Coping with Pet Mental Disabilities

Canine Dementia - Sundowners Syndrome - Canine Mental Illness

Our first experience with Sundowners and Canine Altzheimers was with our two elderly girls Mulan and Jasmine. Mulan began to have severe enough symptoms with anxiety that they eventually caused her to bloat - a life threatening condition. She's 13 years old and managed to pull through bloating twice in a week - so we had to figure out what was causing it - and fast. Jasmine's only symptoms seemed to be "yelling" at us for no apparent reason, but she didn't get anxious - it was just annoying! Canine cognitive dysfunction (CCD) is a disease prevalent in dogs that exhibit symptoms of dementia or Alzheimer's disease similar to that in humans. In the dog's brain, the protein beta-amyloid accumulates, creating protein deposits called plaques.

Sundowning is a symptom of Alzheimer's disease and other forms of dementia. It's also known as “late-day confusion." Their confusion and agitation may get worse in the late afternoon and evening. One of our dogs, Mulan would get extremely agitated in the evening starting around 6pm - as the sun was going down. She would begin panting nervously gulping air, and on two occasions bloated. Yet, during the day she was her normal self.

Our brains are not that different from dogs' - dogs with cognitive dysfunction wander restlessly in the evening in a manner reminiscent of the “sundown syndrome" of Alzheimer's patients. They may get up and wander the house at night when the family is asleep, or seem nervous and agitated the later it gets - and then by morning is fine again. More significantly, finding familiar surroundings strangely unfamiliar often triggers anxiety and agitation. Unusual shadows at this time of day can cause confusion, as can unusual excitement and activity in the household.

Initially symptoms of the disorder are mild enough you don't even notice, but over time they tend to gradually worsen. This is called “cognitive decline." In fact, clinical signs of cognitive dysfunction syndrome are found in 50 percent of dogs over the age of 11, and by the age of 15, 68 percent of dogs display at least one sign.

What are the signs of dementia in dogs?

Just like humans, dogs can suffer from many of the same symptoms:

Symptoms of Canine Cognitive Dysfunction (CCD)

• Increased, excessive, or unusual vocalizations.
• Pacing and restlessness.
• "Spacing out" and staring at walls, or at nothing.
• Less interested in interacting with family (or with other pets).
• Increased (or more easily triggered) irritability or aggression.
• Decreased interest in activity - including playing, going for walks, or socializing.
• Confusion or disorientation (for example, waiting at the wrong side of the door to go outside).
• Housebreaking accidents.
• Changes in the sleep-wake cycle - sleeping more during the day, awake more at night.
• Increased or persistent anxiety.

Symptoms of Sundowners in Dogs

Sundowning is considered a behavioral disorder that results from canine cognitive dysfunction that seems to occur more at night. Signs of sundowning typically begin to show in the late afternoon or evening, as night approaches, and can continue throughout the night. Symptoms include:

• Restlessness and pacing, often back and forth along the same path.
• Barking or vocalizing for no apparent reason.
• Becoming more 'needy' or clingy, and needing reassurance.
• Increase in general anxiety. Dogs may constantly pant. This may or may not be accompanied by pacing.
• Inability to settle down and sleep. Dogs may try to settle but repeatedly get up to pace.
• An increase in irritability, sometimes even aggression.
• Staring at walls
• Some deep chested breeds are inclined to bloat from the anxiety.
• May forget their house training - forgetting to ask, or becoming anxious rather than asking to go out.

So how do I deal with this strange new anxiety?

Eliminate Medical or Pain Issues

Pain is often worse at night. Dogs, particularly older dogs, might be experiencing pain from arthritis or other disease. Other medical issues can also cause restlessness, which may be more noticeable at night because the house is quieter or because the pain is more intense at that time. It's a good idea to visit the vet to rule out the possibility of any pain issues that could be causing the restlessness. Sometimes treating underlying medical conditions can help to decrease or minimize sundowning behavior.

Your veterinarian can also discuss the symptoms your dog is showing and give an opinion on whether he believes your dog has canine cognitive dysfunction and is 'sundowning'.

Stick to a schedule

Dementia can make it hard to develop and remember new routines. Your pet might react to unfamiliar places and things with feelings of stress, confusion, and aggression. These feelings can play a large role in sundowning.

Stick to the same schedule every day to help your pet feel more calm and collected. Try to avoid making changes to routines that work for you both. If you need to make changes, try to adjust their routine gradually and as little as possible.

Light up their life

This is a method that sometimes helps with dogs who haven't yet lost their eyesight. Flooding the rooms with light can help to eliminate any spooky shadows or indistinct objects that might be frightening to confused pets.

During the day, take advantage of the natural light. Open up blinds in all parts of the home that your dog visits. As natural daylight fades, start turning on lights throughout the house (LED light bulbs are perfect for this - they save significant amounts of energy over the use of the normal incandescent bulbs, and they typically last much longer). Keep the lights on until bedtime, when lights can be turned off. If your dog noticeably gets more anxious or agitated when the lights are off, you may want to try putting him in his own room with the lights left on all night or use night lights. This seems to help some dogs, but if your dog still seems anxious, try unplugging the night light so that it's totally dark. Sometimes even the glow from the tiny night light is enough to illuminate weird shadows or objects and scare the pet. With Mulan we found the night light seemed to help her act as a beacon....so if she wandered away from her bed at night, in the dark she could find her way back again easier.

Music

Dogs who are losing their hearing may become more sound-sensitive. Sounds that they can't readily identify may be scary to them. Playing background music can help to lessen anxiety in some dogs. Classical music is a good choice, or there are various calming music CD's just for dogs.

Melatonin

Melatonin is a naturally-occuring hormone that can help to reduce anxiety in dogs as well as promote a more natural sleep-wake cycle. In general, dogs who are less than 25 lbs can get 3 mg every evening, while larger dogs can take 6 mg. Give the pill one hour before bedtime.

Make sure to only use pure melatonin, not one that's mixed with other substances (like xylitol, which is toxic to dogs). If in doubt, buy melatonin that has been specifically made for dogs. Your pet might experience sundowning as the result of changes in their circadian rhythms — their sleep-wake cycles. Adjusting the light in their home might help reduce their symptoms.

According to a research review published in Psychiatric Investigation, some studies suggest light therapy can reduce agitation and confusion in people with dementia so it may help dogs as well. Consider placing a full-spectrum fluorescent light about a yard away from your pet likes to hang out for a couple of hours each morning. You can also try brightening the lights when your pet feels confused or agitated.

Use an Anti-Anxiety Wrap

The best-known anti-anxiety wrap is the ThunderShirt. The Thundershirt uses gentle, constant pressure to calm anxious dogs. It has helped many dogs who are afraid of thunderstorms. It doesn't work on every dog, however it's an easy, drug-free way that has a good chance of helping. Put it on about an hour before bedtime. Dogs can comfortably sleep while wearing it. Since Mulan had both legs shaved in spots for IV's (due to the bloat), I made her a pair of leggings which she wears around the house. My original purpose for making them was to keep the shaved spots warm when she went outside in -10 weather...but they seem to also act as a thundershirt - giving her confidence around the other dogs. Dogs are aware that other dogs will attack a weak dog's front legs to 'take them out'...so my thinking is having her front legs covered makes her feel more 'safe' with the other dogs. Just a theory, but it does seem to help her.

Exercise

Some dogs respond well to extra exercise as means of alleviating some anxiety. Take an afternoon walk or engage in some play time. Be sure to tailor this exercise time to your dog's abilities. Older dogs with arthritis or mobility issues will need shorter, gentler walks or may just want to go outside with you for 5 minutes to sniff the air!

Confinement

Dogs may find their crates comforting when they are feeling anxious. Make sure the crate is lined with comfortable bedding, there is water available, and the crate is big enough for your dog to fully stand-up, turn around, and comfortably lie down.

Dogs who aren't crate-trained can be confined to a room with a comfortable bed and drinking water. If your pet is accustomed to sleeping in the same room as you, you could simply close the bedroom door and see if that helps. We let Mulan sleep on the bed when she felt especially anxious. She's still very good about not having accidents so that was an easy option to put her at ease. We have to help her up, but she lies still and stays there instead of wandering at night (and she'd always been a wiggler before this!). So that may be an option for some pets and their people.

Being crated or confined can actually increase anxiety in some dogs, so be sure to monitor your pet carefully.

Dogs who experience sundowning syndrome have trouble sleeping at night. In turn, fatigue is a common trigger of sundowning. This can create a vicious cycle.

Eating patterns

Adjusting your pet's eating patterns may also help reduce their sundowning symptoms. Because Mulan had bloated, we decided to go from 2 meals a day to 5 smaller ones. Large meals can increase their agitation and may keep them up at night. Limiting evening food intake has helped her feel more comfortable and rest easier at night. This is not always possible to do if you are gone during the day...but if you can feed smaller more frequent meals it does seem to help.

Minimize their stress

Try to help your pet stay calm in the evening hours. Encourage them to stick to simple activities that aren’t too challenging or frightening. Frustration and stress can add to their confusion and irritability. Pets will also want to stick closer to the humans at this time of day. Allow it. She now joins us to watch TV when it was never a priority before.

Provide comfort and familiarity

For a pet with dementia, the world can become a scary place. Comfort and familiarity can help them cope with this difficult time in life. Make them a soft bed, if there is a way to separate it from other pets, that would be a plus. We used furniture as a "wall" to give her extra space in a corner she could 'defend' and fill up with her favorite toys and nightlight to feel safe. She'll often sit in the entranceway, looking at her toys knowing none of the other dogs can invade her space.

Watch for Patterns

It's also helpful if you can figure out your pet's triggers, use a journal or smartphone app to track their daily behaviors. Look for patterns to learn which activities or environments seem to make their symptoms worse. I just discovered last night that shadows from the moon coming in the window at night disorients her when she's being helped on to the bed - it caused her to jerk around and fall off the bed! Meals that are too big. Other dogs creating a ruckus or aggression toward the sundowner dog, for example, can create anxiety.

What About Medication?

If the pacing and restlessness is extreme, or none of the other methods help, it may be time to consider medication. The reason we went that route is because Mulan had bloated twice in a week (bloat is life threatening - the stomach inflates and can cut off circulation and kill the dog) due to the anxiety. Talk to your veterinarian about anti-anxiety meds or Anipryl, a drug that's used to treat dementia in dogs. Our vet put Mulan on Trazodone. She gets one pill with her 4pm snack and is pretty spacey by 6:00 by not anxious at all...we've experimented with the timing and that worked best for her. By morning most of it has worn off and the anxiety is gone. Ask your vet what might work for your dog.

Long-Term Management

Dealing with sundowner syndrome in dogs can be frustrating (especially when you're exhausted from lack of sleep!) but remember, despite the sundowning, your dog is still the same dog you've always loved. Be patient, be gentle, and understand that he isn't behaving this way on purpose. It can take time and some help from your veterinarian to figure out what method, or combination of methods works best for your household and pet. Patience, understanding, and plenty of love will help to reassure your dog that he's still an important part of your family.