Biases with cognitive dysfunction can be a barrier to an underlying diagnosis in pets

One of the most common topics that comes up with the families I'm connected to these days is cognition—especially dementia—in pets. 

It’s no surprise, really, with the focus of my practice being on seniors, geriatrics, hospice and end-of-life care support. With pets living longer and better, yes—more dogs and cats are developing noticeable cognitive changes. There is a lot more available to us in the way of understanding cognition, and how that can and does decline with age and is more palpable in advanced age. We also know how it can be supported medically, non-medically with environmental safety, with enrichment and so much more. 

And as with other hot topics, canine and feline cognition can get us a little too far into the weeds which doesn’t serve pets, their families nor their vet teams in a way that makes best sense. In fact, I often observe that the line gets so blurry, that good common sense often goes by the way side and what begins is, well, pardon the expression, a turd hunt. The end result frequently looks like a pet whose needs aren’t being met—along with a family who’s frustrated, overwhelmed and opting for euthanasia care far sooner than they might have expected. 

A while back, a family-of-record got in touch to pick my brain about non-medical management strategies of Canine Cognitive Dysfunction after a vet urgent care visit that they had just returned from. A succession of behavioral changes had presented, which were very uncharacteristic of the geriatric dog in question and had really surprised me. I’d not seen the dog too long before and I’d not observed anything that would suggest a bonafide cognitive diagnosis. In any case, the vet had assessed that cognitive decline was most likely, though it seems important to note that the guardian wondered about it and that is why they were there. A supplement designed to meet the needs of a pet with cognitive dysfunction and a prescription diet was prescribed, and a discharge report was sent home. I reviewed that and one detail that jumped out that made me question why it hadn’t been explored. But before I relayed that, I’d asked the dog’s very worried human how they were feeling about all of this, and what was important to them. They expressed some concern about the assessment, which they felt diverged from what was really going on—pain. 

I agreed that it was worth exploring.

The report noted that eye drops that had been prescribed years before to control inflammation and discomfort due to a progressive eye disease has been discontinued by the guardian because the dog would seem out of sorts after they were instilled. And this made sense: some eye drops can cause a bad taste in the mouth, and having eye drops put in your eyes can be understandably unpleasant.  

“These drops seemed to be doing the job as intended, but maybe the vet ophthalmologist can sort another option for comfort care. The pain your pet is experiencing is significant enough to impact their cognition, and so getting that under control will help,” I encouraged.

(It did.) 

That’s not to say the supplement and the food weren’t a good idea—they likely were. But not addressing the underlying issue of the behavior changes was not. And I’m never comfortable landing on cognitive decline being the reason why a pet’s behavior has changed unless other more common things have been sorted.

Canine Cognitive Dysfunction, Feline Cognitive Dysfunction—sometimes referred to as Cognitive Dysfunction Syndrome—are assessments that some pets do develop and it can be predominant when it comes to their health conditions. I’ve seen it be an unmistakable part of their life with its features of disorientation, affecting interactions, pacing and whining at night or sleeping much of the day, having accidents in the house soon after they’ve had an opportunity to go potty outside, decreased interest in the things they’ve always found interesting like playing or exploring. Appetite changes like anorexia can be present, as can anxiousness, restlessness, phobias to noise or other things and a notable decrease in learning and memory. Vocalizing can be present, though my experience is that this is more common with cats and that seems to be correlated with hearing loss. 

Pets might develop some semblance of these signs. And while I’m grateful that pet guardians and vet teams have cognition on their radar, and they are assessing for cognitive decline appropriately, what I often find is that this diagnosis is too easily reached for. And it makes sense, right? Pet guardians are the first to report that something is up. And that is usually along the lines of having accidents in the house, peeing outside the litterbox, or pacing or restlessness at night—behavioral changes that impact the human’s well being.

The problem with that is there’s so much else that can be triggering dull mentation or any of these behavior changes that too often doesn’t get explored. Things like pain, nausea and queasiness, gastrointestinal issues, a change in appetite, anxiousness, perhaps a change in routine, or other disease processes that aren’t yet diagnosed or are inadequately managed, for example, osteoarthritis, metabolic disease or urinary tract issues, like infections or in cats, feline lower urinary tract disease (FLUTD).  

It’s really easy for a frustrated, overwhelmed pet guardian to immediately gravitate toward ‘it’s part of aging’ or as is too common for my liking these days, ‘my pet probably has dementia’ with no context for any other possibility being behind the behavior changes. And behavior changes are what tell us something isn’t quite right with a pet. 

It’s the reporting of symptoms (that show up as behavior changes) by family to the vet team that begins the process of sorting things out. It’s also natural for a pet guardian to lean on the storytelling that is steeped in their worst fears, which for many, is a diagnosis related to cognition. Especially the word that evokes such worry, dementia. 

It seems important to note that the under- or unmanaged symptoms can lead to cognition changes and cognitive decline. And that's very different than a pet having CCD or FCD as a predominant diagnosis.

And so, pet guardians, I urge you to honor your instincts when there are behavior changes, and zoom out a bit to gain some perspective on what’s happening. Use pain scales and grimace scales to evaluate your pet’s comfort level. Tap into a quality of well being assessment tool that can give you the big picture about your pet without focusing solely on symptoms. Keep a log of your pet’s habits and any changes. Make that vet appointment armed with this data — your vet team will thank you, and you’ll look back and be glad you did. 

A robust source of resources to help recognize and track behavior changes and well being are available by clicking here. 

With over 20 years of experience in pet care and the past 12 of  those focused on animal hospice, Lorrie Shaw is a Certified Animal Hospice Practitioner, Certified Hospice Palliative Care Advocate, and pet loss & grief companioning certified professional. She is founder of Telos Companion Animal Services, LLC & can be found at lorrieshaw.com.