Dementia in Elderly Pets

Dementia (cognitive dysfunction) is one of the top two problems that can lead to severe quality-of-life issues in elderly pets. (The other one is mobility and pain; there’s a Resources article about that too.)

Dementia in pets is much more common than most people realize. They can’t talk to us, so it’s hard to know they’re confused until it’s quite advanced, though there are some reliable (but subtle!) hints in their behavior even early on. As confusion increases, it’s easier to recognize, but many families (and even some vets!) don’t fully understand how significant its effects on our pets can be. Dementia in cats is harder to see than dementia in dogs.

Classic signs of advanced dementia:

• Your dog goes to the wrong side (hinge side) of the door when it’s time to go out
• Your dog gets lost or stuck among the legs of tables and chairs or behind furniture
• Your dog or cat loses their housetraining, perhaps only partially or only sometimes
• Your dog can’t find you, even though you’re in the next room
• Your cat or dog walks in circles, or wanders restlessly (dogs often lie down, get up, walk around, lie down, get up, walk around…over and over)
• Your dog barks at nothing, barks randomly, or stares at the wall
• Your cat frequently yowls at night
• Your dog or cat is restless at night, and/or around dinnertime

Less obvious signs:

• Your pet acts like they want something from you, but everything you try doesn’t work or only works briefly
• They eat more, or less; they drink a lot but don’t have a medical reason for it; they start drinking in new places (toilet, sink, shower)
• They have a spacey or unfocused look in their eyes
• Their vision or hearing, or both, seems worse
• Your dog pants a lot
• Your cat or dog seems more withdrawn or more anxious and clingy, hangs out in places they didn’t used to, or has other behavior changes
• Your dog’s tail is always down, or they have stopped wagging their tail

Ups and Downs

As with humans, pets with dementia may have good days and bad days, or seem worse or better at various times throughout the day. In addition, confusion and anxiety can increase with illness, or changes in their environment or routine (travel, moving, petsitter, etc.).

Stress and Anxiety

This is the primary way dementia can really damage a pet’s quality of life. As with people, some pets are calm about their confusion, while others can be quite distressed and anxious—and of course, the whole range in between. This can change throughout the day, but is often worse around dinnertime and overnight.

The signs that your pet is anxious include restlessness (pacing, circling, won’t settle down); random barking and/or panting (dogs); yowling (cats, usually at night); being newly clingy; and acting like they want something but you can’t figure out what, or you give them what they want (food, going out to pee) and then they don’t seem to want it.

Like people with dementia, pets have a persistent sense of “Something isn’t right, I’m in a strange place, I don’t feel at home, I have to fix something.” Other signs come from us: if we don’t want to leave our pet for travel, or even for more than a few hours, we are doing this because they’re anxious. The more of this you see, the more distressed they are. This is a form of pain, but it’s emotional pain, not physical pain.

Decreased Social Interaction and Activity

Has your dog stopped wagging their tail? Does your pet seem uninterested in activities they used to enjoy? Do they just seem kind of blah and flat, or compulsive, with little evidence of happiness? Do they leave the room to be alone when they didn’t used to? They may have forgotten who you are, and who they are. This is another form of poor quality of life. They may not be anxious, but they lack joy.

House-Soiling

Cats may stop using their litterbox consistently. Sometimes they are having mobility problems (a lower side on the litterbox may help them get in), but often they’ve forgotten (or are intermittently forgetting) that they’re supposed to use the litterbox.

Dogs often follow a progression: Initially, they drop stool (often while walking or sleeping); pooping is happening, but they don’t seem to be aware of it (although sometimes they smell it and then look around like “Who did that?”). Then, they start peeing or pooping in the house (they still “go” outside, but have forgotten that they’re only supposed to “go” outside). You might take them out to “do their business” and be out there for 20 minutes, only to find that 10 minutes after coming inside they’ve peed on the floor. (This is different from incontinence, which is leaking small amounts of pee consistently, sometimes while sleeping.) In the very advanced stage, they’ve forgotten that poop is something to avoid; this is the time when you start waking up (or coming home) to find that they’ve pooped and gotten it all over themselves, or all over the rug or the room or the house.

Blind, Deaf—or Confused

Just like people with dementia, pets can have vision or hearing changes that are actually caused by confusion rather than a specific problem with their eyes or ears. (Of course, it’s also possible that they have age-related vision or hearing loss; it’s hard to tell the difference.) Their eyes and ears might work fine, but their brain doesn’t always know how to make sense of the information coming in. Stairs, table legs, and darkness can be confusing; objects like furniture and water bowls may no longer be recognized, so they fail to walk around them. An approaching hand is no longer known as a hand, so they startle when we touch them. They may understand or remember some things they hear (food-related sounds, often), but not others, or their hearing might cycle between better and worse (people often describe this as “selective hearing”).

What Can We Do?

Cats and dogs with cognitive dysfunction benefit from consistent routines and environmental enrichment, as long as it’s not stressful or painful. Keeping your pet with you in the office, where people come in and out, can keep their attention activated and is like brain exercise (and can help them sleep better at night). Food puzzles can be helpful, as long as they’re not beyond their ability to understand. Frequent short walks (to the extent possible with their mobility limitations) and/or car rides, if they’re not stressful, can be stimulating to the senses and the brain. Playing, treats, reassurance, and love are very important.

There’s good evidence that supplements and special diets can benefit some pets, especially if we start them before we see signs of significant dementia (the earlier the better). We don’t have specific medical treatment for cognitive dysfunction, but it’s really important to make sure other medical and comfort problems are well-managed. As we know from people with dementia, uncovering and treating other medical issues, including pain, can significantly reduce dementia symptoms. In addition, medication for anxiety can be life-changing for quality of life and nighttime rest (yours and your pet’s!). Be sure to check with your vet before starting anything new, and of course, never give medications for humans to your pet without advice from a veterinarian.

How Do I Know When it Might be Time for End-of-Life Help?

Despite improvement you might see from some of the above strategies, dementia inevitably gets worse, and often plays a large role in euthanasia decisions, even when everything else about their health seems okay. You are the best person to judge this for your pet. Much of the time, it’s more about your gut feelings about how they feel and what you would want for yourself if you were in their place rather than any specific benchmark. Remember, also, that unless they have another disease, or severe mobility problems, you might be making this decision at a time when you don’t feel all the “okayness” lines have been crossed in every area of their life.

The exception here may be house-soiling; not only is it a huge amount of work for caregivers (especially if the pet is hard to keep clean), it can lead to isolation (if you have to separate them to manage the mess) and, while the humans are probably more distressed about these changes than the pet is, the loss of housetraining is a sign that they are pretty confused about lots of other things. They may not be as obviously unhappy as pets who show more anxiety; but think about the person with dementia who’s not disruptive or aggressive, but who doesn’t recognize their own family members, is in memory care because they need too much help to live on their own (or family can’t handle their constant needs), and is always asking to go home. Like thse people, if your dog or a cat remains fairly calm, we don’t know the full extent of their confusion (they can’t tell us) and how much this affects their quality of life.

Our loved ones’ dementia is extremely difficult, both to manage and to decipher, and you’re not alone in finding it stressful and painful. Getting some good information and advice from your regular vet, an end-of-life care vet, or someone you know who’s been through similar challenges can help a lot.