Difference between revisions of "Feline Cognitive Dysfunction"
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==Overview== | ==Overview== | ||
− | Cognitive dysfunction syndrome (CDS) is a condition that leads to an overall progressive decline in cognitive function and increase in brain pathology | + | Cognitive dysfunction syndrome (CDS) is a condition that leads to an overall progressive decline in cognitive function and increase in brain pathology, with similar pathological changes seen in dogs and humans with Alzheimer's disease (AD); canine CDS is being researched as naturally occurring mode of AD<ref name="Landsberg1">Landsberg GM, Hunthausen W, Ackerman L. The effects of aging on the behavior of senior pets. In: Handbook of behavior problems of the dog and cat. 2nd edn. Oxford; Saunders,2003: 269–304.</ref><ref>Milgram NW, Head E, Weiner E, Thomas E. Cognitive functions and aging in the dog: acquisition of non spatial visual tasks. Behav Neurosci1994; 108:57–68.</ref><ref>Cummings BJ, Head E, Afagh AJ, Milgram NW, Cotman CW. Beta-amyloid accumulation correlates with cognitive dysfunction in the aged canine. Neurobiol Learn Mem1996; 66:11–23</ref><ref>Tapp PD, Siwak CT, Gao FQ, et al. Frontal lobe volume, function, and beta-amyloid pathology in a canine model of ageing. J Neurosci2004; 24: 8205–13.</ref><ref>Borras D, Ferrer I, Pumarola M. Age related changes in the brain of the dog. Vet Pathol 1999; 36:202–11.</ref><ref>Colle M-A, Hauw J-J, Crespau F, et al. Vascular and parenchymal beta-amyloid deposition in the aging dog: correlation with behavior. Neurobiol Aging 2000; 21:695–704.</ref><ref>Salvin HE, McGreevy PD, Sachev PS, Valenzuela MJ. Underdiagnosis of canine cognitive dysfunction; a cross-sectional survey of older companion dogs. Vet J 2010; 184:277–81.</ref>. Similar pathological changes have also been observed in the cat<ref>Cummings BJ, Satou T, Head E, et al. Diffuse plaques contain C-terminal A beta 42 and not A beta 40: evidence from cats and dogs. Neurobiol Aging1996; 17:653–59</ref>. In comparative studies of the effect of selegiline, a drug licensed for the treatment of canine CDS, similar responses were seen in canine and human patients<ref>Ruehl WW, Bruyette WW, DePaoli DS, et al. Canine cognitive dysfunction as a model for human age-related cognitive decline, dementia, and Alzheimer’s disease: clinical presentation, cognitive testing, pathology and response to l-deprenyl therapy. Prog Brain Res 1995; 106:217–25.</ref><ref>Campbell S, Trettien A, Kozan B. A noncomparative open-label study evaluating the effect of selegiline hydrochloride in a clinical setting. Vet There 2001; 2:24–39.</ref>. |
− | Effects of feline cognitive | + | Effects of feline cognitive disfunction (FCD) include impairment of memory, learning, information processing and perception, as well as increased behavioural disinhibition; this leads to observed signs of confusion/disorientation, deranged sleep patterns, inappropriate elimination, and reduced social interaction. Previously learned behaviours, such as elimination habits, may be forgotten and affected cats show increased [[Feline Fear and Stress|fear and anxiety]]. Disinhibition can lead to an increase in irritability and [[Feline Aggression|aggressiveness]]. [[Feline Social Behaviour|Social relationships]] with both other animals and humans can also be affected. In general, cognitive dysfuncion is less frequently reported in cats than dogs. |
It is thought that FCD affects 28% of cats between the ages of eleven and fourteen, and 50% of cats over fifteen years old <ref name="Landsberg2">Landsberg, G.M., Denenberg, S., Araujo, J.A., 2010. Cognitive Dysfunction in Cats: A Syndrome we Used to Dismiss as 'Old Age'. Journal of Feline Medicine and Surgery 12: 837</ref>. Although clinical signs in cats generally seem to become evident at around ten to eleven years old, neurones in the caudate nucleus start to show functional changes by six-seven years of age<ref>Levine MS, Lloyd RL, Fisher RS, Hull CD, Buchwald NA. Sensory, motor and cognitive alterations in aged cats. Neurobiol Aging 1987; 8: 253–63</ref><ref>Levine MS, Lloyd RL, Hull CD, Fisher RS, Buchwald NA. Neurophysiological alterations in caudate neurons in aged cats. Brain Res 1987; 401:213–30</ref><ref>Harrison J, Buchwald J. Eyeblink conditioning deficits in the old cat. Neurobiol Aging 1983; 4:45–51</ref>. Diagnosis of CDS in cats is a greater challenge than in dogs, as the signs are often less apparent due to the cat's independent outdoor lifestyle. | It is thought that FCD affects 28% of cats between the ages of eleven and fourteen, and 50% of cats over fifteen years old <ref name="Landsberg2">Landsberg, G.M., Denenberg, S., Araujo, J.A., 2010. Cognitive Dysfunction in Cats: A Syndrome we Used to Dismiss as 'Old Age'. Journal of Feline Medicine and Surgery 12: 837</ref>. Although clinical signs in cats generally seem to become evident at around ten to eleven years old, neurones in the caudate nucleus start to show functional changes by six-seven years of age<ref>Levine MS, Lloyd RL, Fisher RS, Hull CD, Buchwald NA. Sensory, motor and cognitive alterations in aged cats. Neurobiol Aging 1987; 8: 253–63</ref><ref>Levine MS, Lloyd RL, Hull CD, Fisher RS, Buchwald NA. Neurophysiological alterations in caudate neurons in aged cats. Brain Res 1987; 401:213–30</ref><ref>Harrison J, Buchwald J. Eyeblink conditioning deficits in the old cat. Neurobiol Aging 1983; 4:45–51</ref>. Diagnosis of CDS in cats is a greater challenge than in dogs, as the signs are often less apparent due to the cat's independent outdoor lifestyle. | ||
− | == | + | ==Signs and Diagnosis== |
− | ''' | + | '''Behaviours signs of FCD include'''<ref>Gunn-Moore, D., Moffat, K., Christie, L.A. & Head, E., 2007. Cognitive dysfunction and the neurobiology of ageing in cats. Journal of Small Animal Practice 48, 546-553.</ref><ref name= "Landsberg2" />: |
*'''Reduced activity''' | *'''Reduced activity''' | ||
− | :Moves around the home environment less, plays, and grooms less, but sleeps more. | + | :*Moves around the home environment less, plays, and grooms less, but sleeps more. |
*'''Unusual sleeping patterns''' | *'''Unusual sleeping patterns''' | ||
− | :Sleeping longer during the day, waking up at night, restless when asleep, increased vocalisation at night | + | :*Sleeping longer during the day, waking up at night, restless when asleep, increased vocalisation at night |
*'''Disorientation''' | *'''Disorientation''' | ||
− | : | + | :*Gets lost, even in familiar places, staring either at specific things, aimless wandering, inability to find way around or over objects. |
*'''Memory and learning''' | *'''Memory and learning''' | ||
− | :[[Inappropriate Elimination - Cat|Inappropriate elimination]] outside litter tray, including in sleeping areas or near food. May be unable to recognise people or | + | :*[[Inappropriate Elimination - Cat|Inappropriate elimination]] outside litter tray, including in sleeping areas or near food. May be unable to recognise people or pets. |
*'''Social behaviour''' | *'''Social behaviour''' | ||
− | :Decreased interest in being stroked, or interacting with people or other animals or becomes increasingly dependent and doesn't like being alone. | + | :*Decreased interest in being stroked, or interacting with people or other animals or becomes increasingly dependent and doesn't like being alone. |
*'''Anxiety''' | *'''Anxiety''' | ||
− | :Restlessness, increaesed vocalisation and general irritability. | + | :*Restlessness, increaesed vocalisation and general irritability. |
− | Since a number of these signs could arise from, or be aggravated by medical conditions | + | Since a number of these signs could arise from, or be aggravated by, medical conditions it is essential to complete medical and behavioural history is essential for the accurate diagnosis of FCD, this is especially important in older animals. This should be accompanied by a laboratory work up, as well as a thorough physical examination with special consideration of [[:Category:Neurological Diseases - Cat|neurological conditions]]. As with all behavioural disorders it is important to ensure that any medical causes for unusual behaviour are ruled out. Medical conditions which could cause behaviour similar to that of FCD include: |
*Arthritis | *Arthritis | ||
*Dental pain | *Dental pain | ||
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==Treatment== | ==Treatment== | ||
Depending on signs, treatment can include the following: | Depending on signs, treatment can include the following: | ||
− | * Maintaining an environment that is stable and easily accessible by the animal | + | * Maintaining an environment that is stable and easily accessible by the animal. |
* Medication to improve sleep patterns | * Medication to improve sleep patterns | ||
* Medication to improve cognitive function | * Medication to improve cognitive function | ||
− | * Medication to alleviate emotional problems (e.g. | + | * Medication to alleviate emotional problems (e.g. anxiety) |
− | No drugs are | + | No drugs are licensed to treat FCD, however [[Selegiline|selegiline]]<ref>Landsberg G. Therapeutic options for cognitive decline in senior pets. J Am Anim Hosp Assoc 2006; 42:407–13.</ref> and propentofylline are sometimes used unlicensed. Serotonergic drugs, such as fluoxetine or clomipramine, may be used to reduce anxiety in cats that show predominantly emotional changes with minimal reduction in cognitive function, drugs such as selegiline may be used when cognitive impairment is the predominant feature. It is important to note that selegiline must not be used concurrently with an SRI/SSRI drug, and that there should be a 2-week washout between the use of these drug types in order to avoid serotonin syndrome. There is little peer reviewed evidence supporting the clinical efficacy of [[Effect of Diet on Behaviour|dietary modification]] and [[Nutraceuticals in Behaviour|supplementation]] in FCD, but diets and supplements including elevated levels of antioxidants, carnitine, phosphatidylserine, arginine, B vitamins and fish oils are commercially promoted for the treatment of FCD based on effects in dogs and laboratory animals. |
− | ====Treatment and | + | ====Treatment and management approaches to specific behavioural aspects of FCD==== |
− | *[[Inappropriate Elimination - Cat|'''Inappropriate | + | *[[Inappropriate Elimination - Cat|'''Inappropriate elimination''']]: The many other potential underlying and aggravating medical and behavioural factors should be ruled out and/or treated. Increasing the number of [[Cat Latrines|litter trays]] available, either on different floors or in different rooms which are obvious to the cat and easily accessible (without high edges or being high up) may help avoid house soiling problems. |
− | *'''Disorientation''': Ensure that locations of food, water | + | *'''Disorientation''': Ensure that locations of food, water, litter trays are constant and that the cat's daily routine is maintained as much as possible. If a cat is extremely disorientated or confused it can help to reduce the area accessible to the cat, so it can find its way around more easily. |
− | *'''Unusual | + | *'''Unusual sleeping patterns''': Loss of eyesight and hearing may affect the cat's sleep patterns. Increasing daytime and evening activity through play and simulated foraging may enable the cat to sleep better at night, but sedatives may be needed. [[Feline Fear and Stress|Anxiety]] associated with darkness or absence of owners at night may be improved with anti-anxiety medications. |
− | *'''Exaggerated Vocalisation''': This may be related to anxiety, or confusion and disorientation; the underlying cause should be addressed. Pheromonotherapy and | + | *'''Exaggerated Vocalisation''': This may be related to anxiety, or confusion and disorientation; the underlying cause should be addressed. [[Pheromonotherapy - Cat|Artificial pheromones]] such as the synthetic analogue of the F3 fraction of feline facial and flank marking pheromone may help to reduce stress, by increasing the strength of core territory chemical marks, but this has not been specifically tested in cats with FCD. Serotonergic medication, such as fluoxetine, may be used to reduce anxiety, or medication and die at modification may be used to improve cognition. |
− | *'''Reduced | + | *'''Reduced activity''': The use of a specialised diet for elderly felines may help stimulate activity and mental function<ref>Cupp, C.J., Jean-Philippe, C., Kerr, W.W., Patil, A.R. & Perez-Camargo, G., 2006. Effect of nutritional interventions on longevity of senior cats. International Journal of Applied Research in Medicine 4, 34-50.</ref>. |
− | *'''Social | + | *'''Social behaviour''': If there are other animals in the household, provide various sleeping areas so the older cat is able to find a safe place to rest if it does not want to interact. |
− | Changes to the | + | Changes to the cats environment should be kept to an absolute minimum where possible. If changes are necessary they should be made very gradually and carefully, taking special care to reassure the cat so as not to induce stress which can cause the display of further symptoms of FCD<ref>Houpt, K.A. & Beaver, B., 1981. Behavioural problems of geriatric dogs and cats. Veterinary Clinics of North America: Small Animal Practice 11, 643-652.</ref>. |
==Prognosis== | ==Prognosis== | ||
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<references/> | <references/> | ||
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[[Category:Feline Problem Behaviour]] | [[Category:Feline Problem Behaviour]] | ||
+ | [[Category:JBowen reviewing]] |
Revision as of 09:47, 4 July 2014
Overview
Cognitive dysfunction syndrome (CDS) is a condition that leads to an overall progressive decline in cognitive function and increase in brain pathology, with similar pathological changes seen in dogs and humans with Alzheimer's disease (AD); canine CDS is being researched as naturally occurring mode of AD[1][2][3][4][5][6][7]. Similar pathological changes have also been observed in the cat[8]. In comparative studies of the effect of selegiline, a drug licensed for the treatment of canine CDS, similar responses were seen in canine and human patients[9][10]. Effects of feline cognitive disfunction (FCD) include impairment of memory, learning, information processing and perception, as well as increased behavioural disinhibition; this leads to observed signs of confusion/disorientation, deranged sleep patterns, inappropriate elimination, and reduced social interaction. Previously learned behaviours, such as elimination habits, may be forgotten and affected cats show increased fear and anxiety. Disinhibition can lead to an increase in irritability and aggressiveness. Social relationships with both other animals and humans can also be affected. In general, cognitive dysfuncion is less frequently reported in cats than dogs. It is thought that FCD affects 28% of cats between the ages of eleven and fourteen, and 50% of cats over fifteen years old [11]. Although clinical signs in cats generally seem to become evident at around ten to eleven years old, neurones in the caudate nucleus start to show functional changes by six-seven years of age[12][13][14]. Diagnosis of CDS in cats is a greater challenge than in dogs, as the signs are often less apparent due to the cat's independent outdoor lifestyle.
Signs and Diagnosis
Behaviours signs of FCD include[15][11]:
- Reduced activity
- Moves around the home environment less, plays, and grooms less, but sleeps more.
- Unusual sleeping patterns
- Sleeping longer during the day, waking up at night, restless when asleep, increased vocalisation at night
- Disorientation
- Gets lost, even in familiar places, staring either at specific things, aimless wandering, inability to find way around or over objects.
- Memory and learning
- Inappropriate elimination outside litter tray, including in sleeping areas or near food. May be unable to recognise people or pets.
- Social behaviour
- Decreased interest in being stroked, or interacting with people or other animals or becomes increasingly dependent and doesn't like being alone.
- Anxiety
- Restlessness, increaesed vocalisation and general irritability.
Since a number of these signs could arise from, or be aggravated by, medical conditions it is essential to complete medical and behavioural history is essential for the accurate diagnosis of FCD, this is especially important in older animals. This should be accompanied by a laboratory work up, as well as a thorough physical examination with special consideration of neurological conditions. As with all behavioural disorders it is important to ensure that any medical causes for unusual behaviour are ruled out. Medical conditions which could cause behaviour similar to that of FCD include:
- Arthritis
- Dental pain
- Thyroid dysfunction
- Diabetes mellitus
- Neoplasms
- Gastrointestinal conditions
- Reduced sight and/or hearing
- Urinary tract disease
- Hepatic disease
- Hypertension
- Neurologic conditions, including neoplasms, motor and sensory deficits
- Infectious causes, including FIV, FeLV
- Stress
Although all medical causes for FCD must first be excluded and if present treated, their presence does not necessarily eliminate the simultaneous existences of FCD. Conversely, failure to treat concurrent painful or debilitating conditions, such as arthritis, will lead to an apparent failure of response to FCD treatment.
Treatment
Depending on signs, treatment can include the following:
- Maintaining an environment that is stable and easily accessible by the animal.
- Medication to improve sleep patterns
- Medication to improve cognitive function
- Medication to alleviate emotional problems (e.g. anxiety)
No drugs are licensed to treat FCD, however selegiline[16] and propentofylline are sometimes used unlicensed. Serotonergic drugs, such as fluoxetine or clomipramine, may be used to reduce anxiety in cats that show predominantly emotional changes with minimal reduction in cognitive function, drugs such as selegiline may be used when cognitive impairment is the predominant feature. It is important to note that selegiline must not be used concurrently with an SRI/SSRI drug, and that there should be a 2-week washout between the use of these drug types in order to avoid serotonin syndrome. There is little peer reviewed evidence supporting the clinical efficacy of dietary modification and supplementation in FCD, but diets and supplements including elevated levels of antioxidants, carnitine, phosphatidylserine, arginine, B vitamins and fish oils are commercially promoted for the treatment of FCD based on effects in dogs and laboratory animals.
Treatment and management approaches to specific behavioural aspects of FCD
- Inappropriate elimination: The many other potential underlying and aggravating medical and behavioural factors should be ruled out and/or treated. Increasing the number of litter trays available, either on different floors or in different rooms which are obvious to the cat and easily accessible (without high edges or being high up) may help avoid house soiling problems.
- Disorientation: Ensure that locations of food, water, litter trays are constant and that the cat's daily routine is maintained as much as possible. If a cat is extremely disorientated or confused it can help to reduce the area accessible to the cat, so it can find its way around more easily.
- Unusual sleeping patterns: Loss of eyesight and hearing may affect the cat's sleep patterns. Increasing daytime and evening activity through play and simulated foraging may enable the cat to sleep better at night, but sedatives may be needed. Anxiety associated with darkness or absence of owners at night may be improved with anti-anxiety medications.
- Exaggerated Vocalisation: This may be related to anxiety, or confusion and disorientation; the underlying cause should be addressed. Artificial pheromones such as the synthetic analogue of the F3 fraction of feline facial and flank marking pheromone may help to reduce stress, by increasing the strength of core territory chemical marks, but this has not been specifically tested in cats with FCD. Serotonergic medication, such as fluoxetine, may be used to reduce anxiety, or medication and die at modification may be used to improve cognition.
- Reduced activity: The use of a specialised diet for elderly felines may help stimulate activity and mental function[17].
- Social behaviour: If there are other animals in the household, provide various sleeping areas so the older cat is able to find a safe place to rest if it does not want to interact.
Changes to the cats environment should be kept to an absolute minimum where possible. If changes are necessary they should be made very gradually and carefully, taking special care to reassure the cat so as not to induce stress which can cause the display of further symptoms of FCD[18].
Prognosis
FCD is a progressive illness, however management and treatment measures can help to slow this gradual decline and occasionally allow cats to regain some of their lost mental function. In order to attempt to slow progression prompt intervention early on in the disease process is essential[1].
References
- ↑ 1.0 1.1 Landsberg GM, Hunthausen W, Ackerman L. The effects of aging on the behavior of senior pets. In: Handbook of behavior problems of the dog and cat. 2nd edn. Oxford; Saunders,2003: 269–304.
- ↑ Milgram NW, Head E, Weiner E, Thomas E. Cognitive functions and aging in the dog: acquisition of non spatial visual tasks. Behav Neurosci1994; 108:57–68.
- ↑ Cummings BJ, Head E, Afagh AJ, Milgram NW, Cotman CW. Beta-amyloid accumulation correlates with cognitive dysfunction in the aged canine. Neurobiol Learn Mem1996; 66:11–23
- ↑ Tapp PD, Siwak CT, Gao FQ, et al. Frontal lobe volume, function, and beta-amyloid pathology in a canine model of ageing. J Neurosci2004; 24: 8205–13.
- ↑ Borras D, Ferrer I, Pumarola M. Age related changes in the brain of the dog. Vet Pathol 1999; 36:202–11.
- ↑ Colle M-A, Hauw J-J, Crespau F, et al. Vascular and parenchymal beta-amyloid deposition in the aging dog: correlation with behavior. Neurobiol Aging 2000; 21:695–704.
- ↑ Salvin HE, McGreevy PD, Sachev PS, Valenzuela MJ. Underdiagnosis of canine cognitive dysfunction; a cross-sectional survey of older companion dogs. Vet J 2010; 184:277–81.
- ↑ Cummings BJ, Satou T, Head E, et al. Diffuse plaques contain C-terminal A beta 42 and not A beta 40: evidence from cats and dogs. Neurobiol Aging1996; 17:653–59
- ↑ Ruehl WW, Bruyette WW, DePaoli DS, et al. Canine cognitive dysfunction as a model for human age-related cognitive decline, dementia, and Alzheimer’s disease: clinical presentation, cognitive testing, pathology and response to l-deprenyl therapy. Prog Brain Res 1995; 106:217–25.
- ↑ Campbell S, Trettien A, Kozan B. A noncomparative open-label study evaluating the effect of selegiline hydrochloride in a clinical setting. Vet There 2001; 2:24–39.
- ↑ 11.0 11.1 Landsberg, G.M., Denenberg, S., Araujo, J.A., 2010. Cognitive Dysfunction in Cats: A Syndrome we Used to Dismiss as 'Old Age'. Journal of Feline Medicine and Surgery 12: 837
- ↑ Levine MS, Lloyd RL, Fisher RS, Hull CD, Buchwald NA. Sensory, motor and cognitive alterations in aged cats. Neurobiol Aging 1987; 8: 253–63
- ↑ Levine MS, Lloyd RL, Hull CD, Fisher RS, Buchwald NA. Neurophysiological alterations in caudate neurons in aged cats. Brain Res 1987; 401:213–30
- ↑ Harrison J, Buchwald J. Eyeblink conditioning deficits in the old cat. Neurobiol Aging 1983; 4:45–51
- ↑ Gunn-Moore, D., Moffat, K., Christie, L.A. & Head, E., 2007. Cognitive dysfunction and the neurobiology of ageing in cats. Journal of Small Animal Practice 48, 546-553.
- ↑ Landsberg G. Therapeutic options for cognitive decline in senior pets. J Am Anim Hosp Assoc 2006; 42:407–13.
- ↑ Cupp, C.J., Jean-Philippe, C., Kerr, W.W., Patil, A.R. & Perez-Camargo, G., 2006. Effect of nutritional interventions on longevity of senior cats. International Journal of Applied Research in Medicine 4, 34-50.
- ↑ Houpt, K.A. & Beaver, B., 1981. Behavioural problems of geriatric dogs and cats. Veterinary Clinics of North America: Small Animal Practice 11, 643-652.
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