art by Cal Meyer

Cats and boxes are a purrfect combination.  An enclosed space like a box can be a safe place, help keep a cat warm and give him a vantage point to ambush “prey” (unfortunate insects, catnip mice…). Boxes are also popular with other animals – big cats are often given boxes for enrichment at zoos and refuges; dogs also like boxes to play in but some may tend to chew the box up!

Cats will also sit on just about anything, comfortable or not. Anyone who does craft projects well knows that once the fabric is out to be cut, a cat will be sitting on it soon enough. Years ago, cats sat on newspapers if you tried to spread the paper out on the table – nowadays, they park on computer keyboards. Some of this is attention-seeking behavior – Zelda only lets me type so long Sunday mornings before she gets up on my desk and threatens to contribute to the post if I don’t take her for her morning walk.

In 2009, the USPS came up with the Christmas slogan, “If it fits, it ships”.  A few years later, a variant of the slogan became an Internet cat meme: “It it fits, I sits”.  This gave rise to posts of cats in all sort of places, from egg cartons and shoeboxes, to bowls and sinks.

The Internet exploded again in 2017 as people used tape to outline squares on the floor for their cats to sit in. Cats were “trapped” in all manner of taped shapes, with cat experts offering explanations ranging from cats reacting to new smells (from the tape) to survival instinct, where the cats must investigate something new (the taped square) to determine if it poses danger to them.  Some felt that the taped square offered the cat a sense of security, much like a real box.

The phenomenon did not stop here – in 2020, during the COVID pandemic, a woman in the Philippines photographed stray cats practicing “social distancing” – the cats sat on circles painted on the ground 6 feet apart outside a food market.

cats and boxes: optical illusions


It is not surprising that cats in taped squares became the subject of a research study investigating cats’ responses to optical illusions. In a two month study in June-August of 2020, researchers at Hunter College enrolled over 500 cat owners to participate in a study to assess cats’ responses to a taped square, a Kanizsa square (which gives the illusion of a square), and a control figure.

Enrolled owners were sent booklets containing pairs of these shapes that they affixed to the floor.  The owners then took videos of their cats’ responses to the shape-pairs and submitted the videos to the research team.  They were to do this once daily for 6 days.

The results found that of the 30 cats that completed all six trials of the experiment, only nine of them “participated”, that is, sat in one of the shapes. These cats were just as likely to sit in the taped square as the Kanizsa square. Only once did one of the cats choose to sit in the control shape.

What does this tell us about cats? Are they susceptible to the optical illusion of a square? Do they recognize it as a square? I think more research will have to be done:

  • Only 9 out 30 cats actually sat in the shapes.
  • Cats are not as tall as we are and don’t see well close up. Can they see the squares from their vantage point?
  • I, for one, would like to know how many cats will voluntarily sit in a taped outline – I tried leaving a hula hoop out on the floor to see if any of my four cats would voluntarily sit in the circular outline. I did not have any takers!

This study is the first to use “citizen scientists” (the owners) to observe the cats in their home environments, thereby avoiding stress-induced behaviors that cats can exhibit in unfamiliar settings, such as a laboratory.

Back to cats and boxes…


Cats are practical. They prefer their owners to their owners’ T-shirts. I feel that they would prefer a physical box to a taped outline. A box is a great source of enrichment – it can be a bed, a den, it can be place to hide while ambushing a toy mouse going by. Shelter cats acclimate to their surroundings more quickly when provided a box to hide in.

Boxes that are too small to allow a cat to hide may make him feel good by putting physical pressure on his body, like when we wedge ourselves in the corner of the sofa watching a favorite TV program.  Pressure on soft tissue has been shown to promote relaxation and reduce anxiety in both humans and animals.

So, make sure your cat has a safe place – a place he can call his own, a place that is secure, secluded, a hiding place to retreat to, warm in the winter, cool in the summer. It can be a cardboard box in a closet or in a secluded corner!

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Identifying signs of cat dementia is not always straightforward. In the hubbub of daily life, behavior changes can be subtle and go unnoticed until they are more severe.

Changes in behavior can indicate if your cat’s mental state has changed. The acronym VISHDAAL summarizes the behavior changes we need to observe to care for our senior cats.

V = changes or increase in vocalization
I = changes in interaction with us and other pets
S = changes in sleep-wake cycle: restlessness, night time activity
H = housesoiling
D = disorientation and confusion
A = changes in activity
A = anxiety
L = learning and memory

Three cats – three outcomes


rupert, 18 year old neutered male siamese

Cat on sailboat


I had two senior Siamese cats when I had my first child.  A first-time mom, I was frazzled, dealing with the completely new experience of parenting and was not paying as much attention as I should have to my cats.

One day, an acquaintance asked why one of the cats, Rupert, was sitting on the kitchen counter, in a corner, facing the wall. I had been aware that he did that sometimes but when I paid closer attention, I found that he would eat in the morning, use his litter box and then spend the day on the counter, facing the wall. He would come down to eat, drink, and use the litter box but always returned to the counter.

Behavior Changes – signs of cat dementia?

  • I – Rupert was no longer interacting with us.
  • D – He seemed confused and “out of it” – sitting on the counter all day
  • A – His activity had changed – he did not move much from the counter

Diagnosis:

Rupert had lost quite a bit of weight, although he was eating well. My vet diagnosed him with hyperthyroidism, which was a new disease in cats at that time.

Outcome:

Use of radioactive iodine to treat the disease was pioneered about 10 years earlier but it was not commonplace. Surgery was an option but at 18 years of age, Rupert was not a good candidate for surgery and we elected euthanasia due to his declining Quality of Life.

The Takeway:

I suspect that Rupert had moderate to severe cat dementia. The symptoms were most likely apparent earlier and I just did not recognize them. Nowadays, drug therapy for hyperthyroidism is readily available – methimazole is an FDA approved treatment for hyperthyroid cats. Perhaps treatment of the hyperthyroidism would have reduced the symptoms of cat dementia enough for Rupert to have had some more time with us.

Athena, 16 year old spayed female


Athena had been slowing down over the past year, was not eating as well and was spending most of her time sleeping. We had provided her with steps to access window perches and our bed; we also provided her with a heated bed.

Behavior Changes – signs of cat dementia?

  • I – Although still willing to play, Athena was interacting less with us; she had previously been a “nosy, busybody” kind of cat.
  • A – Athena no longer went on her daily walk and was less active in general

Diagnosis:

Diagnostic blood work did not show any significant changes over the past year. Athena did not show other signs of cat dementia and would still learn new tricks when hungry for treats.

X-rays showed moderate to severe arthritis in one of her hips and knees. We decided to treat her arthritis pain with the drug gabapentin.

Outcome:

Treatment for her arthritis pain has been a game changer for her; her activity level has increased, her appetite has increased, and she is back to “being in your face” when she wants something.

The Takeaway:

Regular checkups and treatment of chronic conditions can make you and your cat happier! Some symptoms typical of dementia may be due to treatable, medical conditions.

Marley, 15 year old neutered male

cat with food puzzle
Marley works the Poker Box, a food puzzle.

Marley is a friendly, affectionate cat with good health overall. In the past several months, Marley showed some of the behavior changes that we need to monitor in senior cats.

Behavior Changes – signs of cat dementia?

  • I – Marley had become more clingy than usual and more interactive
  • D – He seemed confused when playing the nightly game of “treat toss” – he seemed to forget that he was chasing a treat!
  • A – He did not want to walk outside with us (which he has been doing for years).
  • A – He seemed anxious and a little fearful. His interactions with the other cats became timid.

Diagnosis

Marley’s senior exam and blood work did not reveal any abnormalities other than a slight decline in kidney function which could be expected at his age.

Marley appears to have some mild cat dementia. Since these changes were mild, we decided to try SAMe, a dietary supplement. SAMe has been shown to be effective at reducing symptoms of dementia in cats in the early stages of cat dementia.

Outcome

About 2 months have gone by with daily supplementation. Marley is taking his daily walk again and is not as clingy with his humans. He is no longer stand-offish with the other cats and is “catching” his treats again when we play the nightly treat toss.

A Final Word…


Cat dementia cannot be cured but it can be managed. With early diagnosis, appropriate environmental modifications, dietary supplements, therapeutic diets, and medication can help can reduce the symptoms of dementia and improve Quality of Life for both you and your cat.

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Cat using food puzzle

At the veterinary clinic where I work, I often hear people say when I ask about their cat’s activity and play, “she sleeps most of the time and meows a lot at night. She doesn’t play – she’s an older cat”. How much of these behaviors is due to “normal” aging? How much is due to other medical conditions or a declining brain?

Cognitive Dysfunction Syndrome in cats or cat dementia refers to the decline in mental abilities associated with aging.

Cat dementia results from damage to the brain.  As your cat ages, the the numbers of molecules called  free radicals are no longer balanced out by the antioxidants in his body. These free radicals are reactive and cross the blood-brain barrier, damaging cells in the brain.

Changes in blood flow to the brain can also cause damage by starving the neurons of oxygen.  High blood pressure, heart disease, anemia – are all conditions that alter the flow of blood to the brain.

How can we tell if our cats are undergoing mental decline? Is there anything we can do about it?

VISHDAAL – behavior changes


Changes in behavior can indicate if your cat’s mental state has declined. The acronym VISHDAAL summarizes the behavior changes we need to monitor in our senior cats, from the most prevalent (vocalizing) to least frequent (changes in learning and memory).

V = vocalization
I = changes in interaction with us and other pets
S = changes in sleep-wake cycle
H = house soiling
D = disorientation
A = changes in activity
A = anxiety
L = learning and memory

How do we sort out behavior changes due to disease and those due to declining mental capacity?

Changes in behavior signal the onset of cognitive decline but they may also arise from other health issues:

  • Cats with untreated high blood pressure or hyperthyroidism may meow at night (vocalizing).
  • Cats with untreated hyperthyroidism may be restless and beg us for food (changes in interactions and sleep).
  • Kidney disease can be accompanied by increased thirst and urination which may result in house soiling (house soiling)
  • Cats with osteoarthritis may have difficulty accessing the litter box (house soiling).

behavior changes: disease vs Dementia


Regular veterinary exams and diagnostics can identify medical conditions such as high blood pressure, hyperthyroidism, and osteoarthritis.  If behavioral changes persist after treating these other medical conditions, your cat may have CDS or cat dementia. 

Cat dementia is a “diagnosis of exclusion” – it is the diagnosis that remains after all the other possible diagnoses have been eliminated. Cat dementia will usually have a slow onset and behavioral symptoms will gradually get worse.

Cognitive Dysfunction (CDS) cannot be cured but management can reduce the symptoms and improve the Quality of Life for both you and your cat.

managing cat dementia


  • environmental enrichment/modification
  • dietary supplements
  • therapeutic diets
  • medication

Environmental enrichment/modification


In the early stages of cat dementia, enrichment increases mental stimulation, leading to the growth and survival of neurons, preserving the thinking processes.  Enrichment should be tailored to the individual cat.  For example, some cats prefer high places; others are “ground dwellers”.  Arthritic cats will not have the range of motion of healthier cats but will still enjoy play that does not require lots of jumping.

Ways to enrich your cat’s environment:

  • play – interactive play and toys
  • scent enrichment – catnip, silvervine
  • food puzzles
  • motion – climbing (cat trees) and exploring (cardboard boxes)
  • supervised outdoor access

As CDS progresses…

Environmental changes become stressful and confusing. Cats with severe cat dementia need an environment that does not change much – daily routines and feeding schedules must be maintained. Litter boxes and feeding stations need to stay in the same place.

A cat with severe CDS may benefit from a “room of his own”, with easy access to his resources. Changes that need to be made must be done slowly. If you need to move a litter box or feeding station, do it gradually over a number of days so the cat can still find it.

Environmental modifications

Modifications to the environment of the cat with dementia should take into account the behavior that she is exhibiting.

  • Cats that constantly beg for food may benefit from a timed feeder at night or treat balls. 
  • Cats with house soiling tendencies may need more litter boxes and ones that are easily accessed, with a lower entry for example. 
  • Cats that become disoriented and confused may benefit from a night light and radio playing soft music.

Dietary Supplements


Dietary supplements in general seek to restore the balance between the activity of antioxidants in the body and the  production of free radicals.  Antioxidants give up electrons to the free radical, effectively “neutralizing” it so that it is no longer reactive. So, these supplements usually contain antioxidants.

SAMe: (S-adenosyl-methionine)  aids in the production of glutathione, an antioxidant. When elderly cats were supplemented with SAMe, there was improvement in cognitive tests. SAMe is best used pro-actively – it is most effective in cats in the early stages of cat dementia.

Proprietary supplements containing vitamins, resveratrol (antioxidant), and fish oils are on the market but there is no clinical data testing cats for these at this time.

other supplements


Melatonin: hormone in the body that is thought to promote sleep. It also has antioxidant properties. Melatonin declines with age.

Pheromones (Feliway), Zylkene, Anxitane (L-theanine) may help reduce anxiety in cats that are disoriented and may promote sleep.

Therapeutic diets


Therapeutic diets containing antioxidants and fish oils have been shown to help cat dementia. 

  • Feline Mature adult Hill’s Pet Nutrition
  • Purina Pro Plan Age 7+
  • Hills prescription diet j/d with fish oil for osteroarthritis

Diets that reduce anxiety may also help with cat dementia

  • RC Calm diets
  • Hill’s urinary support

Medications


Selegiline: licensed to treat dementia in dogs. Like the dietary suplements, it aims to reduce the production of free radicals.  Selegiline stimulates the production of enzymes that eliminate free radicals.

Anxiolytics: Prozac, gabapentin and clonazepam are used to treat dementia by reducing anxiety.

boxes as enrichment for cats
Boxes can be source of enrichment for senior cats.

If you feel there has been a significant change in your cat’s behaviors, keep a journal or log and make sure to mention it at her next senior exam. Start the conversation with your vet about cat dementia and how to manage it!

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