Guest post by Ingrid R. Niesman, MS PhD
If you start your day wondering where your car keys are, think how your cat feels when they can’t find their favorite toy anymore? Humans with cognitive decline, be it Alzheimer’s disease or any number of Lewy Body dementia diseases, have resources such as memory care facilities to aid families in care-giving. Cats with symptomatic cognitive dysfunction syndrome (fCDS) are sadly considered disposable.
Feline CDS is currently untreatable
The first truth is that there is very little research on this disease in felines. Canine disease was recognized a few decades ago, and animal behaviorists are designing interventions for pet owners. Yet, the outcome for either dogs or cats is the same: eventual euthanasia. This condition is untreatable at the physiological level.
There is a lack of awareness by veterinarians and the public
The second truth is that few veterinarians have encountered feline CDS routinely in their practices. With better nutrition and an increased awareness of the importance of pets in our lives, cats are living long and pampered lives. Once an anomaly, 20-year-old cats are not a rare occurrence anymore. Just like in people, the incidence of neurological issues rises with age, but distinguishing true neurodegeneration from medical background noise is creating confusion. Clinical fCDS diagnosis requires an MRI, an expensive test many cat parents will not consider for their aging cats.
Early symptoms are easily dismissed
Early in the course of this disease, symptoms are mainly behavioral changes. As far back as 2007, a study concluded that nearly 30% of senior cats (aged 11- 14 years) and over 50% of geriatric cats (15 years and older) display at least one or more of the classical symptomology of CDS:
- altered sleep patterns
- loss of house training
- eating changes
- excessive nighttime vocalizations
Each symptom by itself would not necessarily raise an alarm. Even the most vigilant caretaker can easily misinterpret the signs. It isn’t until the latter stages of the disease that the underlying pathology in the brain is apparent. Therefore many cats will go without a clinical finding and valuable medical information is lost.
There are no drugs in clinical trials for fCDS
The incentives to develop drug therapies for cats just aren’t there for pharmaceutical companies. Until recently, the use of cats as a potential model for human neurodegenerative diseases was considered farfetched. Yet, cats, unlike dogs, are shown to have human-like neuropathological changes, suggesting therapies that work on humans will work on cats and vice versa.
Dogs have been treated with selegiline (Anipryl®, L-deprenyl) with reported significant improvements in quality of life. Selegiline is a drug that raises the concentration of the neurotransmitter dopamine and as such acts as an anti-anxiety medication. But, this drug is not commonly prescribed or used in felines. Although recommended by the American Association of Feline Practitioners for treatment of fCDS, its use in cats is not FDA approved and is considered “off-label”. There are significant side effects and it should not be used unless a clear diagnosis of fCDS is evident, which is confounding. Again, this is a treatment, not a cure and won’t slow the progressive loss of brain cells.
Alternative treatments are few and far between
Dr. Stefanie Schwartz, DVM, MSc, DACVB, a board-certified veterinary behaviorist and owner of Pet Behavior Medicine, suggests that fCDS is uncommon. “Owners with an 18-year-old cat showing neurological symptoms will favor euthanasia over treatment,” explains Dr. Schwartz. Behavior modifications may help alleviate some of the more troubling symptoms. For example, for excessive nighttime vocalizations, Dr. Schwartz advices “keeping your cat up and stimulated with play and physical interaction during the day.”
Sadly however, few of the behaviorists I contacted had any experience treating cognitively impaired cats. Without client cats, behavioral intervention studies are scant and uncontrolled. We need more patients.
Environmental enrichment and stimulation such as play and food puzzles are routinely suggested for all cats, and may aid in prevention of cognitive decline. Studies in animals and humans have shown for decades that enrichment and exercise increase neuronal connections and stimulate growth of new young neurons. Whether or not this approach will slow the cell death in the brains of afflicted felines will require longitudinal studies and a significant number of diagnosed client cats.
Although we are still in the dark about human mild cognitive impairment, adding antioxidants and dietary supplements is one recommendation routinely suggested as a method of long-term prevention of neurological diseases. There are several nutritional products on the market sold as feline cognitive enhancing formulations that include omega-3 fatty acids, vitamin E, D, B6 and B12, L-carnitine, and amino acids in varying concentrations. Similar formulations for canines have resulted in some cognitive improvements. Client reviews seem positive for feline brands, but these recommendations are not a substitute for controlled clinical studies.
True clinical trials on a significant number of confirmed fCDS cats would provide a more definitive answer to the question whether supplementation improve cognitive performance over time.
The emotional costs of this disease linger
When a previously loving and adventurous cat rapidly changes, the effects on a family can be devasting. Lori Gould describes her experience when her beloved Siamese-mix Ivory suddenly began to exhibit behavioral symptoms reminiscent of fCDS following a harrowing escape from major flooding. “We were flooded out and rescued by helicopter in September. I carried Ivory’s crate in my arms to safety. On March 13th of the following year, I noticed that her behavior was odd…She was clingy, yet somehow distant. I couldn’t convey these changes to my vet but I knew something was different.” Her decline continued with eating disorders. “She was hungry but forgot how to feed herself,” explained Lori, “I syringe fed her until the end.” Ivory passed away on her own terms. Unfortunately, like many other cats, she was never officially diagnosed or treated specifically for fCDS, leaving not only a hole in her family’s heart but a widening gap in our understanding of this disease.
The funding for all companion animal CDS research doesn’t cover costs
The importance of increasing our funding for companion animal health should be a priority. Companion animals share our common environments, eat prepared foods, and have many similar health issues. They also have more limited lifespans, making them ideal prototypes to understand the efficacies for medical interventions. When we treat cats for similar human conditions, we treat ourselves as well.
This attitude is a paradigm shift. Instead of using animals as disposable human models, we need to use our companions as gatekeepers, unlocking the potential of new therapies and interventions that benefit both animals and people. What is lacking is money. Animal foundations have shouldered much of the costs for research, but their budgets are limited. $50,000 sounds like a lot of money, but for labs doing high-end research, that amount is supply money for maybe 6 months.
How do we fight for our feline friends?
Given the facts, prevention and early diagnosis are the best options for maintaining your cats’ mental capacity as they age. Just like the explosion of Alzheimer’s disease in humans, fCDS cases will increase as the pet population ages. Until researchers understand more about the earliest triggers for neurodegeneration, cats and humans should follow the same advice: exercise, eat a healthy diet and get plenty of mental stimulation over a lifetime. Take your aging cat for regular check-ups and observe them carefully over time for signs of cognitive decline. The more data that is collected and the more treatments attempted on diagnosed cats, the faster we can help everyone.
Ingrid R. Niesman MS PhD is the Director of the SDSU Electron Microscope Imaging Facility at San Diego State University.