Cognitive Dysfunction, Part III: Behavior Modification

In Parts I and II of this series, we have discussed what Cognitive Dysfunction Syndrome (CDS) is, and what medical treatments are available for it. In this section, we will discuss what an owner can do at home, through behavior modification, to help maintain his senior dog's aging brain.

One of the symptoms of CDS is alterations to the dog's sleep/wake cycle. Many of these dogs sleep all day and pace around the house all night, keeping owners awake. Attempts should be made to keep these dogs active and awake during the day. Take the pet for a walk, play games outside or inside the house. If the dog is active during the day, then hopefully he will be more tired and apt to sleep when the owner chooses to, also.

Another symptom of CDS is house soiling in a previously well-trained dog. Try to get the dog outside to eliminate on a very regular and perhaps more frequent schedule. Some of these older dogs forget what they went outside for, so taking them to a special toileting area can help them to remember their "duty."

It is well-discussed how protective "brain games" can be for human minds in protecting them against dementia. There are also "brain games" you can play with your dog (and it can be fun, even in a young dog!). These activities increase blood flow to the brain, which can be protective, even in a dog who does not exhibit signs of CDS.

• Find It! Have a family member or friend hold your dog in a room while you go into another room to hide a treat or favorite toy. Return to your dog, and tell him to find the treat. Start easy, and as your dog gets the gist of the game, make it more challenging.
• The Shell Game. Turn 3 cups upside down and place a piece of kibble or treat under one of them. Shuffle the cups around and have your dog "pick" one of the cups. If he selects the correct cup, then he gets the treat!
• New tricks. Teach your old dog a new trick. While there are many methods for trick training, clicker training is a method that is positive, hands-off, and stimulates the dog to think. Tricks for older dogs include: Walk backwards, speak, hand touch, touch a target, such as a plastic lid, circle right, circle left, play dead, shake hands, wave. The possibilities are endless!
• Take your dog for a walk. Walking off your property can be more than just exercise for the body, it is very stimulating for the brain. When a dog sniffs, he is reading the scent paths of all those who have gone before him - people, other dogs, cats, and wildlife.

Cognitive Dysfunction Syndrome, Part II: Treatment

There are multiple medical treatments that can help to alleviate, or at least slow to progression of signs Cognitive Dysfunction Syndrome (CDS).

Anipryl (selegiline hydrochloride) is the first and only drug approved by the FDA to control the clinical signs of CDS. Anipryl is a monoamine oxidase inhibitor that will help to decrease the breakdown of dopamine in the brain, not only making dopamine more available, but also reducing the dangerous, cell-killing free radicals that are produced during dopamine metabolism. Anipryl should not be used concurrently with tricyclic antidepressants (i.e., amitriptyline, clomipramine) or selective serotonin reuptake inhibitors (i.e., fluoxetine). Use with any product containing Amitraz (i.e., Preventic collar, Mitaban dip, Certifect) is also not recommended.

Hill's b/d diet contains antioxidants and omega-3 fatty acids to help protect brain cells from the dangerous free radicals that are generated by the breakdown of dopamine by monoamine oxidase B (MAOB).

S-AdenosylMethionine (SAMe) is a molecule naturally present in the body that is well documented for its effects on membrane fluidity, antioxidant cellular activity and the renewal of certain neurotransmitters in the central nervous system. This molecule is available in a neutraceutical form called Novifit. This form of SAMe is a specific salt that can penetrate the blood-brain barrier for increased efficacy in the brain.

Senilife is another nutritional supplement that is a proprietary mixture containing phosphatidylserine, pyridoxine, Ginkgo Biloba, resveratrol and vitamin E that can help to prevent cognitive decline.

neutricks is a new supplement that is supported by evidence-based research for healthy brain aging. This supplement contains apoaequorin, a jellyfish calcium-binding protein. This supplement was shown to improve learning, accuracy, and enhance attention.

These medical treatment options can be used singly or in combination. Please consult with your veterinarian what might be best for your dog if you suspect your dog has CDS.


Coming up next.. Part III: Behavior modification

Cognitive Dysfunction Syndrome, Part I: What is it?

Our geriatric dogs often suffer from a variety of physical ailments. If we are blessed enough to have our dogs live to an advanced age, they do inevitably become arthritic and lumpy, and some become affected by other chronic medical problems. Some older dogs also experience behavior changes unrelated to anything that can be found through physical testing.

Cognitive Dysfunction Syndrome (CDS) is a form of dementia in older dogs. Some of the clinical symptoms include:

• Disorientation: Wanders aimlessly, gets lost in a familiar house or yard, gets "stuck" in corners or under/behind furniture, stares into space, stands at the hinge side of the door to be let out, does not recognize familiar people, does not respond to his name, forgets why he went outside.
• Decreased interaction with family members: Seeks less attention, walks away while being petted, less enthusiasm upon greeting, or fails to greet family members at all.
• Altered activity and sleep patterns: Flipping of day/night activity/sleep cycles, increased wandering/pacing, vocalization (particularly at night) for no reason.
• Lapse in housetraining: Urinates indoors, has accidents inside soon after being outside, does not ask to go outside.

Many of these clinical signs appear very gradually - so much so that the owner is often unaware of the early subtle changes in behavior.

What causes CDS? Beta-amyloid is a protein toxic to neurons that accumulates in the aging brain; it may form plaques. This is similar to findings in the brains of human Alzheimer's patients. The exact role of beta amyloid accumulation in the development of cognitive dysfunction is not yet known, but its accumulation seems to lead to decreased neuronal function in the brain.(1)

Neurotransmitters are also altered during aging. Monoamine oxidase B (MAOB) is an enzyme that has been found to have increased activity in older dogs (2). In dogs with CDS, the increase is even greater than what is considered for a normal aging change. MAOB breaks down dopamine, a neurotransmitter. In humans, dopamine affects brain processes that control movement, emotional response, and ability to experience pleasure and pain. Also, metabolic processing of dopamine results in release of cell-killing free radicals.

A study at the University of California-Davis found that 62% of 11- to 16-year-old dogs showed signs in at least one category of CDS (3, 4).

CDS can make a dog's life lonely, separated from family members who cherish their older dog's companionship. It can be as hard on family members as it is on the dog.

Coming up next.. Part II: Treatment

References:
1. Cummings BJ, Head E, Afagh AJ, Milgram NW, Cotman CW: Beta-amyloid accumulation correlates with cognitive dysfunction in the aged canine. Neurobiol Learning & Memory 1996 Vol 66 (1) pp. 11-23.
2. Campbell S, Trettien A, Kozan B: A noncomparative open-label study evaluating the effect of selegiline hydrochloride in a clinical setting. Vet Ther 2001 Vol 2 (1) pp. 24-39.
3. Neilson JC, Hart BL, Ruehl WW: Cited in Hart BL, Hart LA: Selecting, raising and caring for dogs to avoid problem aggression. JAVMA, 210(8):1129-1134; 1997.
4. Ruehl WW, Hart BL: Canine Cognitive Dysfunction. In Psychopharmacology of Animal Behavior Disorders (Dodman NH, Schuster L, eds.). Boston: Blackwell Scientific, 1998; pp. 283-304.

New toy review: FroliCat

I was in a pet store this weekend and came across a toy new to me. It is called FroliCat Bolt, and it is a device you can place on the floor or any other stable surface, or hold in your hand, and it will emit a low-power laser beam and move it in random patterns for your cat to chase. It also has a timer so that the device will automatically turn off after 15 minutes. It requires four AA batteries. What a great way to exercise/entertain the cat for the busy cat owner!

There is a similar product called FroliCat Dart that has variable speed and timer settings. The Dart is also marketed as a RouseDog Product. WARNING! Do NOT use these types of devices on dogs! You can create a case of obsessive-compulsive disorder (OCD) in your dog by encouraging them to chase lights and shadows (and some dogs do not need much encouragement).

Feline Redirected aggression

The scene: The three-season room at the rear of Mrs. Zee's house

The action: Mrs. Zee is reading the newspaper on the chaise lounge. Ay the cat is sunning on a window sill with a stunning view of the garden. He grooms himself languidly while pausing occasionally to watch a bird or butterfly flit by. Ay shares his window sill with Bee, a fellow feline housemate, who is dozing while basking in the warmth of the sun. Suddenly, See, the new neighbor's Siamese cat saunters through the garden. Ay hisses and growls, and his coat puffs up, but there is no response from See, who cannot see or hear the cat behind the window. Ay then attacks Bee, jumps on his back and bites him. Bee, not knowing what happened, runs away, completely bewildered and injured. Mrs. Zee, also bewildered and quite angry at Ay, throws her paper in Ay's direction and hurries to find out the extent of Bee's injuries.

The analysis: Redirected aggression is a phenomenon in which the recipient of the aggression is not the stimulus for the aggression, and is often an innocent bystander. This type of aggression can occur in both dogs and cats, but I tend to see it more frequently in cats. The victims of this form of aggression can include other cats, dogs, or people. The owners of these cats often express surprise at the sudden violence that can erupt between parties that previously shared a friendly relationship. Owners may or may not know what the stimulus of the aggression was; often the location of the incident provides clues to this.

The solution to this type of problem is to identify and manage the source of the aggression. This can be especially tricky in cats because the early signs of aggression can be so subtle. In Mrs. Zee's case, she would either need to keep neighboring cats out of her garden (www.cat-repellant.info), keep Ay out of the room where he can look out the window, or she would need to block her cat's view of the garden through which cats can stray. Obstructing the cats' view can be acheived through curtains, blinds, or translucent contact paper on the lower half of the window.

Also a word of caution: owners should not use their hands (or other body parts) to physically separate fighting pets. Throw a blanket over them, douse them in large volumes of water, sound an air horn, use a broom to physically separate them. A 2006 study published in the Journal of Hand Surgery revealed that stray animals do not contribute the majority of bites to the hand. Two-thirds of the patients in this study required hospitalization for at least intravenous antibiotics.

Attention-Seeking Behavior

Dogs are very social creatures, and they often crave attention from their humans. Cats can also be very attached to their people. Attention seeking behaviors can range from sitting next to, and staring at the human of interest, to touching, licking, jumping, vocalizing, scratching, biting, humping and stealing to demand attention.

This is a mild behavior problem that can be extremely annoying for owners and their friends. Often the barrier to fixing this problem is not the pet, but the owners who inadvertantly reward the attention-seeking behavior. It is important to realize that attention comes in multiple forms, including touching, speaking to, or even looking at the pet. Some pets also do not recognize the difference between positive attention (petting, cooing) and negative attention (punishment); attention is attention!

The obvious solution to the problem of attention-seeking behavior is to (1) teach the pet when and how it is appropriate to solicit attention, and (2) remove all attention from the pet when he actively solicits it otherwise.

It may help to have scheduled interactions with the pet. Keeping activities such as playing, brushing, and teaching tricks on a regular, predictable schedule can help the pet, particularly if he is anxious. I recommend 15 minutes in the morning and 15 minutes in the evening for the quality interaction.

Also employing the "Nothing in Life is Free" philosophy (see post on this blog from June 2009) can help to set up a way for the dog to ask for attention in a manner that is not obnoxious, or that feeds into his anxiety.

What should be done if the pet acts in an unacceptable manner to solicit attention? Below is a list of common behaviors and solutions:

1. Touching, head on lap or foot, leaning against the leg; also licking - Remove your body part from the pet. If the pet persists, get up and leave the room.
2. Jumping, jumping onto your lap - Silently turn away from the dog and allow the dog's paws to slough off your body. If you are seated, slowly rise without touching the dog and allow the dog to slide off your lap. If the dog persists and tries to jump on your back, walk away, and put a door between you and the dog. Do not push the dog off you or knee the dog, for that provides negative attention (and remember, negative attention is still attention!).
3. Vocalizing (this can run the gamut from whining to vociferous barking and screaming) - Ignore the dog. Put in ear plugs, listen to an MP3 player through ear phones. If not ignored, this particular behavior has great potential to escalate.
4. Humping (owner, other pets, or inanimate objects) - Ignore the dog unless the victim is in danger. If the pet is humping your leg, remove your body part and walk away without saying a word.
5. Stealing (shoes, remote controls, children's toys, etc.) - Ignore the dog unless he is in danger. When the dog seems to lose interest, call the dog to you, make him sit (Nothing in life is free!), then reward him for the sit. Then, isolate the dog and retrieve the stolen item.
6. Scratching, biting - When the pet does bodily harm in the attempt to demand attention, try to keep any limbs in close to the body so there is as little as possible to "grab". You may need to use an aversive to prevent the harmful behavior. The aversive would in response to behavior that precedes the bodily contact, including stalking, eye contact, and sometimes even approach. Aversives include sounding an air horn, using a battery-powered water gun, using a citronella-scented compressed air canister (Spray Shield). If the people in the household need to be reminded to be vigilant about the pet's behavior, consider having the pet wear a bell attached to the collar.

It is easier to list what one should NOT do, it is harder for most owners to remember what they SHOULD do. If your pet approaches you and sits, pay attention to your pet, for he has just exhibited polite behavior and should be accordingly rewarded.

Coprophagia, Part 2

Dogs eating dog or wild animal feces is a common problem, but perhaps even more common is the problem of dogs eating cat feces out of the litter box. This is a behavior that is not only unacceptable by human standards, but can be potentially life-threatening.

Clumping cat litter is designed to absorb fluid (cat urine) and harden into a solid clump for easy clean-up of waste. If large amounts of cat litter are consumed by a dog, the litter absorbs fluid from the stomach and intestines and can create a solid obstruction to normal flow through the gastrointestinal tract. Needless to say, this requires a surgical solution. Additionally, snacking from the cat litter box can result in transmission of intestinal parasites from cat to dog, including roundworms, hookworms, tapeworms and Giardia.

The best way to prevent raiding of the cat litter box is to prevent the dog from having access to it. Below are some suggestions for just that:

1. Use a baby gate across a doorway.


2. Install a cat door into an interior door.



3. Use a hook and eye assembly to keep a door ajar just a few inches, no more, no less.


4. Use a covered litter box, or a large rubber or plastic box to keep the opening within just a few inches of the wall, or to provide a top entrance to the litter box.
5. Consider a litter box containment system. This is the most expensive option, but it could also be the most effective. Litter box containment systems are dog-proof boxes, usually wooden, with two levels: one at the top where the cat enters and one at the bottom where a litter tray is contained.