October 25, 2017

AVMA 2017: Behavioral Problems in Senior Dogs

Improving quality of life for older dogs with behavioral problems entails first identifying the root cause of the problem and then taking a multimodal approach to treatment.
By Nicola M. Parry, BVSc, MRCVS, MSc, DACVP, ELS
Problems Related to Cognitive Decline
Because many medical conditions in older dogs have signs that mimic those of cognitive decline, when evaluating senior dogs with behavioral problems, Dr. Reich noted that “the possibility of cognitive dysfunction always looms in the background, but it’s really a diagnosis of exclusion.”

The acronym DISHA can help clinicians recognize the signs of cognitive dysfunction in senior dogs:
  • Disorientation: Dogs may walk aimlessly, stare at walls, or lose balance and fall.
  • Interactions: Dogs may begin to interact differently with people or other pets in the home.
  • Sleep: Dogs that previously slept through the night may now be restless during the night or wake frequently.
  • House soiling: Dogs may no longer alert the owner to the need to go outside and may urinate indoors or be incontinent.
  • Activity level changes: Dogs may be restless, agitated, or show other signs of anxiety such as separation anxiety; they may stop grooming or may have a decreased appetite.

Treating Behvaioral Problems
Treatment of behavioral problems in senior dogs varies depending on whether the problem is a true primary behavioral problem, secondary to a medical problem, or cognitive dysfunction, said Dr. Reich. She stressed that clinicians should treat any underlying medical issues first. Treatment plans may also require medications or changes in how the owner manages the dog.

Managing Undesired Behaviors
Some behavioral problems—including separation anxiety—are managed the same way in older dogs as in younger dogs, said Dr. Reich. Behavioral modification techniques are also the same in older and younger dogs, but Dr. Reich stressed that such techniques may not be as effective in seniors. She discussed using treats or rewards to redirect or facilitate desired behaviors; in addition, although clinicians can use desensitization and counterconditioning to help dogs that fear noises, scary stimuli, and being alone, Dr. Reich noted that these techniques may be difficult to implement in seniors. “Dogs have limited learning ability as they age,” she said.

Owners may also need to implement various management changes, depending on the dog’s behavioral problem. For example, in cases involving food aggression, owners should feed the dog where it cannot be disturbed. In cases involving house soiling, owners should take the dog outside more frequently to urinate, including as late as possible before bedtime. Owners may also wish to teach their dog a cue for elimination if the dog is easily distracted when outside. They can also train their dog to urinate on pads or paper indoors.

Supplements and Drug Therapy
Dr. Reich discussed various supplements that have been used to treat senior dogs with behavioral problems, including S-adenosylmethionine (SAMe), apoaequorin, alpha-casozepine, and omega-3 fatty acids.

Although Dr. Reich said that many of the medications used to treat young dogs with behavioral problems can also be used in seniors, she stressed that drugs with fewer adverse effects are preferred—for example, selective serotonin reuptake inhibitors such as fluoxetine and sertraline.

For dogs with poor liver function, Dr. Reich advises that clinicians avoid using diazepam and instead choose other benzodiazepines, such as lorazepam and clonazepam, because metabolism of these drugs is minimally affected by age and liver disease. She also recommends that clinicians perform bloodwork regularly—once or twice each year—on dogs receiving long-term medications for behavioral problems to ensure that the drugs are not adversely affecting the animal’s metabolism.

For dogs with cognitive dysfunction, in particular, Dr. Reich favors using SAMe supplements. “I try to treat as many senior dogs as possible with SAMe,” she said. It stimulates brain glutathione and decreases oxidative stress, which is implicated in cognitive dysfunction, she explained. Many dogs that receive SAMe supplementation show clinical improvement, she said.

In contrast, Dr. Reich noted that she does not typically use selegiline, a monoamine oxidase-B inhibitor, for dogs with cognitive dysfunction because of its potential to interact with other products or drugs such as amitraz and fluoxetine.

Combination Therapy
For managing senior dogs with behavioral problems, Dr. Reich recommends using an approach that combines medical, behavioral, and environmental management strategies, with drug therapy as needed. This approach can help to improve quality of life for both the dog and the owner.

Dr. Parry, a board-certified veterinary pathologist, graduated from the University of Liverpool in 1997. After 13 years in academia, she founded Midwest Veterinary Pathology, LLC, where she now works as a private consultant. Dr. Parry writes regularly for veterinary organizations and publications.

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