Diagnosing, Treating Behavior Problems in Geriatric Pets
Natalie Stilwell, DVM, MS, PhD
Dr. Natalie Stilwell provides freelance medical writing and aquatic veterinary consulting services through her business, Seastar Communications and Consulting. In addition to her DVM obtained from Auburn University, she holds a MS in fisheries and aquatic sciences and a PhD in veterinary medical sciences from the University of Florida.
Painful diseases, sensory deficits, and cognitive issues often cause changes in behavior in elderly pets.
Geriatric medicine is an important component of companion animal practice, as dogs and cats are living increasingly longer lives. A recent article in Veterinary Clinics of North America: Small Animal Practice provided special considerations for diagnosis and management of behavioral issues in geriatric pets.
Causes of Behavioral Changes
According to the article, older dogs and cats are more likely to develop behavioral issues than are younger pets due to a unique combination of health issues and normal changes in the aging body, including muscle and organ degeneration.
Cognitive dysfunction syndrome (CDS) is a progressive neurodegenerative disease that typically causes a combination of behavioral changes, including spatial disorientation, altered social interactions, disturbance in sleep-wake cycles, house soiling, and changes in activity.
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Many other geriatric diseases, including osteoarthritis, neoplasia, encephalopathy, and dental disease, are painful and may lead to aggression, irritability, or altered sleep patterns. Some geriatric health issues, such as cataracts and deafness, also cause sensory deficits that change the pet’s perception of its environment. Chronic renal failure, diabetes mellitus, and hyperadrenocorticism may alter elimination habits, resulting in inappropriate house soiling. Older pets also tend to have a heightened stress response to lifestyle changes, such as moving or a change in schedule, that may result in separation anxiety, depression, or lack of appetite.
Diagnosis and Management
Diagnosing behavioral issues in the geriatric patient is a challenging process that first involves obtaining a detailed history and screening for potential medical causes. A thorough clinical examination should include measurements of weight, body condition score, and blood pressure; neurologic and sensory examinations; blood and urine analysis; and a thyroid profile. If no underlying medical conditions are identified, then a detailed behavioral assessment and standard cognitive tests may help characterize behavioral issues.
Treatment of behavior problems is usually multimodal. Pharmacologic options for CDS may help slow progression of clinical signs. Selegiline is approved for use in dogs, but should not be used concurrently with other monoamine oxidase inhibitors. Propentofylline, nicergoline, adrafinil, and modafinil are other possible drug options for CDS treatment. Cholinesterase inhibitors, NSAIDs, statins, N-methyl-D-aspartate receptor antagonists, and hormone replacement therapy have also been used; however, their benefits for geriatric patients are not yet well characterized.
Nonpharmacologic treatments work by modifying the animal’s behavior and environment. Adding opportunities for play and exploration, interactive training, and gentle exercise all improve the pet’s quality of life. Treatment for inappropriate elimination may include increased trips outdoors or additional litter boxes with nonslip ramps. Increasing daylight exposure and activity while reducing light levels before bedtime can help sleepless pets.
CDS patients may benefit from dietary docosahexaenoic acid in the form of fish oil. Many neutraceuticals are also advertised for possible cognitive enhancement effects, but most have not been clinically tested.
Finally, geriatric patients should have frequent follow-up veterinary visits to monitor treatment progress, and owners should be educated on the subjects of pain management and quality of life in elderly pets.
Dr. Stilwell received her DVM from Auburn University, followed by a MS in fisheries and aquatic sciences and a PhD in veterinary medical sciences from the University of Florida. She provides freelance medical writing and aquatic veterinary consulting services through her business, Seastar Communications and Consulting.