Caring for Dogs with Advanced Dementia
Canine cognitive dysfunction (CCD) is similar to Alzheimer’s disease in humans; it is a “progressive age-related neurodegenerative condition that affects cognitive function”. The disease, both in dogs and in humans, affects many parts of the way an individual thinks, remembers, and feels. It is marked by memory loss, a decreased ability to learn, problems regulating emotions and interacting socially, problems with sleeping and waking, confusion and disorientation that can lead to wandering and circling, heightened anxiety, bladder and bowel control issues, and a decrease in overall activity levels (Fast et al., 2013; Madari et. al., 2015; Schütt et al., 2015).
Symptoms of CCD are not uncommon in the estimated 30 million senior and geriatric dogs in the U.S. (Madari et al., 2015). Pan (2011) notes that 27.5% of dogs aged 11 to 12 years suffer from mild to severe cognitive impairment, but that number rises to 67% in dogs aged 15 to 16 years. As Sara Fraser puts it, “With upwards of 1 in 5 senior-aged companion dogs experiencing impaired cognitive function, it is critical that we work to better understand, identify, treat and manage CCD in our aging pets to ensure their later years are as comfortable and low stress as possible.”
The following case study came to me through a friend who is a geriatric social worker specializing in dementia. She called concerned about her foster dog’s behavior, which when described, sounded like CCD. Even though she was an expert in dementia in humans and a lifetime dog owner, she was unaware of dementia in dogs. She wanted to share her experience and educate dog lovers about this common malady, so I suggested that she chronicle Mitsy’s story and I would do the research, hence, this paper. I visited Mitsy, and Sara stayed in close contact with me until the ultimate decision was made. Sara was a natural caregiver for Mitsy and has since fostered more geriatric dogs. Because of her experience, she was able to compare her foster dog’s behaviors with some of the behaviors seen in her human patients and recognize that they were symptoms of similar underlying needs: for routine, safety, and comfort.
Case Study: Mitsy
Mitsy was a small mixed-breed terrier, brought to an animal shelter in the winter. Her chip showed she was 15; she was thin, uncared for, unclaimed, and cold. Her foster, experienced in fostering old dogs, cats, and horses, offered a “forever” foster with a warm bed and love. Mitsy was said to be house-trained. After a week’s home care and observation, it was evident that Mitsy was highly anxious; she could not control her bowel or bladder, and she attempted to flee when outdoors if not kept on a leash, which she resisted. A call placed to the shelter director garnered this response: “She has doggie dementia!” When Sara called me, I agreed with this assessment. As a clinical social worker specializing in dementia care for many years, Sara now understood all the behaviors she had been observing in Mitsy.
Mitsy exhibited daily separation anxiety and followed Sara’s every step in the house, a behavior noted in humans with Alzheimer’s by Gayatri Devi in her new book, The Spectrum of Hope. Devi characterizes Alzheimer’s disease as a kind of spectrum disorder, one that can present in multiple different ways and that can respond to treatment that at least slows its progression. Separation anxiety is one such symptom that presents in some dogs with CCD but not in others, and the distress it causes can be minimized with behavioral support—including bringing in a certified behavior consultant—and adapting the dog’s environment.
The spouse or adult child caring for an elder with dementia is likely to know this behavior well, and can start to feel overcome and emotionally drained by the constant presence of the elder. Mitsy, too, followed so closely that a stop caused her to run into Sara! Mitsy became anxious at separation, and when united again with her foster she became aggressive, snapping and lunging at her. The adult with dementia can also exhibit aggressive behavior when uniting with their caregiver, because they are overcome with anxiety and the need to be close and secure with that familiar person.
If she wasn’t following closely behind Sara or sleeping, Mitsy paced the house, wandering back and forth through the hall and rooms, never stopping until she went back to her bed to sleep. When taken out for a walk on a long lead, she pulled forward at all times. She could not stand still. If Sara stopped, Mitsy continued forward in a circle, pulling on her lead. If the end of the long lead was not held high up to make a “merry-go-round” so that Mitsy could continue circling, she literally wrapped the long cord around Sara’s legs.
Mitsy also exhibited spatial confusion, showing difficulty exiting through a door, hesitance to walk over a shiny floor, difficulty finding an opening—all the same behaviors many adults with a more advanced stage of dementia exhibit.
Now that Sara had a better understanding of the underlying cause of Mitsy’s behaviors, a care plan was created just as it would be created for an elder human. Because of the advanced nature of Mitsy’s CCD, routine was the critical part of the plan, with as little variation and stimulation as possible.
Mitsy needed to remain in the same home environment, eat at the same times with her bowl in the same place for each meal, and only interact with her two people, and the two dogs and three cats in the house. Every day’s routine was the same: going out for her morning potty time at 6 a.m. with her two doggy companions, returning to the house for the morning meal, morning walks through the yard on a lead, daytime in the company of the two dogs and three cats, her evening meal at 5 p.m., then a long walk on the farm on her lead, returning to the house for the evening, then outdoors again at 9 p.m. for more yard time on her lead, then to her garage bed for the night. Introduction of other activities or people created anxiety in Mitsy that usually led to urinating or defecation on the spot. Calming activities such as being held or brushed while on her bed or being lifted to the sofa and cuddled helped to resettle Mitsy and calm her.
A care plan for an adult with advanced dementia is created in the same way. Every day needs to be the same, with a daily routine established for meal times, for bathing and dressing, for activities such as walks, music, old movies, and for going to bed. Changes in this routine—such as a trip outside the home for a medical appointment, meals away from home, or visitors in the home—often cause behavioral changes and challenges.
The needs for Mitsy’s routine were learned by trial and error. A guest in the house prompted immediate defecation in the room where her humans were visiting, so this observation led to putting Mitsy in the garage with her bed and water when another person was expected to visit in the home. When Mitsy was brought back into the house from her garage bed, Sara held her close for several minutes, which eliminated the aggressive biting when she saw Sara again.
After a month of established routine, Mitsy’s daily habits as a housedog were much more acceptable. With an increase of being petted, brushed lightly, and being held, Mitsy’s anxiety and pacing almost completely vanished. She settled into her routine of going outdoors with her foster mom for shorter walks on the leash at the same times of the day and night until her bedtime. Shortening her time exposed to the stimulation of walks decreased her anxiety. She no longer wandered and paced in the house, but she still stayed within a step of her foster mom at all times that she was awake, following right behind her at every step. Dog beds throughout the house allowed Mitsy to always be next to Sara, which she did until her last day.
The most important factors in Mitsy’s care plan were the daily routine, avoidance of any new stimulation, providing a care environment that allowed Mitsy to be next to Sara at every opportunity, and providing more time for hugging, petting, and cuddling on the sofa. Mitsy was much calmer and more content, and the accidents in the house greatly decreased. Understanding the needs of the senior dog with dementia greatly relieves the stress on the caregiver, just as training for those who are caring for a human with dementia decreases the stress and fatigue of caregiving.
Caring for the canine senior citizen
The formula for developing a care plan for a human showing signs and symptoms of cognitive impairment or decline is similar to that of a dog. The first rule is routine, routine, routine! It is best to create a daily routine for meals, dressing, naps, bedtime, visitors, or outings, and prevent change as much as possible. If the routine must be varied, it is best to do so in early hours of the day before fatigue sets in from the day’s activities. Any stressors such as rushing to complete a task, a change of environment, visitors that create anxiety (such as small, active children), loud noises, and expressions of anger or frustration by the caregiver, can create challenging behaviors, also called “catastrophic reactions.”
In humans with dementia, a catastrophic reaction might be crying, yelling, pounding fists, pacing, kicking, fleeing, throwing things, refusing care or food, or whatever reaction relates to the event causing the stress. This reaction is brought on by stressful events and experiences like anxiety, confusion, pain, overstimulation, or loss of a comforting possession. For the senior dog, the same is true. Making demands of the dog, correcting the dog, yelling at the dog, attempting to hurry the dog, and introducing the dog to any new experience or environment all cause anxiety and stress for the dog with cognitive impairment. They cannot take in new information, their reasoning is impaired, and they do not know how to respond. A catastrophic reaction may result.
If you’ve just started noticing these behaviors in your dog, it’s best to seek a formal diagnosis from a veterinarian. An MRI is the gold standard, although expensive. Your veterinarian may also ask about changes in the dog’s behavior. Your veterinarian can also prescribe interventions that can help slow down cognitive decline. These can take the form of dietary supplements, specially formulated foods, and medications. Due to Mitsy’s advanced age and already frail physical condition, and the fact that she was from a rural dog shelter with limited financial means, no medications, supplements, or sedatives were tried. The goal of Mitsy’s foster mom and the shelter director were to provide end-of-life comfort and love for this old dog.
Not all cases of CCD are as advanced as Mitsy’s, and dogs in the early stages of cognitive decline can benefit greatly from medication and behavioral therapies. As a behavior consultant, I recommend behavioral enrichment to help keep senior dogs engaged and prevent the progression of dementia-like symptoms before they become as challenging as Mitsy’s case. Don’t just let your senior dog curl up and sleep all day! Behavioral enrichment can include cognitive stimulation in the form of food puzzles, access to novel toys, training and practicing simple behaviors, and working on more complex cognitive tasks such as discrimination and concept training; it can include social enrichment in the form of access to and positive interaction with conspecific friends and human friends; and it can include physical exercise by way of leash walks and off-leash playtime (Landsberg, 2005; Pop et al., 2010). Keeping a dog active both mentally and physically with training, interaction, and play in their geriatric years, combined with regular exercise, is known to decrease cognitive impairment. Research backs this up too — a multitude of studies confirm that the provision of cognitive and environmental enrichment opportunities can prevent, delay, and improve symptoms of cognitive decline. See Sara Fraser’s recently published literature review for a summary of the latest research on CCD.
For dogs with advanced dementia, however, this approach can be counterproductive. I would not recommend that a caregiver introduce any puzzles or novel toys, because the inability to focus and understand what is expected of the dog is likely to cause a stress reaction. They can’t learn something new, so work on cognitive tasks would not be recommended for a dog with advanced dementia. Comfort for these dogs is what is needed. Gentle, predictable walks or other exercise they can tolerate can still be a source of pleasure, as can play if they can enjoy simple games, such as going a few feet for a ball, but no new activities. I would also recommend against the introduction of unknown people or animals — a trip to a dog park, for example, would likely overstimulate a dog with this stage of the condition.
Caring for the caretaker
The family caregiver for the adult with moderate to advanced dementia is at risk for multiple mental and physical complications. Fatigue is most common, due to the lack of sleep and the 24-hour daily need to be alert, provide care, provide verbal responses, and the constant need to be aware of safety. Human caregivers suffer not only fatigue but multiple physical responses to stress, and many mental responses such as depression, grief, anxiety, anger, social isolation, and multiple losses. The owner of a geriatric dog with cognitive loss will experience many of the same responses. Sleepless nights, and hyper-awareness of changes and needs can lead to fatigue and mental exhaustion. Emotional responses of depression and grief about the impending loss of their loved companion are also common. The human responsible for the elder dog also has the added responsibility of making that difficult decision about when to euthanize their pet.
Support and education groups for the owners of old dogs and dogs with cognitive impairment are greatly needed. Animal shelters, the Humane Society, rescue organizations, and veterinary clinics all need to become aware of this progressive condition as we all keep our companions with us as long as possible. Just as the excellent veterinary care available now can keep a canine companion physically healthy longer, that longer life can lead to more experiences of cognitive disorders in late life. Education and emotional support can be the key to the quality of life of both the canine and the human caregiver.
Canine cognitive dysfunction will affect one in every five geriatric companion dogs, so the chances are if you own senior dogs or work in sheltering, foster, or rescue, you’re likely to encounter this condition eventually. It is therefore useful to educate yourself on how to spot the signs of both the early stages and the more advanced symptoms like Mitsy’s, as they may be missed by others.
CCD not only affects the quality of the dog’s and caregiver’s daily lives, but their relationship as well. Anything that we can do, no matter how small, to keep our senior citizens comfortable in a time of disorientation, stress, and anxiety would be a gift. Routine is the foundation for both dog and caregiver in coping with the emotional, mental, and physical changes of CCD. Having a balanced perspective of the realities of the world you both find yourselves in, with a sense of gratitude and acceptance, will be a comfort during this last stage of the dog’s life.
Fast, R., Schütt, T., Toft, N., Møller, A., & Berendt, M. (2013). An Observational Study with Long-Term Follow-Up of Canine Cognitive Dysfunction: Clinical Characteristics, Survival, and Risk Factors. Journal of Veterinary Internal Medicine, 27(4), 822-829.
Madari, A., Farbakova, J., Katina, S., Smolek, T., Novak, P., et al. (2015). Assessment of severity and progression of canine cognitive dysfunction syndrome using the CAnine DEmentia Scale (CADES). Applied Animal Behaviour Science, 171 138-145.
Pop, V., Head, E., Hill, M., Gillen, D., Berchtold, N. C., et al. (2010). Synergistic effects of long-term antioxidant diet and behavioral enrichment on β-amyloid load and non-amyloidogenic processing in aged canines. Journal of Neuroscience 30(29), 9831-9839.
Schütt, T., Toft, N., & Berendt, M. (2015). Cognitive function, progression of age-related behavioral changes, biomarkers, and survival in dogs more than 8 years old. Journal of Veterinary Internal Medicine, 29(6), 1569-1577.
Melissa McMath Hatfield, MS, CBCC-KA, CDBC, earned a master’s in counseling psychology and is a retired licensed psychological examiner. Her mission is to enhance the human-dog relationship through understanding, knowledge and empathy. Currently she has a private behavior consulting practice where her main focus is performing temperament assessments and behavior evaluations of dogs who are exhibiting mental health issues. For further information please go to her website.
Sara Cain-Bartlett, MSW, LCSW, C-ASWCM, has practiced medical and geriatric clinical social work for over twenty years, specializing in dementia care. She has written workbooks on the challenging behaviors presented in dementia care and has had a private practice as a geriatric care consultant since 2010. Sara also fosters large dogs and horses for the Animal League of Washington County, Arkansas. Mitsy was a foster from the Prairie Grove, Arkansas shelter.