Visiting Vet: Our aging pets

If your older cat is anxious or experiencing other behavioral changes, it could be Feline Cognitive Dysfunction.

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A behavioral change in an older cat may signal the start of a cognitive dysfunction. — Lynn Christoffers

Pre-pandemic, when I got to be face-to-face with my clients, here’s what would sometimes happen. An appointment would end. The cat would be back in her carrier, the dog off the table, tugging on his leash to go home. I would escort person and pet to the reception area for check out, but then the human would pause. “Oh, one more thing. . .”  I would smile (most days), silently praying it was something simple. Often a belated request for a nail trim. Well, my assistant has already disinfected the table and swept the floor and my next client is tapping her toes . . . but, okay, sure, we can do that. Back into the exam room we go. Inconvenient, but manageable.

Many last-minute queries, however, are not so easy to accommodate, especially as they are often about behavior problems. Aggression. Inappropriate urination. Excessive vocalization. Separation anxiety. Not issues we can address quickly. Behavioral concerns in pets, like in people, take time to evaluate. Cats and dogs cannot tell us in words what’s bothering them. We need extensive behavioral histories and examinations specifically focused on discovering any  factors — medical, emotional, environmental — causing the undesirable activities.

The pandemic has made “on the way out the door” questions even harder to address.  Nowadays it’s usually Fawn, my assistant, who gets asked these questions while she’s returning  pets to their owners outside. I call it “playing COVID telephone.” Client tells Fawn “Oh, one more thing . . .” Fawn comes inside and tells me. I call client. Client’s cell is on mute or airplane mode. Fawn goes outside, asks client to unmute phone. (No, I can’t come out and shout an entire behavior consult from the porch.) Client and I finally connect by phone. I am now 20 minutes late for my next patient. Sigh. Recently several people have had the exact same last-minute question. So let’s talk about old cats who yowl now, instead of at the end of your next appointment.

Take Opal, an elderly cat who has started wandering around the house in the middle of the night crying. Not a sweet little meow, but a loud plaintive yowl. Maybe she stops if you feed her, talk to her, or pick her up. Maybe she doesn’t. You’re having trouble getting a decent night’s sleep. Why is Opal yowling incessantly? The list of possible causes include pain, metabolic abnormalities, sensory deprivation, and feline cognitive dysfunction. We’ll take them one at a time.

Pain. Is Opal walking stiffly? Having trouble jumping onto the counter? Maybe she’s experiencing age-related arthritis. Is she pawing at her mouth, drooling, reluctant to eat dry food? Maybe she has dental disease. Metabolic. Undiagnosed or inadequately treated hyperthyroidism, hypertension, and/or diabetes are the most frequent culprits. Laboratory tests are necessary for diagnosis, but you can watch at home for symptoms such as excessive appetite, thirst, or urination, combined with weight loss. Sensory deprivation. Opal’s hearing, eyesight, and sense of smell may be declining with age, which may leave her confused or anxious. With any of these conditions, when the sun is out and there is activity and company to occupy Opal’s attention, she may not get upset. But at night it’s dark. It’s quiet. It’s lonely.  “Where am I? Where is everybody? I don’t feel good,” Opal meows.

If your veterinarian has ruled out these physical causes for Opal’s behavior, we are left with a presumptive diagnosis of primary neurological disease. Brain tumor or stroke have to be considered but require advanced imagery such as a CT-scan for diagnosis. The most common presumptive diagnosis, however, is Feline Cognitive Dysfunction (FCD), an age-related degenerative disease of the brain causing gradual decline of Opal’s cognitive ability and function. You could also call it senility or dementia.

FDS symptoms vary but frequently include urgent, excessive vocalization, especially at night. Opal may exhibit irritability, anxiety, and memory loss. She may not recognize you or other household pets, becoming aloof or even aggressive. Or she may do the opposite, acting excessively needy, wanting constant contact and affection. Spatial disorientation may cause her to  “get lost” in the house, wander aimlessly, or stare into space. She may forget how to use the litter box or where the cat door is and urinate or defecate in inappropriate places. Altered sleep-wake cycle can cause excessive daytime sleepiness and restlessness at night

Environmental changes can be helpful. Keep Opal’s schedule and surroundings as consistent as possible. Leave a nightlight on. Provide multiple litter boxes with low sides in easy-to-find locations that do not require her to climb up or down stairs. Be sure to put a box near where she sleeps at night. Play with her during the day to keep her awake and active so she may sleep more at night. Pheromone sprays like Feliway ® can be the kitty equivalent of calming aromatherapy. These are available as sprays or diffusers. Sometimes confining Opal to a small room with easy access to food, water, bed, and litter box, with a night light and a radio can help quiet her down.

If these interventions don’t help, some veterinarians prescribe selegiline, a medication used for Parkinson’s disease in people and for cognitive dysfunction in dogs. The drug is not approved for use in cats nor has it been proven efficacious in kitties, but in severe cases it may be worth a try. Another approach is giving anti-anxiety medications such as gabapentin, which may also help by relieving any pain and providing a little sedation at bedtime.

FDS affects more than half of all cats aged 11 to 15 and more than eighty percent of cats over 16. That’s a lot of yowling. Mild cases are a minor annoyance but severe cases can be extremely distressing for both cat and owner. If Opal is driving you crazy at night, if you’re unable to sleep or worried she’s in pain, don’t play a game of COVID telephone. Make an appointment with your veterinarian to evaluate this behavior as the main focus of your visit.