Losing your Boston to THE ZONE

"I found her wandering through the house again aimlessly. Molly started showing signs that something just wasn’t quite right. There were early signs but they were very slowly and gradually. It took me a long time to figure out what was happening to her. She could make anyone feel good about themselves, even on a bad day. But that was when she was younger. I had to learn that sometimes you have to put the past behind and get a grip on what is currently happening. And I did not like it, the changes scared me. I did not see it coming and then BAMM... There it was….."

Canine and feline cognitive dysfunction syndromes are degenerative brain diseases that are often missed until the signs become so advanced that it may be too late to help the pet or owner.

"One of the greatest problems we have with cognitive dysfunction is the lack of awareness, not only on the part of the public, but on the part of the practicing veterinarians. They understand that it is out there, but they don’t appreciate how common it is,” said Jeff Nichol, DVM, a veterinary behavior practitioner at the Veterinary Emergency & Specialty Hospital in Albuquerque, N.M.

Another concern is when do you know it is time to let your pet go?  This is a great worry no one wants to face or talk about but something we must. Eileen Anderson, a dog blogger and author of a new book about canine dementia, recommends that pet owners use a scale developed by veterinarian Alice Villalobos to determine an aging pet’s quality of life. The scale lists seven criteria, including the animal’s hunger and pain levels and hygiene habits, and suggests pet owners rank each on a scale of 1 to 10. When the pet suffers “more bad days than good,” Villalobos says, it is probably best to humanely put the animal to death.
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The technical term for the condition, "Cognitive Dysfunction Syndrome," has only more recently become recognized as a disease in dogs. Now, it is estimated that more than 50 percent of dogs over the age of 10 will exhibit symptoms of cognitive decline".  Well learning this did not make be feel any better. Nor did the statement  "Although dementia is almost never fatal on its own, cognitive dysfunction and physical health problems are a debilitating combination,"  that I read somewhere... no help either. This is just making me sadder.

"Veterinarians assume that the owner will tell them ‘My older dog is not acting the same’ during the course of an exam,” Dr. Nichol says. "But many pet owners assume the behavior changes are a normal part of aging.” Traditionally, these old-dog behaviors have been dismissed as normal aging changes, but modern veterinary research has found that many of them are caused by changes in the brain similar, although not identical, to the effect of Alzheimer's disease in people.

Dementia is more common in pets past 10 years of age   
 The symptoms include personality changes, cognitive dysfunction, fixed gaze and confusion. The vet will prescribe certain medicines to control nerve impulses in the brain. Pet owners also have to learn techniques to manage pets suffering from dementia.

 It has became apparent that caring for a senior human who has Alzheimer's, that the symptoms and behaviors are almost identical.  For many caretakers of humans this helped owners of older Bostons to understand what they are going through.

Okay, so what should you do? Here are some ideas to deal with different behaviors you might see. 

 Not all of our dear seniors will have the same symptoms, so some of these you may not have to deal with. Like human dementia this could be slow moving in an otherwise healthy dog...

 WANDERING/ Seems lost in a familiar room 

Use your intuition as a guide to help you guess what your dog is attempting to communicate. Ask yourself, is there a need that is not being filled? First check if he needs to go outside to do his business, after that if he continues, take/guide him to his water bowl for a drink, after that if he continues, guide/take him to his bed sit down with him and give him some petting and talk to him.

ZONES OUT/IN THE ZONE / FIXATED/STARING

If your Boston seems to just sit and stare out into space or become fixated for long periods of time. One suggestion was to use distraction to bring her out of it. Try leading her to her bed or play a little game, cuddle, brush, take her out into the yard or even a little treat to help her come out of it.

NEW/ STRANGE/ THINGS ARE OUT OF PLACE

Just as recommended for blind or sight impaired Bostons, it is suggested not to move things like furniture. Sometimes even things we would not normally think a problem might cause confusion; like water bowls, their beds, shutting a door that is normally open, moving a foot stool or moving a potted plant to a different corner. For the demented their territory is not the same, it is not recognizable.

ROUTINES BECOME IMPORTANT

Because keeping a daily routine will help the dog's body clock. If events happen the same time every day this might prevent  wondering lost or other strange behaviors. Having the same walking time, bed time and eating done at the same time and place is less confusing for them.  Just like with humans loud crashing noises, loud music and crowds of people can be frightening for the dog with dementia.

LOST AND DISORIENTED IN THE DARK

It appears that it is not unusual for a dog to start barking in the middle of the night. Even when you take the Boston outside thinking that was the reason for the barking. One person suggested their dog was waking them up every night until they realized the dog was getting out of his bed getting lost in the dark and barking because he could not find his bed. They put some “SOLAR LIGHTS” on the floor on either side of his bed, a bit like a guiding light and the problem went away. The reason for the solar lights is because they are portable, cheap to use and you can place them wherever you want, in this case close to the bedding. These practical suggestions were from Judith Collins.

A suggestion that also made sense from another reader was that "older dogs might get cold at night and putting on a sweater or even doggie PJ's might help keep them warm and provide a "cuddly feeling"  or ensuring there are loose blankets to snuggle up on or under. 

A large 2011 study out of Australia bears this out.
Researchers found that the overall prevalence of cognitive dysfunction was a little more than 14 percent, but only about 1.9 percent of cases are diagnosed. The same study found that the chances of having cognitive dysfunction increase with age, so that by the time dogs are 15 years old, 41 percent will have at least one sign consistent with cognitive decline. Neilson and Hart estimated the prevalence in geriatric dogs at 68 percent.

In a 2011 review, Gunn-Moore estimated that one-third of cats 11 to 14 years old has age-related cognitive decline, which increased to more than 50 percent of cats 15 years old or older.

Unfortunately, less is known about the cognitive effects of aging on senior cats than on senior dogs, but their management is similar.

Just as veterinarians monitor other body systems in aging pets, they should ask pointed questions about behavior, according to Marsha Reich, DVM, Dipl. ACVB, owner of Maryland-Virginia Veterinary Behavioral Consulting in Silver Spring, Md."Just because he’s getting old doesn’t mean that we just stand on the sidelines and let him get old. There are things we can do to intervene and improve the dog’s ability to function and improve its quality of life,” she said."This is critical. Early recognition allows for early intervention,” added Gary M. Landsberg BSc, DVM, Dipl. ACVB, Dipl. ECAWBM (behavior), director of veterinary affairs at CanCog Technologies and a veterinary behaviorist at the North Toronto Animal Clinic in Ontario, Canada.

But older dogs have many co-morbidities that must be managed, so veterinarians might need help assuring that behavior issues are addressed.

So many conditions in an older pet mimic cognitive decline that it is important to rule out any other physical reason for the complaint.
For instance, if the pet is just standing in the middle of the room staring for a moment, it might be having a partial seizure. If it has disengaged with its owner, it could be in pain. Relieving itself in the house or outside the litter box could signal kidney disease.

Therefore, every senior pet with suspected cognitive dysfunction should receive a CBC and chemistry panel, urinalysis and a neurological examination, the experts said.

"You want to find out what is going on with the pet before you put the dog on medication because the medications for cognitive dysfunction won’t help if the dog has kidney disease,” Reich said. Nichol suggested reviewing the medications the pet is taking because sometimes the senior pet metabolizes drugs differently than younger pets. For instance, he had a patient that had been taking an anti-anxiety drug for a long time, but as it got older, it became confused.

If a cat is not using the litter box, make sure that it doesn’t have trouble getting in and out of the box. Perhaps it needs a ramp or a space cut out of the side to make access easier. Older dogs that are house soiling might need to go outside more often.

  It cannot be cured and veterinarians need to make sure that owners recognize this inevitability. Depending on how far the cognition has declined before it is discovered, the goal is increasing quality of life for months, maybe a few years.

Changes in the diet are the first steps. The behaviorists recommend putting the dog on an anti-oxidant-rich diet, such as Hill’s Prescription Diet b/d or Purina’s One Vibrant Maturity 7+ Senior formula. Many also prescribe fish oil because omega fatty acids might be good for brain health. Selegiline (Anipryl, Zoetis), which is used to treat human dementia, is the only medication with a veterinary indication to treat canine cognitive dysfunction. However, several dietary supplements have also been shown to improve cognitive dysfunction.
Some dogs seem to have more problems at night. They sleep all day and are awake all night. They pace. They make noise. They might be anxious and uncomfortable. Behaviorists recommend melatonin, which not only promotes sedation, but is also an antioxidant.

If the dog appears anxious, Reich recommends an additional nutraceutical, Anxitane (suntheanine, Virbac).

They tend to use all of the supplements together. "The scientific way is to start with one treatment, and see how it works. But dogs don’t have that much time. We use all these modalities at once,” Nichol explained.

Exercise is another important component of the program. Taking the dog for a leash walk enables it to use all of its senses, but Reich said to make sure the owner understands the dog’s limitations. Don’t turn a simple walk into an endurance contest. No one benefits if it is too strenuous or stressful.

"Exercise is helpful,” she said, "but one has to stay within the dog’s physical limits. Make sure that people don’t overdo it.”

Just as staying active helps a person with dementia, playing and working with the owner helps to mentally stimulate the pet. Puzzles and toys that require mental agility can stimulate their brains.

"Enrichment plays a key role in slowing cognitive decline,” Landsberg said. "Both physical exercise and mental activities--training, food manipulation toys and games--are beneficial. In addition, behavior counseling (and sometimes other psychotropic drugs or natural supplements for anxiety) will often be needed to improve behaviors such as night waking, house soiling and fears and phobias.”
None of these will provide much help for a dog that is in the end-stages of cognitive decline, so it is crucial to diagnose this disease and start making changes, such as one of the supplements or diets for brain aging, as the dog hits its senior years.

How long the dementia lasts?
It can last up to several years if the dog is otherwise healthy. There is sometimes an appetite change, or the dog just gets more and more frail. 

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