings, they may suggest further investigations, such as urine analysis or blood tests, to obtain a complete picture of your dog’s health.
- Your vet will assess the results of their investigations, which may have revealed other conditions or disease processes that could explain your dog’s behaviour. They can then recommend treatment options to you. If a medical problem, for instance, osteoarthritis (which is common in older dogs), is contributing to the behavioural changes, getting that under control would be expected to improve the behavioural symptoms.
- If your vet’s investigations find no evidence of other medical conditions, they may be able to diagnose canine dementia or cognitive decline. They may, on the other hand, feel that more information is required, or they might even suspect a different behaviour problem, unrelated to dementia.
- A diagnosis of cognitive decline or dementia, while being unwelcome news, means that you can take measures to slow its development and improve your dog’s quality of life.
A dog 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
Getting lost in familiar places, for example, getting stuck in a room. Staring blankly at or walking into walls or doors. Forgetting that they have just been let out and asking to go out again. Going to the hinge side, rather than the opening side, of a once-familiar door. Decreased recognition of people or animals. Altered reactivity to sights and sounds – they may become less responsive or, conversely, more reactive and perhaps noisier.
I = Social Interactions
Altered relationships with people or other animals. Many dogs become clingy and needy, while others may seem disinterested in interacting with anyone, or show reduced greeting behaviour. Some dogs might become irritable or even show aggression towards people or other animals. They might seem as though they don’t recognise people or animals they know.
S = Sleep-wake cycle
Dogs developing dementia tend to sleep more during the day, while being restless or awake during the night. This behaviour change is often one of the most noticeable and most difficult to live with. It might also be associated with repetitive barking or whining during the night.
H = House-soiling
Loss of toilet-training behaviour, including going to the toilet indoors or in their bed or crate. Not asking to go outside.
A = Alterations in Activity levels
Activity levels may change, for instance, there could be aimless pacing or wandering, and repetitive behaviour, such as obsessive licking or snapping at thin air. Alternatively, there may no longer be enthusiasm about being taken out, playing or exploring their environment. They may be disinterested in eating or keeping themselves clean.
A = Anxiety
Dogs with dementia can’t make sense of their world as they used to, and this makes them anxious. This may lead to attention seeking or separation anxiety, or to fearfulness of people, places or things they know.
L = Learning and memory
Dogs may forget previously learned behaviour. They might seem unable or less likely to respond to commands they’ve been taught or they might seem slow to pick up new things or adapt to change.
Although there is no cure for canine dementia, steps can be taken to slow its progression and improve a dog’s quality of life. Caring and living with a dog with dementia, who can be at times demanding and who may pace around or whine during the night can be exhausting. Improving the dog’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 dog and their family.
Every dog 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 dogs with declining cognitive function. This can involve adaptations to the dog’s living environment and interactions, dietary support and supplementation and sometimes medications. Other medical conditions also need to be addressed, to reduce their impact on the dog’s wellbeing.
Dogs suffering from cognitive decline may be less tolerant of other family members, so it’s a good idea to provide places where they can rest undisturbed. Make sure that everyone in the home knows to leave the dog to rest when they’re in their ‘den’. With dogs who are becoming disorientated, sleeping more during the day and waking at night, it’s especially important to let children know that they could make the dog jump if they disturb them when they’re sleeping. Taking dogs for short, extra walks during the day and having a bedtime routine, including a trip outside to the toilet, can help them to settle better at night.
It’s common for dogs with cognitive decline to keep asking their owners to let them out, even if they’ve only just come back indoors. Some dogs forget how to signal that they need to go out, or why they went outside, and they may start to toilet in different places, including indoors. This can be difficult for their owners to cope with. It may help to accompany your older dog to the garden regularly, rather than waiting for them to ask. If a dog isn’t quite making it to the garden to go to the toilet, an indoor toilet area, for instance, laying down puppy training pads in strategic places, for instance, by the door, can make cleaning up easier.
Disorientation often leads older dogs to struggle to find their way around the home and they may get ‘stuck’ behind furniture or doors. If this is happening, it could help to alter the arrangement of furniture within rooms to prevent the dog from becoming trapped. Go down to your dog’s eye level and move around the room, looking for places they may get trapped, get their head stuck or trip over. Tidy away any bundles of wires so that your dog can’t get tangled in them. Placing your dog’s resources in a corner can help to prevent them from falling over or walking through those. You could also try to give your dog clues to help them to locate their food, water bowls and toys, and also the way to the door, by laying down mats that provide traction and a noticeable walking surface. Many dogs with cognitive impairment find change stressful and are unable to cope with alterations to their environment, so if you do make any modifications to try to help your dog to find their way around, monitor them closely, to be sure that this doesn’t make things worse.
Dogs with canine dementia tend to forget learned behaviour and training. Owners sometimes think their dogs are ignoring them when they don’t perform an action, such as ‘sit’, when asked. It could be that it’s difficult for an older dog to complete an action, because of joint pain from osteoarthritis, or it could be that the dog’s hearing is in decline. It is also quite likely that the dog can no longer associate the command with the action. It may help to try to teach your dog visual cues, such as hand signals, and to use strong motivators, such as tasty treats, to help them to perform the desired action. You could also consider training new actions that are easier for your dog to manage, such as a ‘watch’ command, rather than a sit. The earlier you begin to teach any new commands, the better, as it may become more difficult for your dog to learn as the disease progresses.
If you take your older dog out anywhere, it’s a good idea to put a close-fitting harness on them with a short length of trailing line so that, should you need to grab them in a hurry, you don’t have to rely on a failing recall command. If you’re exercising your dog somewhere with good visibility, with little risk of tripping anyone up or getting it caught on trees and undergrowth, you could use an extendable lead to allow them some freedom. Always use a fixed-length lead if you’re taking your dog along roads and pavements and switch to the extendable lead when safe to do so.
Sometimes, older dogs displaying symptoms of dementia can become targets of aggression from other dogs. The lack of normal body language and slow reactions to signals from other dogs can be confusing or worrying, leading to unsettled or aggressive behaviour. If you have other dogs in the house, keep a close eye on them to monitor how well everyone is coping. If you have to leave your dogs unsupervised it can be safest to confine the other dogs to a different part of the home until you return.
It can help to reduce your dog’s anxiety if you implement some routine and predictability. Dogs with cognitive decline find change difficult to cope with so, if you plan to go away from home, it would be much less disruptive if they could be cared for by a pet-sitter in their own surroundings, rather than being taken to a boarding kennels.
Spending quality time with your dog, fussing and grooming them, practising training or playing gentle games to provide some mental stimulation also improves quality of life and helps to maintain cognitive function. In the same way as older people feel it keeps them ‘sharp’ to practise the daily crossword or complete sudoku puzzles, a little training with your dog every day can help to give their brain some ‘exercise’. Dogs love to use their noses, so teaching your dog to sniff out hidden treats around the home can be beneficial, as well as fun. Also, you could help to familiarise your dog with a puzzle feeder or snuffle mat.
Diets aimed at helping dogs with cognitive decline are available. The primary focus of such diets is to reduce the effect of toxic free radicals. Chemical products of metabolism, free radicals are normally removed by the body’s own antioxidants. With age, this process becomes less efficient and free radicals react with their surroundings, leading to oxidative damage and death of cells, including those in the brain.
There is evidence that diets containing antioxidants and omega-3 fatty acids, among other ingredients, are beneficial to older dogs. The greatest benefits to cognitive function are seen when a diet formulated for brain health is fed alongside regular behavioural enrichment measures, including a short training session most days, social interactions, weekly rotation of toys and regular, gentle exercise outdoors.
The main energy source for nerve cells is glucose. As dogs get older, it becomes more difficult for them to utilise glucose for this purpose and other sources of energy are needed. Supplementing the diet with medium-chain triglycerides (MCTs) provides the brain with alternative energy sources in the form of ketones and essential fatty acids (EFAs). In studies, long-term supplementation of the diet with MCTs improves cognitive function in older dogs.
Supplements are available that are specifically designed to support dogs with dementia and loss of cognitive function. They contain ingredients shown to be beneficial to brain health and, in trials, some have demonstrated positive effects on dogs’ dementia-related symptoms. The ingredients include antioxidants, EFAs, vitamins and amino acids.
Some supplements contain S-adenosylmethionine (SAMe), which helps to protect neurons by increasing the body’s own production of the antioxidant glutathione. Some formulations of SAMe are more effective than others, but it has been shown to improve some of the symptoms of dementia in dogs.
A licenced prescription medicine is available in the UK for use in dogs showing symptoms of dementia. The active ingredient is a drug called selegiline hydrochloride. Among other effects, the benefits of selegiline use include increased antioxidant activity and decreased free radical formation. Studies have found that, after just four weeks of selegiline treatment, dogs showed improvements in their sleep-wake cycle, toilet training and activity levels.
Propentofyllene is a licenced treatment that has been shown to increase blood flow (and therefore oxygen delivery) to the brain, the skeletal muscles and the heart. It may improve an older dog’s willingness to exercise.
Anti-anxiety medications can be helpful in dogs with dementia. Most are not licenced for use in dogs so, if your vet feels this type of drug might be helpful to your dog, they will ask you to sign a form to say you have given informed consent to use an ‘off-label’ medication.
Other ways to help with anxiety include Thundershirts, which are a stretchy, wrap-around dog jacket that ‘hugs’ your dog’s body and can help to bring comfort. Dog pheromone products, available as sprays and plug-in diffusers, can be used around the home and on your dog’s bedding. Pheromones work on a special part of the brain and can help to make dogs of all ages feel confident and calm. Massage and acupuncture may also be useful as complementary therapies, as long as they are well-tolerated.