Latest / Senior Pet Talk | for dogs + cats / 25. The Truth About Medications for Dementia
Transcript
- SPT Ep 25 Final: You are listening to Senior Pet Talk, the show where we combine Western and Chinese medicine to give senior dog and cat parents the knowledge, the clarity, and the confidence to make sure that your pets' senior years are their best years yet. I'm Dr. Amanda Steffen. Let's get started. What should you know as a pet parent when it comes to medications for dementia? We're talking about dog and cat dementia today and the options that we have when it comes to medications to treat the disease and to treat the symptoms associated with the disease, which is the most common part of that. Thank you for tuning in to another episode. I am Dr. Amanda Steffen. I run an in-home integrative. Senior Pet Focused Clinic in the Ohio area. And I also am the host of Senior Pet Talk, this podcast, here to talk to you every week about ways that you can help your senior pet. There are a couple medications that we do use for basically the signs associated with dementia. So there is only one medication approved only in dogs here in the US. Specifically for doggy dementia or canine cognitive dysfunction syndrome. If you are unaware with doggy or kitty dementia, about 30% of dogs and cats over the age of 11 have symptoms of dementia. And that goes up to about 50% of dogs and cats over the age of 15 are gonna have symptoms of dementia. Different studies show different numbers. I think those values are actually pretty low for what we see in clinical practice. So I think it is something worth noting. There are studies that say that dogs as young as six, a large percentage of them can have clinical signs. So it is something for you to definitely know about. Sometimes when they are starting to pace around more, they are starting to seem a little distant from you. They are starting to have some house soiling, they're starting to have some interaction changes or some anxiety. Those things can actually be symptoms of dementia. And we may misinterpret them as something else. So it is very important. If you have not, go back to episode number four, where I talk to you in detail about what all of those specific symptoms are. But today I want to talk to you about some of the options that we have when it comes to medications and then what I have seen and what I recommend on the other side of that. As an integrative veterinarian, so as someone who practices Western and Chinese medicine, if you are tuning in live, you get to see my doggies over here and my little friend she Mabel's back there too, but she's hard to see because she blends in with the gray betting. They are taking a very good snooze today. So I had a dog named Molly, and Molly lived to be 17 years old, and she did suffer from dementia. She did a lot of pacing. So we would say that she was doing her nightly patrol. So like every hour on the hour, typically at night, it was every two to three hours. She would get up, she would go take a lap around the house, stare into every room, and then come back and lay down. At the time we lived in a house that was about 1200 square feet. was one level. So it was safe for her to do that. She did not have any issues getting around. And she would go and come back and lay back down and go to sleep. And that was the most of hers. She did not have a lot of other dementia symptoms, which is good. But that was one of my first interactions with living with a pet that had dementia. And then I had Floyd and Floyd's dementia was Unfortunately, much more of a concern for his quality of life than Molly's was. So Floyd would pace, you know, he would get up and lap around the living room every twenty minutes, twenty, thirty minutes. And he woke up in the middle of the night and needed to go outside. He would need to go outside to actually go to the bathroom. So it wasn't like I could just not let him go outside. He would kind of get stuck in corners. He would do a lot of these other signs that did affect his quality of life. So we had to make some modifications for him. And we're going to talk about that in another episode. But there were definitely some things that I looked into when it came to his quality of life and were there any medications that I could use with him. So we have all of one FDA-approved medication in the United States. For cognitive dysfunction. And unfortunately, this isn't even approved for cats. It's only approved for dogs. Don't worry, cat people, stay with me because I am going to still talk about cats with some of these other symptomatic treatments that we use. Okay. So hang out for this. The medication that we have available is called sleduline or anapyl. So The way that this medication works is it reduces free radical damage in the brain and supports dopamine and serotonin activity. If you do not know, as the brain ages in senior dogs and cats, their serotonin and dopamine levels decline. And those levels decline, that causes an increase in their anxiety. So They also have an excess amount of free radical damage, which is why a lot of the things that we use to help treat it are antioxidants. There have been some studies. There was a very large clinical trial that they did of 641 dogs. And in this study, 77% of dogs showed overall improvement about two months into that. It is worth knowing that there was not a placebo control. So it was open label. So everyone knew whether their pet was getting the placebo or whether their pet was getting the medication. So the real world results of this may be a little bit lower. And I will say from personal experience, I typically tell pet parents 5050. I'm gonna tell you 50% of people who I have had that have tried this drug and they Tell me they see an improvement in their pets' dementia symptoms. The other 50% say they notice no change. And it is one of those drugs that we have to talk about. If we notice no worsening of clinical signs at two months, does that mean it is working? Because we know dementia is a progressive disease, right? So we have to think about dementia in this way of like, It is going to get worse over time. And sometimes stagnating or stopping that progression is actually efficacy of that product. So that is something we have to keep in mind. But ideally, we want to show some improvement in the clinical signs of what they have going on, right? So the responses that seem to have the best To this legaline were disorientation and social interaction or withdrawal. So unfortunately, those situations are not typically the ones that we're saying end of life for. So the things that we care more about are sleep wake cycles typically and restlessness. So it's not as much going to help for the up all night pacing patient, which is often. the conversation that is being had about the sign that is causing pet parents the most distress in their home, right? And for the pet. We don't want them up pacing around all night long. We want them comfortable and able to sleep through the night. So it is something that affects them a good bit as well. Another thing to know about syllegaline is that it is a drug that needs to have about one to two months or four to eight weeks. of time before we decide whether it works or not. So it is not something where we are going to be able to know in two weeks or three weeks even. We have to give it a good, I usually say six to eight weeks, so about two months course of it and see whether we notice an improvement or not with that. So it is not something that's going to fix things that are causing disarray right then. The side effects of this drug are generally fairly mild if it is being used by itself. And we'll talk about that a little bit more in a second. So drooling, decreased appetite, diarrhea, maybe some vomiting that basically only happened in about 3% of patients on the drug in the trials or is reported to the company. So it's a pretty small percentage and not major side effects, which is really nice to think about too when we're trying to give this to our pets. It can be something that we definitely talk about though, because if it does decrease their appetite in a patient that's already a little picky about their food, that is a quality of life concern to me. And we're going to talk about what do we do if that happens. I want to talk to you about a couple other medications that are often used to treat the signs associated with dementia. But first I want to talk to you a little bit about something called serotonin syndrome. So there is a phenomenon in humans, I believe, as well and animals, where if we mix a couple medications together that are in specific categories, they can cause something called serotonin syndrome. And this serotonin syndrome is basically like a ramped up version of sedation. So it can make them have some tremors and twitching, it can make them really, really sleepy, it can cause coma, it can cause seizures. It can cause some pretty substantial problems, them being minimally responsive. If we mix this medication with other medications that are typically also like what we would consider downer type medications, or often we're talking about medications that are anti-anxieties. If we're mixing those together, and Benadryl goes in that category too. So if you give your pet an occasional Benadryl or Claritin for allergies, you really have to have a conversation about this specific drug and others in this in the categories of sedation, because it can cause this serotonin syndrome phenomenon. This does not happen in every patient that we mix these two medications in or that we mix some of these medications together in. It is a smaller percentage, but it is a substantial side effect if it does happen. So it is worth noting, and we try really hard in veterinary medicine to not mix a couple of these medications together that could cause this serotonin syndrome. Specific ones are more prone to cause it than others. So you may notice that some of these medications have been mixed together and do not cause these issues noted as often, and some do. So this is something to keep in mind. Okay, I want to talk to you about two other medications. And then two other like supportive supplements that are often given for dementia in dogs and given in cats. And let's go through what have seen, what I recommend, and you know what we do in practice. The first of those is called trazodone. Now, if your pet has ever had trazodone, we often use trazodone in veterinary medicine for its side effect, which is sleepiness. Which I also think is what they do in humans. I know quite a few people who, especially older people that are on trazodone for sleep, it's to help them fall asleep. Because when you get older, you have a hard time falling asleep at night. So there are times where this trazodone is given in the same way to animals. If you were to come into a Western practice and say, Hey, look, Fluffy has me up seven times a night. And I can't sleep and I can't do this, then your veterinarian may offer trazodone as a way to fix this side effect of dementia or this symptom of dementia for you. I wanna be very clear that trazodone is not treating dementia. It is treating a sign that is associated with the dementia. So it's making them sleepy and sleep through the night. So we are giving them an anti-anxiety. It's called an SSRI. So it is an anti-anxiety technically, but it is specifically being used for kind of that side effect component of it, that sedation component of it, which is absolutely perfectly fine to do. I just always want people to understand what we're actually treating when we're doing this. There are a lot of patients who do very well with this medication. To help them sleep through the night, because it is very important for all of us to get an important amount of sleep at night. So it is something that we can use. It's just I want to be very open with people about what it's actually doing, right? And then the second one that we have is gabapentin. So gabapentin is sometimes used in conjunction with trazodone. And again, the serotonin syndrome can happen, but it is pretty uncommon with transit and gabapetin used at appropriate doses. Okay. So gabapetin is basically a nerve pain medication, but it also has a side effect of sleepiness. So it can sometimes be used for sleepiness. If we think that a patient has more of a pain component to their pacing or things like that, GABAPetin may be the one that a Western practitioner would reach for first. compared to trazodone. And often gabapetin is not going to make them as sleepy as trazodone is. So if we really need them to sleep, trazodone is probably our better answer if they're a patient who may not handle a heavier sedation better. Or, you know, again, we may have some pain component to it, then we're going to try gabapetin first. It also is state dependent here in the United States. I I don't know the number of states, but some states do control GABAPETEN and some states don't control GABAPETEN. So it may also vary based on the comfort of the hospital and the abilities of the hospital, whether they prescribe a controlled medication or not for this. I know where I live, Kentucky has controlled laws on GABAPETEN and Cincinnati or Ohio does not. So it's interesting to see the variation just across that border area border area. So the side effects with those, so trazidone typically is going to make them sleepy. It can cause some GI upset. Sometimes it can cause some like watery eyes. With gabapetin, we see more of like sedation and loss of coordination. So I do not love gabapetin for senior pets. And there are a couple of reasons why. One of them is we now know that the pain effect of gabapetin is not as substantial as we once thought it was. It can help with pain, I do believe it does, but it is not as substantial as we once thought it was for pain. So it can help like a little bit, right? But the problem is in dogs and in cats, we can use both of these medications. We typically would. reach more towards gabapetin with cats than we would trazodone, but I've used both. The problem with gabapetin is that it causes this ataxia or this wobbliness of their back end. And the the issue there for me is a lot of senior dogs and cats already have muscle wasting and a weak back end. They have a weak core, therefore they have a weak back hit it back end. Go listen to the episode on Core exercises and helping with PT exercises, because I promise you, most seniors, humans and animals, have a very weak core and that substantiates urinary incontinence and a lot of these other symptoms that go along with it. So my concern here is if GABAPentin makes them feel drunk and one of the Veterinarians who is an anesthesiologist I listened to last year at the hospice and palliative care conference said this and it stuck with me. She said, if they need to day drink, then we use gabapentin. So if they need to just like feel good, you know, feel, feel kind of like you had MMOSA at brunch and, you know, that's how you feel for the rest of the day. If they need to feel that way, then gabapetin can be helpful. However, it does make them feel a little drunk. It does have that side effect. And it's gonna make them a little bit more wobbly in their back end. So then I have a client who comes to me and says, Well, they seem more wobbly than they used to be. And then my question is, okay, well, is this a worsening of their arthritis and their neurologic disease, or is this secondary to the GABA patent? So it gets hard to differentiate those things and that gets a little concerning. There's also some newer studies in humans. Taking GABAPETEN long term, that it could actually worsen or make them more predisposed to dementia in people. Studies have not been done, to my knowledge, in animals, but they have been done in people. So I also worry, could we be making dementia worse if we're using gabapetin in the long term, or could we be potentiating them more to that? So if your pet is on gabapetin long term for pain control. I would say, hey, there are other options that we could look into that may actually catch on that pain a little better as opposed to, you know, being on gabapetin, which could have some long-term issues or side effects. Something to keep in mind. Okay. The other two that I want to talk about, these are not medications. They are supplements, but we do often see them use for dementia. One of them is called melatonin. So melatonin, the idea here is that it helps mostly with this sleep wake cycle. So it's gonna help to kind of get them back on a normal sleep wake cycle. Melatonin is typically given at night, and it is something that could help with regulation. There is specifically dog and cat melatonin. It is something to talk with your veterinarian about because some melatonin contains xylitol, which is toxic to dogs, potentially to cats as well. It is an artificial ch sugar. Unfortunately, the a lot of the companies are now calling it birch sugar, which is just trying to make it sound less artificial, but it is still xylitol, which is an artificial sweetener, and it is still toxic to pets. It is really frustrating when a conglomeration Or, you know, an entire the entire food industry decides to start using a different word because we have ingrained in a lot of people that xylitol is bad. And now we have to say, and it's also called birch sugar. So like a birch tree, B-I-R-C-H. So yeah, just keep an eye out for that as well. Make sure that whatever you're using does not contain xylitol or artificial sugars. Because that is toxic to those guys. It will cause their glucose to tank substantially and they can start to have seizures and it can cause some substantial issues. So we want to make sure that does not happen. Melatonin, I have seen it work and it is fairly low risk. There's not a lot of side effects with it as long as we're not using a xylitol version. One of the unfortunate caveats to melatonin in animals and in people is that you can get used to it. And there is a human study now looking at can long-term melatonin cause dementia? So other things to keep in mind with that for sure. The other thing that I wanted to touch on is pheromones. So there is like adaptyl collars for dogs and like feel away for cats, but any sort of like dog or cat pheromone, it's a pheromone that basically helps to decrease anxiety levels and decrease stress levels. It does have some good studies behind it. It reduces anxiety-related behavior. So, and it's really low risk, right? So feel away is often a plug-in format. Adaptil is usually a collar format. They do make sprays and things like that with it too. Basically, like what I tend to tell people is use it for two months. And if you don't see an improvement, then stop using it. But it can help a lot with anxiety. I would say feel away for the people that I have talked to in my career about 50-50 again. It's one of those that I have some clients who tell me they know when that feel away diffuser runs out because they can tell the difference in their cat. And I have a lot of people who say they never notice the difference. So not every pet is going to respond the same to every option, which is why I fully a hundred percent believe and it is a pillar of mine, in an individualized approach, because it is very important for us to individualize a plan to a pet. I have 50 patients at a time typically in my in-home business, and not a single one of them is on the same protocol, Chinese and Western. So it is important to just make sure that we're getting a full plan for each of these guys and not looking at them as another patient as opposed to looking at them as Emmet the Frenchie who's seven years old and has a very special set of needs compared to Mabel the Neapolitan Mastiff Mix who is ten years old and has her own very specific lists of things that we need to coordinate around, right? Have you ever left the vet with more questions than answers? And then you drive home and you go straight on to Google. Yeah, I hear that a lot. And honestly, is exactly why I created my senior pet virtual consultations. Imagine we have 45 minutes where we go through everything, your pet's full history, their specific challenges, their daily life, no rushing. We're gonna cover nutrition, integrative options, whole modifications, and quality of life. And I send you a personalized plan after so that nothing slips through the cracks here. But don't just take my word for it. Chelsea called it a senior pup therapy session and said she felt so much better afterwards. Adiba got recommendations her own vet had never thought to suggest, and Denise said that the consult was incredibly informative and helpful, giving her many options to help her dog Loki feel better. This is the conversation that your senior pet deserves. And honestly, The one you deserve to. The link is in the description. I'd love to help you. Okay. So in my experience, I think saleguline is something that's worth trying, but I do want you to make sure you're having a conversation about are we on any of these other sedation medications and is anything that we're using contraindicated using the salagulene? I have personally seen better success with diet changes. And honestly, I've seen way more success with acupuncture and herbal remedies. I have a couple patients that I've treated with herbs and they have had really wonderful improvements, especially with nighttime waking and yowling and cats. I had one patient that I treated for the yowling and he did really good on an herbal formulation for him. I have another patient right now who is a it's the dog of a colleague of mine. And she gets a An herbal remedy called Shen Calmer. And they're not all the same. So, and that is a prescription herb. You're not going to be able to get it over the counter, but it is something that can be tried. I do know that places like Standard Process also have some like new cognitive dysfunction herbs. They're a really good herbal company. Like there's a couple of different formulations in like the thorn herbs line and things like that too. But it is something to meet up with a Chinese practitioner about. You don't have to be licensed in herbal therapy to be able to s prescribe herbs. You just have to be able to get a Chinese diagnosis and work up the patient a little bit. And often a lot of these herbal companies will allow you to call in and kind of talk through the case with them and then get a plan together for that pet. I really like Con herbs. They do a fantastic job of that. Jintong is another herbal company that's associated with the Qi Institute. They do that as well. So that's really helpful. For any veterinarians listening. Okay, so medication is just one piece, but I do want you to know what your options are for medications with that. So there you have it. We have selegaline and we have a couple other more just symptomatic treatment options. And then there's a couple supplements thrown in there. There are going to be other episodes, and there are past episodes on things like diet and then. environmental changes and other changes associated with that. So make sure you subscribe so you do not miss a single episode. And if you have enjoyed this podcast up until now, I really, really would love if you could just do one simple thing for me. And that is rate it and leave me a review. Okay. Because it helps me to know what episodes people really appreciated and what episodes may need to be tweaked or just didn't hit as well with people. And it helps me know what to bring to you next. So if you would not mind, please subscribing and rating the podcast. If there's anything I can do to make sure it's a five-star review, please reach out to me. And I thank you for being here. There will be transcripts available from here on out. I received a message from someone who is deaf and could not listen to the podcast. And I did not realize we weren't adding transcripts onto there. And there are captions. There should always be captions. But I want to make sure that we are helping absolutely everyone that we can. So please, please, please, if something is of concern to you, you can say it to your friends or whatever if you want to, but I don't know unless you tell me. So please tell me what your concerns are. Please let me help. That is my whole goal of being here is to help you and to help your senior pet to get more time and to just feel more confident as a pet parent. So thank you so much for spending your time with me. I really appreciate you. And I hope you have a beautiful day. Know that you are doing the absolute best job that you can right now. And your senior pet loves you. And I love you and have a beautiful day. That's it for today. If this episode helped you, please leave a review or rate this podcast so we can get the word out to more pet parents who need to hear that they are doing a good job. And if you're interested in working more with me, you can find me on social media or at senior petconnection.com because we all need to stay connected. Remember that you are doing a great job with the information that you have in this moment. And I am just here to give you more of it. See you next week.