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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Cats greet other friendly cats by sniffing them first, before engaging in other social activities such as rubbing against each other or grooming each other’s heads. Scent is a way that members of a cat colony identify each other.

We are members of our cats’ social groups and they identify us by our  scent. They greet us by sniffing and rubbing against us. When leaving your cat at the vet or boarding facility, you may be asked to bring a blanket or t-shirt with your scent on it.  Does your scent comfort your cat when she is away from you?

Recently, researchers at Oregon State University tried to test whether such an object actually reduces a cat’s anxiety when her owner is gone. In this study, owners of 42 cats were asked to bring an unwashed object with their scent on it. Scent objects could include the owner’s shoe, sock, night shirt, or blanket.

The test started by evaluating the cat’s attachment to his/her owner – secure or insecure?
The owner would then leave: in some trials, the scent object was left behind; in others, the cat was alone.

The cat’s behavior was evaluated:

  • when he was with his owner
  • when he was alone with the scent object
  • when he was alone without the scent object
  • when his owner returned

Measuring attachment
Psychological attachment is measured using the Secure Base Test. The cat and owner are placed in a strange room for a few minutes; the owner then leaves for a few minutes and returns. The cat’s behavior is observed when the owner is present, when cat is alone, and when the owner returns.

Securely attached cats
willing to explore when Owner is present
continue to explore after Owner leaves
greets Owner on return but continues to explore and play

Insecurely attached cats
reluctant to explore even with Owner present
sit with Owner or hide in corner
do not explore when Owner leaves
may or may not solicit contact with Owner on return

Does your scent comfort your cat when you are not with her?


Researchers took videos of the sessions, recording how often cats vocalized, rubbed on their owners or the scent object, and how long they would stay close to the owner or scent object.

Researcher’s predictions


  • Cats would prefer their human caretaker over a scent stimulus alone.
  • Insecurely attached cats would interact with the scent object more than the securely attached cats.
  • Cats would be comforted by their owner’s scent.

what actually happened


  • Cats preferred their owners over the scent object – they vocalized less when owners were with them and rubbed on their owners
  • Insecure cats did spend more time close to the scent object than secure cats but only 4 of the 42 cats actually rubbed the object
  • The scent object did not seem to alleviate anxiety – cats vocalized just as much when alone with the scent object as they did when alone without the scent object.

Cats communicate in a large part by smell. They identify other cats and their owners by their scent and greet them by sniffing them and rubbing against them. To your cat, your t-shirt smells like you but does your scent comfort your cat the way your physical presence does? The answer is no according to this study.

Your t-shirt is not the same for your cat as a teddy bear that a young child clutches to face the world. The teddy bear is a “transitional object” that helps a human child become less dependent on his parents and learn to relate to other people.

Your cat is attached to you – not your t-shirt. It won’t hurt to leave the t-shirt at home when going to the vet or boarding facility.

Other Thoughts


 A cat’s territory where she feels safe is marked with her own scent. Providing your cat with a blanket from home with her scent might make her less anxious.

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Why do cats purr? What does a purr mean? I would say that most of us think of a purring cat as contented. I wondered if there was more to the purr – my ex-street cat, Gus, does not seem to purr at all.

Contented Cat

How cats purr


Purring seems effortless. People who study purring say that the opening and closing of the vocal folds (vocal cords) in the cat’s larynx while he breathes in and out produces the sound we call “purring”.

Purring is different from other vocalizations such as meowing because it occurs not only when the cat breathes out, but also when he breathes in. Meowing, hissing, chirping, for example, occur only on expiration, when breathing out.

Purring is a low frequency sound (25-150 Hz) and does not vary much in frequency. Vocalizations like the meow are higher frequency sounds. They are generated by vibrations of the vocal folds in the larynx. Changes in the tension (length) of the vocal folds produce sounds with a range of several octaves at frequencies exceeding 100 Hz.

The cat can control the separation of his vocal folds independently of their length (or tension).  So the cat can purr while he is meowing!

the cats that roar and the cats that purr


Around 1916, Reginald Innes Pocock divided the cat family into the “cats that roar” (lion, tiger, jaguar, leopards) and the “cats that purr” (domestic cats, cheetahs). This classification was based on the anatomy of the hyoid bone, a u-shaped bone in the neck that supports the tongue. Currently, the hyoid bone is not thought to determine whether or not a cat can purr (indeed, snow leopards can purr).  The classification of cat species is now based on molecular characteristics, eg. DNA.

when cats purr


So, cats purr as they breathe in and out and their vocal folds open and close. When do they purr?

Feline guru John Bradshaw notes that cats may purr:

  • when being groomed by another cat
  • a cat may purr while grooming himself
  • kittens purr while nursing and often their mother joins in
  • some cats purr when they are just walking around
  • when greeting a friendly cat
  • when in contact with another cat

Purring is not particularly loud (when compared with a howl!) and is heard over short distances; it most likely originated as a sound made by kittens, to induce their mother to feed them. Purring kittens with mama cat is the ultimate picture of contentment!

the healing purr


Cats are know to purr when they are in pain or anxious, for example, at the veterinary clinic. The purr ranges in frequency from 25 – 150 Hz. The purr of domestic cats, servals, ocelots, and pumas produce strong frequencies at 25 Hz, 50 Hz and 100 Hz.

In human medicine, the application of low frequency vibrations (25-50 Hz) has been found to inhibit bone loss and initiate bone repair.  Frequencies around 100 Hz are used to treat pain, swelling, and wounds .

Are cats able to heal themselves by purring ? Is purring a “feel good” (self-soothing) behavior? (So why isn’t Gus purring?)

The “solicitation purr”


Earlier, we noted that a cat can vocalize and purr at the same time. Cats have taken advantage of this and have developed a “solicitation purr”,  one that has a meow embedded in the purr. Cats have discovered how to use this to alert their owners to their needs, like “I want food”.

Acoustical analysis of the “solicitation purr” shows a peak around 380 Hz in the purr spectra. This frequency is more typical of a cry or meow, not the low frequency purr and is close  to the frequency of a human infant’s cry (300–600Hz)

This cry gives the “solicitation purr” its urgency that drives us to attend to the cat, giving her head rubs, food or whatever else we think she needs. It taps into our inborn sensitivity to the cries of infants, making it hard to ignore.

The purr is a lot more than the sound of a contented cat. It can also be a greeting, a self-soothing behavior or healing mechanism, or a request for someone to do something for the cat. It is a quiet sound so make sure you don’t miss it!

And back to Gus, maybe that rumbly sound in his meows when he rubs against my legs are “solicitation purrs”.  I will keep listening!

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