Good morning, everybody or good evening. I suspect most of you are are looking at this, of of an evening, always lovely to be giving talks for you. And today's talk is one that is very close to my heart.
I've been working with elderly cats for a long time. I call them my old souls, and I do love working with old souls. And for some reason, I seem to have 20 years in my own.
You know, my private life when I always had an old one of my cats was elderly in kind of a cycle. And that's why I got into doing the research with elderly cats. My husband works with, for dementia and people, and it was one evening we'd we'd had a very bad evening and night.
With one of my beautiful cats cardio. He was, he was such a sweet lad and he had a bad night crying. And in the morning, Frank, my long suffering husband, said The cats get Alzheimer's, and I said, we don't know.
They certainly get what looks like dementia. We call it cognitive dysfunction syndrome. But since then, you know my passion is to change its name because, OK, in research world, we can call it cognitive dysfunction syndrome.
But it means nothing to an owner and say, Oh, Mrs Smith Fluffy has got cognitive dysfunction syndrome. You've told them nothing, whereas you say, Mrs Smith, I'm sorry, but Fluffy's got dementia immediately. They know so much about the disease because you want.
It's the same cats and people. So he said, Why hadn't I done any work on it? And I said, because I couldn't get any money.
So he wrote a grant, and, got me some money, and that was the first of the the research studies. So, and I've also taken liberties of putting pictures of my beautiful cats when they were elderly. So this was T and Nic when she was 18, just at the end of her life.
You can see she's she's getting old and tired. I kind of feel the same way myself today. So without anything else to do as they say, I will move on.
So why is it so important that we do good medicine for elderly cats? Well, it is it. It's good medicine, and it's also increasingly important medicine because cats are living longer.
You know, the average age for a house cat? The average age they'll get to is 14 years, whereas if a cat's got access outside, it's only 5 to 6 years with car accidents forming the bulk of the the the the deaths of ghosts. And so as cats are living longer, we need to look out for them, and it's rewarding.
But you can also see just how many cats we're talking about. So, you know, this is this is a good money spinner for the clinic to get this right, too. That's a win win, just just from which cats we're talking about.
We're talking cats, 15 years and older. Really, you might say seniors from 11 years to 14 are our seniors, and then we've renamed them. Owners don't like to be told they've got geriatric cats.
Same with human medicine. They're moving away from the phrase geriatric people. Despite the fact that the study of this is gerontology.
I don't know what they're going to do with that name, but with cats, we've renamed them to super seniors. Don't use geriatric use super seniors at everything ages. This is Nura and NSA is 16 in this picture.
And she used to be a seal tabby point. Burman and you can see that her her mask has really faded, and it's the colour on her legs is almost completely gone. But this talk, we're gonna focus about changes in the brain.
It's important to before we talk about dementia to talk about other causes that can look just like it. Because you know, when a cat comes in showing these kinds of signs, we need to you work out what the other thing might things might be in, particularly the treatable. I always hope that it's hypertension because we can sort that very easily.
We've got between Amlodipine and Dalam time. We've got two very good drugs to to sort high blood pressure. And then, if it is high blood pressure, then we want to try and find the primary cause of hyperthyroidism, kidney disease, diabetes, et cetera.
We're talking about the degenerative diseases as well. So obviously, dementia is where we're going to focus. But deafness deaf cats, like deaf people, will often, talk very lamp.
If it's cancer, it's usually meningioma, but they're very rarely completely central. So you tend to get some kind of lateralizing signs that gives you a clue that, it's AAA cancer rather than degeneration. Infection is also really important.
FELV I'm gonna talk about in a second. But toxoplasmosis. Quite a lot of cats that were hunters when they were older.
The toxo. Gets into their brain because they're quiet, but it just comes out again when they are elderly. So always look at the retina for elderly cats.
One, you're looking for signs of hypertension, but two, you're looking for signs of, toxin. And I put UT I there there, there was one I was going to recruit for, one of my studies and she had had really bad signs of dementia, you know, night yowling, Really clingy. You know, peeing, where she shouldn't be peeing.
And she'd be doing that for about three months. And the only clue that made me think I need to look a bit more closely at her urine was that her owner were asked for. Maybe her urine smells a little bit.
And we found that she had a really bad E. Coli UT I And within three days of antibiotics, all of her signs of dementia had cleared. No more crying, no more cleanliness and no more, peri urea.
So don't forget to check the urine of these counts. Metabolic conditions? Yep.
But encephalopathy, hyperthyroid et cetera. But most of these are pretty obvious, other than possibly B vitamin deficiency relating to hypothyroidism and sometimes that isn't picked up on arthritis is incredibly important because it's so common, and it really exacerbates all the problems of an elderly cat and pain. Believe me, I can tell you pain is is very debilitating and can ultimately end up looking quite a lot like dementia, cause a lot of behavioural problems.
And then the the the social environmental, things, attention seeking, inadvertent home reinforcement. This is so hard not to do because when a cat wakes you up in the middle of the night because it's forgotten that it's like it's dinner, you know, you give them dinner and then that reminds the cat. Oh, I, I do the same.
Tomorrow, I might get some more dinner, and it spirals. Boredom. Frustration.
More like distress with environmental change is a real biggie. And it makes a lot of our elderly cats behave, You know that they are stressed with it and sleep deprivation. Whether it's from, you know, moving house, packing up boxes, et cetera.
Or maybe the cat has been in the clinic. And of course, cats should be having 18 to 20 hours sleep a day. And of course, they don't get that when the hospital moved.
So it's not unusual with with people when they are hospitalised for them to have, dementia can be become much worse. And it can happen with our patients, too. Also, anaesthesia can make it very much worse.
And I just want to mention this study. This is, one I did working with this brilliant young vet, Allen, who was in, in Iran at the time. He's now doing a PhD in Canada.
Very, really bright. And he had noticed that there were a lot of cats with FIB the and he was able to to recruit, try to get 40 cats in each group, but we had a couple of drop outs. So we ended up with almost 40 cats in both groups, it was big.
We used the year of 78 as a cut off. So if they were, less than seven, they were young cats. If they were seven or older, then they were older cats.
And we set up a room like this. So you've got the cat here and then three boxes, four boxes. Sorry.
They all have the favourite food smear on the inside. But then the cat has to watch the, the examiner put the favourite food under one of the boxes. The cat was then picked up, taken out of the room for four minutes and then brought back in again.
And then if they could remember where the food was, that is their physios. Spatial working memory, that's that's good. And then we wanted to assess problem solving with if they could get there the food out.
And we excluded all cats with significant arthritis at the front legs and what we showed. So here we've got, correct choices up the side. And these are the FIV positive cats.
And these are the FIV negative cats, and you can see the correct choices in the young cats are the same whether they were FIV positive or not. But there were far fewer correct choices in the older FIV positive cats. The it didn't affect problem solving.
So what we showed was that FIV exacerbates, that signs of dementia particularly problem solving in older cats. And interesting. And not surprisingly, it correlated with the, PC R pro viral load.
So I thought it was a really interesting study. This is just, all the papers we've published in recent years, and I've been very, very lucky to work with a number of people. Lorena Soto was my PhD student for four years working on dementia.
Most of them come from her also pra cer. She was my master's student and I intern student now doing residency and PhD on F IP. And so you can see and then Amy me She is a lecturer in, animal behaviour.
And she's now we've got money from Morris Animal Foundation to actually develop and validate the questionnaire for assessing our elderly accounts. And we're going to to validate it using, a study very, very much like like this one, so that it will be a fully validated questionnaire. So in in people, if we're thinking about dementia by the time we get to about 85 years old, about 50% of us, depending on the type of dementia and and a number of different studies.
But approximately 50% of people will have signs of dementia talking about cats, then it's 50% by the time cats get to 15 years old. So 15 years old really seems to equate to 85 years for people. If we're talking about dogs, I will mention dogs a couple of times because there is some important work, and not surprisingly, dogs don't age as well as cats and big dogs, particularly don't age as well, and then the behaviours, like they were on the previous picture.
But it's easier for me to map them out like this. The acronym that we've, adopted devised is liah. We've had to devise one that's not the doggy one.
The doggy one is disha, and Disha doesn't even include Vocalisation and vocalisation or hyper VC. That's the most important clinical sign in cats so excessive Vocalisation over 60% of cats will show this in my studies, it's 100% because it's the You can make it the most important inclusion criteria because then it's really easy to monitor. And over 30% at night altered interactions.
Usually these cats become more affectionate. Hence the owners become more bonded with them. Cats will follow them around.
They really want to be with them the whole time. Change, sleep, wake cycle. They're gonna get you out of it.
How soiling. Yeah, it does happen. Particularly urination.
But remember about UTIs disorientation, forgetting where the litter box is by getting by being fed. It's a piggy. One of my cats really showed the boat.
He could never remember it being fed. Alterations in anxiety levels, activity levels on, a a aimless wandering. And you can see there's a few other signs as well.
And this is my beautiful, more black who was Who was my soul cat? He was. He looked after me when my back went he would just lie with his head on my chest here and his poor crop.
It was amazing. And this is a study originally started with Vicky halls, who's a brilliant cat fist and Sarah Ky. And, Yeah, we got it.
There eventually took a while because we really wanted to compare the initial study, which was done by by Vicky with we then repeated it as an online one. They're very similar. All cats older than 11 were included.
Over 50% were didn't want to go outside and were showing signs of polydipsia. 25% were reduced grooming and eating. What was really good is there was a big increase in use of the litter.
I mean, offered a litter box. But despite the fact that over 80% were being offered a litter box, obviously, I'd like to see that it was 100% but still over a third were showing. Sorry.
I haven't changed. This. I should have done.
We're not supposed to call it inappropriate the nation anymore, because it's not inappropriate. Cat house soiling is what we should call it. Increase in affection in it and demanding attention is up to 50%.
And then hypo VC, 60%. What I found so special was that almost all of the owners said, despite the fact that the cat was yowling and waking them up and peeing in places that they shouldn't be peeing and following them around the whole time for cuddles. Almost all owners love their cats as much or more than they've done before.
Which shows you that owners don't want a cat. They want this cat despite the fact that the cat is elderly and has got all these different problems. So it really behoves us as vets to try and keep these cats going as healthily as possible for as long as possible.
This is some of the data. So what we've got is percentage up the top. And then we're showing data for 11 to 13 year old cats, 14 to 16 year old cats, 17 to 19 year old cats and 20 years plus.
And if we look at time spent grooming, the dark colour is decrease. The middle grey is no change, and pale is increased. So you can see we've got reduced.
Grooming got reduced. Going outside. That could be as much for arthritis as for forgetting to do it.
House soiling. We've got a big increase sociability with people increase. No particular change for sociability with animals increased agitation we think related to pain, weight loss, increased water take increased time spent sleeping.
Then these are, the vocalisation and you can see big increase night, and and daytime. And when we asked in depth night and day. So night only was a third day only was a third, and both was a third.
And then, in another study, we asked the owners of these cats what the cat was doing when the when it was crying. We were trying to work out what the primary reason for the hyper vocalisation was. And what we had was attention seeking equally to dissociation in over 40%.
So attention seeking. So as soon as that the cat saw the owner, then it would stop crying after the owner picked them up. If the owner talked to them, the cat would stop crying, whereas with disorientation.
The cat was in a separate room crying, looking at the wall, you know, just confused. Seeking a resource by food, in about 16% and then pain is a primary reason, you know? So when they got up, they would cry.
That's only 3% But these are primary reason when you look at secondary reasons and pain, came up to play a much more important role. We wanted to know about the, caregiver burden. And so we asked the impact on the owners when we tried to ask the how much stress it was between, not at all stressful to five being very stressful.
The average was two. But you can see that, you know, still, quite a few people, fours and fives. This is This was tough.
It is tough because I've done it so often living with a cat with dementia. You feel so guilty. So how do we diagnose it?
Well, we rule out all those other causes as a starting point, and then then let let's take a little bit of time to to think about about the why interestingly, city living has come up in one study as being much more likely, to be as associate, you know, a cap, if they're living in the city, is much more likely to have dementia. Maybe they're more likely to be a flat, like living in a flat. And with more environmental enrichment, maybe it's the particulates and the diesel fumes et cetera.
And certainly that has been linked in people. And ultimately, what happens is that you get damage to the actual blood vessels supplying the blood, and then the cat can't metabolise the oxygen properly and you get free radicals. And ultimately, you get a build up of of two particular proteins that are the hallmark of, the hallmark of, Alzheimer's when we find exactly the same in Cats is that's beta amyloid and then also hyper phosphorylation of tau.
So Tau is what's needed for the neuro tubules to reach out. So if a neuron's gonna speak to another neuron, it's got to reach side to side. And you've got to have Tau working properly.
With Tau not working, you end up with all the dendrites and neurons. They're all sitting like this, and hence the memories are lost so very similar to Alzheimer's. So what causes this?
Well, the black box is what causes the ox a bit damage. Something my husband works on, and what happens is the neurons are then are then damaged. You get an amyloid made by the neurons, and it's secreted out and forms into these plaques To be honest, these plaques are just rubbish.
They don't cause the damage themselves. It's the omas. It's little bits of the protein before it's gathered up into these nasty big deposits of rubbish.
It's the little tiny bits that are actually the toxic bit and what you can see. If you look in this pile of rubbish, you've got these little lacuna. These were all where the neurons were and they're getting killed off and you get inflammation.
Neurotoxicity. At this point, towel gets damaged, and then we get these tangles. So this is a neuron.
That's the the the nerve body. And then all of these tangley bits are the, the dendrites that are no longer working. So if we compare it to Alzheimer's, so the sorry he wants to get a hold of me today, with Alzheimer's, you can see we've got these deposits all the way through, including to the the molecular layer, which is the layer right under the the meninges.
Elderly humans. You still get these deposits, but they don't go right to that area. In in dogs, they get the deposits.
They're not quite as dense. And in cats, that you get these more swathes of of deposit rather than the the really dense deposits. What do they relate to?
Well, age we see them in older cats older than 10. And there does seem to be some association with cognitive defects Here. We've got a blood vessel affected.
You can see it's getting stained. And then here you can see a close up of one of these plaques and you can see we've got holes where neurons have been killed. Where?
Further out. We've got the neurons staining, and they're not dead yet. Whereas when we look at the towel, So this is, Alzheimer's.
You could see lots of these, these dendrites, whereas we see something very, very similar in the cats. Weirdly elderly dogs don't show, towel deposits, but we're not sure why we I. I really do think they probably make them.
They show all the same hallmarks. And if we look at, the towel, then yes, it does relate to age and to cognitive defects and what's really important. We only see pre tangles to tangles in cats that have also got dementia.
So, this was an interesting study looking at primary Taies and the sort of things that, you can see. So this is AAA young cat, and this is an older cat. Older cat.
You see a lot more, MRI, but more liquid bits. So you've got the The cerebellum looks smaller. We've got more CS F all the way around it.
We've got, more CS F in the the ventricles, et cetera, and you can see more black in this is a different, gate. View, I can't remember the word for it, but you can see that the the the brain has has shrunk. And this is just a close up, so you can see this in in a bit more detail.
There you go. So cats and dogs do differ a little bit. Still got more work to do.
We've also looked in in donkeys, and you can see there some stunning towel. But we don't know what clinical demented dementia looks like in a donkey. But we've also got, done studies in in dolphins as well.
They get very similar things. So an awful lot of mammals do show these signs. So, and and cats, cats are a natural model.
You see, most of the research is done on mice, and rats don't get these changes in, in nature. They just don't, And so in order to get them to make them, then they have to be, made as clot made as, there's knockouts, you know, genetic mutations, modifications. Whereas cats do it naturally, dogs do it naturally.
And the owners of cats with dementia, you know, they're really keen to to want to take part in studies, anything to help their can. I said that they really care. So and it's a bit small.
Hopefully, you can make this a bit bigger. So how do you make a diagnosis? Well, the most important thing is, you know, your physical, your retinal, blood pressure assessment.
Then you can take your bloods, including T four and your urine analysis. You rule out, hypothyroidism, diabetes, et cetera, et cetera. You rule out, arthritis pain.
So they need a pain trial for, you know, analgesia trial first, and only when you've ruled out all of those, Then you can come to a diagnosis of of CV S or dementia. So must do the analgesia trial. I got hypertension first and then, Yeah, let's rule out the other things.
Vet Plus have a a an app where you can actually log. Behavioural changes, which can be very useful because it's the changes over time that are really important. And so, the question is to track the changes and highlight concerns and say we're we're working on validating.
We're calling it senica the CN cap. so that will be something that comes through in time. What about treatment, then?
Well, in people there are Well, just on the news this morning, the the new drug, the monoclonal, that is. So this is where it's all going, and it's all very exciting. But of course, it can cause brain swelling because it's a monoclonal against all that protein that's deposited.
So they're not? Yeah, they need drugs are for the fainthearted, but they can, they can really help a lot of people. And so these are the prime things.
So try and prevent it to start with by environmental enrichment and for our elderly people. We know that, hearing loss, sight loss, loneliness, they are, Major Major, precipitants to increase the risk of becoming, dementia. So same for accounts.
We need to think about those, and the role that they play and this study in dogs. It's a really good study. So they set up four groups.
They made a diet which was standard diet. And then they they enriched the diet with antioxidants and then mitochondrial cofactors, central fatty acids, all the things listed there. And then they thought about environmental enrichment as well.
And so they had one group of the dogs which had the lovely environment with a kennel mate and everything else but rubbish food, the boring food. And on the far end, we had, no kennel mates and no environment in Richmond. But they got the the the food and then obviously all combinations thereof.
And one lucky combination, of course, got the food and the the Playmate. And what they showed is there was a rapid improvement in memory, but stunning how effective it was. And, it's now marketed as feels bey.
So if you look at these studies, don't worry about the the different bits underneath. These are just different areas of the brain. What we're looking at is the overall amount of amyloid in their brain at the end of the study.
These were all demented beagles that took part in the study. Can you imagine how much the noise that was going to take and you can see for the the diet there is significantly more, amyloid in the control dogs. So the ones in green are the ones that got the, the antioxidant diet are the ones in red were the ones that didn't, for the environment.
It's there is a difference, but it's not as marked, but interestingly, it's most marked in the part of the brain that is most important for the limbic system, which is gonna be show a lot of signs of dementia. So that's enter rhyme cortex. Also in dogs.
Lots of study on studies on clein. It's a monoamine oxidase inhibitor used in people as well. Lots and lots of studies.
Up to 80%. Improvements are definitely something to consider for dogs. Most studies young cats.
It's not gonna help in really severe cases. So start early is the the advice It's also some work. Not as much, though, on vitton.
This is, this works as, works on a lot of different levels, but it's really the same as a really nice perky cup of tea. But it particularly works on increased improved blood vessels. Blood supply.
So, I particularly use it in cats that have got high blood pressure that's caused to it. Lots of other things have had studies done. You can see a list of them here.
The only other ones that have got significant effects are sunny. That's a Adena or methionin. Amazingly, it was needed for every cell we think of it for liver disease, but actually, it's really good for brain disease as well.
Activate cenel life. You calm all significant, improvements. It's interesting how much of an improvement you can get in dogs in as little as two months of, supplementation.
So what about cats, Mrs. Beautiful Cardi, who I started off telling you about Mrs him when he was 14. He just wanted to hide all the time.
Such a sweet natured boy. So as cats age, they become unable to cope with changes in their environment and it becomes progressive. They still want to go out, which you could see from that original study I started off by talking about, Then they shrink their environment even more.
They don't want to go downstairs, or they don't want to go in the spare room or the conservatory or whatever it is. And ultimately they to wherever they want to sleep, where they feel safest, which is usually the owner's bed, wherever the food is and wherever the litter box is. And they would have them all in one place if they if they possibly could.
So, yeah, it doesn't matter what but the the changes. Elderly cats really don't cope so well. And this is beautiful, Mort like towards the end of his life.
And you can see he's got really bad arthritis and elbows. Both of them are out like wings, his carpi, which is starting to collapse. He's got Mark changes in his eyes, but he still laugh.
So the thing about elderly cats is you've often got multiple diseases, elderly, anything. You're likely to have more than one disease. So, chronic kidney disease, anything that causes PUPD diabetes hyperthyroidism all gonna cause PUPD.
If you add that with arthritis and dementia, you're gonna have, Fura possibly, PB all over the place as well. It tends to be peeing, whereas you've got hypertension. That's definitely going to make the dementia very much worse.
You know, constipation, arthritis, dementia. You're definitely gonna have, pooping outside the box. So all of these are gonna feed into each other.
If you can control these, then the dementia sign of dementia can become much reduced. But it's really important when you're talking about geriatric clinics, elderly cat clinics. You need to tailor them to the individual cat.
There'll be some cats that you can see beautiful, more like. So he needed regular very regular care. Whereas another cat who is might be only 14, but looks like they're still seven.
They're gonna need a lot less attention. Really. Get the owners involved.
If you can convince them to get a set of scales to weigh the cat regularly, that is the best way of tracking what's happening with our elder with any cat. Like a percentage weight loss of more than 5% warrants bloods to be investigated. You know, get them to tell you about urine, PSS production behaviour, questionnaires, all of those to be to be looked into.
But here is the thing. And two of my beautiful elderly cats, and then one of my God cats was definitely bring was blue when blue was 14. Blue, was, Tonkinese and bad elbows.
They all have belt bad elbows. And the question is, why don't owners bring their elderly cats to the clinic? You all know of this, and you could make the list as easily as I can.
But this was you what we discovered. Not surprisingly, they often started by thinking the change was normal. It's normal.
Ageing cat loses a bit of weight. They, you know, that might just be sarcopenia ageing. You know, arthritis.
Well, they all get arthritis, which is true. Also some confusion of our data. That's normal, isn't it?
Then they're embarrassed. No owner is gonna volunteer that they're being woken up all the time because their cat is hyper vocalising. They're not going to own up to the fact that the cat is peeing all over the place because they don't want to be seen to not cope with the elderly cat's problems.
So we need to ask the questions they might say the cat for something else. So elderly cats coming in for their vaccine. They'll still come in for their vaccines.
But they won't volunteer the hyper fal organisation or, house soiling. So I thought this study was really good. So 12 owners OK, I take it back.
12% of owners did volunteer. The caps were showing some signs, but when asked about it, 75% reported that actually, those signs were there. So we must ask then other things is the misconception that we can't do anything.
So what can you do for an elderly cat? Well, you and I know a lot. We can certainly do a lot to help them.
A biggie is the cat gets stressed coming into the clinic. That makes the owner stressed, and they just don't think it's fair. At this age, that's often broader, but then we talk about well, we've got gabapentin, we've got Trazodone, and we've got filio spray.
All of which can make the cat's visit to the vet much, much less stressful and often most of us at all. They're do out of their tree, although that is hard then to see how well they're moving, because they they're a bit wobbly by the time you give them the number to go a bit. But the real biggie is that the owner is worried that we are going to suggest the cat should be euthanized.
So we need to make it clear that when you're going there, if the if the owner is not ready. And there's lots of things we can do to help these sales and their owners. So ask about mobility, activity, grooming and changes in temperament.
And then this is just a little questionnaire that I use it not very eyebrow, but there are more. If these clinical metrology instruments, as we call them coming through, that there is one for the the the Feline Musculoskeletal Pain Index. There's a lot of ones for pain recognition.
What's really, really helpful if the owners take a video of the cancer on multiple videos is even better. Stares up, stares down, you know, doing it, jumping up onto a chair, all that sort of thing and what we want to know the big. The questions are about jumping to assess elderly cats.
The ability to jump up or down are the biggest changes. The most common changes. And quite often they can still make the jump.
But instead of jumping, for example, straight onto the table, none of they go onto a chair and then onto the table. And whether they're more hesitant coming down, that means front leg arthritis, as opposed to jumping up at back leg arthritis or loss of vision. And they can't quite see what they're doing.
So, you know, a questionnaire like this can be really, really helpful. So when it comes to the, actual clinical exam, go at the cat's pace, try not to, to to hurry the cat. I know you've got a limited amount of time, but it really does pay to have longer consults, if at all possible if the owner can afford them.
And well, I say the first thing to do is weigh the cat and calculate the percentage change from the last time you saw the cat. It doesn't have to be the first thing, but it certainly needs to occur before you get very much further on, but I often do a lot. I do.
Most of the consult with the cat sat in the bottom half of its carrier. If it's one of the carriers, you can just take the lid off, then like my preference. Then you get AAA to.
We have a stack of towels that have been sprayed with fly away in the cat treatment room, and you can then put that halfway across the the bottom of the the cat's basket so it can hide. And that way you can. You can just look at the bit of the cat that isn't under the towel, and cats feel much less threatened.
That way you can see this cat was really keen to stay in her basket, and she's having her eyes examined. Retinal exam is being done in with the cat in the box, but before, certainly before you do, blood pressure. Well, you wanna do blood pressure before you do bloods?
That is the most important thing, because the problem is if the cat has got high blood pressure, which there's a high chance that it will taking blood, particularly if you take it from the jugular. That's really gonna raise the intracranial pressure. And that can cause the cat to have a stroke and can die on the end of your needle.
And this isn't a an apocryphal saying, I have done it myself when I was an overly keen resident, and I've had a number of colleagues who've said that it happened to them as well. So get a percentage weight change. And if you tell the owners that you're always gonna do this and if there is more than 5% that you need bloods, if they know that, then they're looking at the scales going.
Oh, yes, it's 5%. You're gonna want to do bloods, aren't you? And so it really buys them in.
So once you've done your physical, don't forget the thyroid exam. Because, of course, these cats are high risk of thyroid. We've got to not particularly keen on having his blood pressure taken, but he's just sat there good as gold.
And cats often like to sit on scales, so that can be really helpful. And then how much further you go will depend on on what you find in finances et cetera. These are some videos from From Neil.
Just the simple way of assessing a cat neurologically to put some obstacles out. Can it walk around? Does it bump into them?
And you can see that this cat is therefore visual? You can see them here. It's responding to to voices.
We're checking visual with bottles of cotton wool as well. And, and a menace, which can easily be done. It's obviously not a full year, but it will give you, guidance very quickly of whether you do need to have the cap in for a full year.
Now, this, so Adam Jolie wonderful man. And he's now a professor of general practise, which is fabulous. And he was, setting up his well kept, well animal clinic, at Ingles vets.
And he asked me to to come and have a look. See what I thought and what would I suggest? And the first thing I said is you need stairs and he said, Why do we need stairs?
And I said, Well, because cats can either walk down them or up them or both. And that's gonna be your best way of assessing their their mobility. He also I.
I made a flippant comment about Well, it would be good to have one of those moving screens with fishes or mice on it. So there's that in the waiting room, obviously somewhere box a place to put the cat's box So the cat gets put on the the the little table here, and it's just watching the screen while waiting. It's great.
He asked me what colour? I was having a brain fart day, and I said, Purple, purple. To be honest, cats don't see red very well, so it probably looks blue to them.
But if you look at the the, fear from, they use a lot of dusty lilacs and stuff as well. So maybe I wasn't completely crazy. And these videos from Sarah, Ky.
A very good friend of mine, she, worked at that clinic regularly. They reinforced the edges of the at them now and you can see this little cat, this cookie going down. He's flicking her wrists.
You know, she's she's really not sure about moving down. She's got arthritis in her elbows, and she gets to there and goes, Ah, OK, I'm just having a rest. And now I can do the the rest of the distance.
So some cats walk up, some cats walk down. It's boa again. Oops.
Sorry. You want to see Ban? Her owners didn't think she had any mobility issues.
What do you guys think? Yeah, apart from the fact she's morbidly obese as well. And now she's going.
I can't walk any further. Please don't make me. And she's licking her lips.
So she's feeling anxious. Apologies for this being very small. Maybe you can, expand it.
So this is from, one of the papers, that that we published was this with, with Lorena, a PhD student. And this was the management of of dementia. And we did it related to the behavioural signs.
Using V. So with vocalisation, I'll do that in the next slide. So changes in interaction with family or pets?
Well, this is where flyway friends. It's called flyway Multi cat. I think in in the US, and keeping cats in separate groups.
You know, if you've got cats that really don't get on, then you know what? Just get in different parts of the house, but for my friends can can really help you Enough resources. They've got to have key resources enough for each cat to be accessed easily.
If there is a house soiling or, disorientation, then they need to have easy access to to a low fronted, high, high sided litter box low front so they can get into it easily. But high sided, particularly at the back, because it's very hard for an elderly cat to get their bottom tucked down when they're peeing or pooing. It's just there's too much arthritis going on back end, so they tend to pee poop with the bottom, hooked itched up.
And if you haven't got a high sighted litter box, it goes over the back. And then the owner was complaining that the cat is being pulled out of his litter box and and it's only doing it by mistake. So, other things to to think of to, improve disorientation.
Leaving a radio on things like that can help some cats. That, by way of anxiolytics and gabapentin again, is our friend Zilche. That's a triptych.
Digestive Caine can certainly help, and some cats come back to these different poten potential treatments. The same triptych Digest is in Royal Canon, Calm and hill CD, Multicare or urinary stress. You've got Flo Classic, but I don't use Feli Classic other than the spray I use F optimum, which has got the combination of the facial pheromones, the classic plus the memory appeasement ones, which is the, that's the few of my friends.
And if they're combined and a optimised, a nightlight can surprisingly help some cats. I think their vision is nowhere near as good when they're elderly. And if their vision is really going, then actually being able to see more easily because they've got some light can help them.
It really helped, one of my boys then a strict feeding ritual, particularly at night time. So they know it's bedtime and and sleep is is now, reducing, the access to all of the house. They tend to reduce it themselves, but making it simpler for the cats.
It's less confusing. They're not going to get lost in the downstairs basement or something, and ultimately it can be creating a room for the cat at night time. They got all their resources and a strict bedtime routine.
So they know now it's bedtime and that they're gonna go into that room. And then I mentioned, you know, Sammy, there is one study where it seems to work at cats and you've got to activate for cats, of course. And S and vitomin, I'll mention all those again in a minute.
So, disorientation about being fed them here. I find timed feeders really helpful. So, putting multiple feeders down so that the cat, the cat isn't remembering.
It's being fed. Then you can be feeding them every 2 to 3 hours. And that really helps some cats, feeding balls if they're still up to the activity of it and then changes in in activity.
Aimless wandering comes back to all of these adaptations. So all of these are are are things to consider if we're talking about, Vocalisation, then if it's attention seeking, spending more time with the cats and certainly, cuddling and holding before bedtime. Positive affirmation is definitely, much better than getting cross with the cat and then it being disorientated because you've been cross with it and then it feels unsure because you were angry with it.
So it's really worried. So then it's gonna vocalise more. You reassure it.
This type of sleep that's fine, particularly if you're using gabapentin as well with confusion and anxiety. Then it's all of the treatment interventions that I that I talked about already. Night lights to, all of them food seeking.
That's the time to feeder, one of my boys Beautiful. More like he was a, he became a food very food motivated. He never ate more than a mouthful or two, but then he would completely forget and ask again an hour later, and at the end of his life, he was having about 16 meals a day.
We used Po feeds a lot. It's pain. Let's treat the pain.
And if there's really you can't find anything to interact with and everything else change doesn't make a difference. Ultimately, in dementia can get bad. If the owner is not ready to accept that the cat's quality of life is poor, it is a case of saying Well, then it's ear plugs for the for the owners, so you know it.
They can be very frustrating, but also rewarding. So by way of environmental changes, I've already mentioned freely optimum combining these two with pet remedy, which may help some. So I've mentioned those then, making sure that they've got all of their key resources such as food, water lid, box resting places, hiding places, and some kind of scratching post that they can now access.
So and we Let's let's go through. Go through those. So but we have food.
We need to make sure that things are either on the same level. Raising food bowls, water bowls can really help because most cats have got some arthritis in their elbows by the time they've got elderly. And getting all the weather heads all the way down is painful, obviously.
Ideally, the food and water should be on different places. Because cats don't normally like them side by side, lots of soft, warm bedding, even heated beds, but not with things like that bed that they can catch the claws in shallow litter. Boxes can really help, as in shallow for them to get into, but then, ideally, high science.
So access to water raised bowls. If they are cats that has been used to, running water. You can see the beautiful Mort like this is only the day before I had to put him to sleep because he started taking having a seizure.
But he still had demanded that he be allowed up. The chair is here. He could jump on the chair and into there, but he couldn't jump back out again, so he would just cry.
And one of us would come and find him and and save him. Some cats are elderly. Have to really like water fountains because that brings the water up to their height.
But we have litter boxes. This is the litter box that we have at home so low at the front and high at the back. You can do the same using, dog beds, and it's a very easy way of doing it.
Or you can create one like this. The flat ones, they do tend to, kick the letter all over the place. I, I love this one.
They've thought about it all steps, even a night light. But then once the cat is inside, how does they get back out? Again, key resources particularly, preferred place to sleep, and that is usually the owner's bed.
This it's Mort like. And initially we have a very tall bed, as you can see, then his toy box that's full of the cat's toys. And that was enough.
But then, when that wasn't enough, a good friend who made these steps for me. But then one catastrophic morning Mort fell through and was was trapped just horrible, like I was still in bed so I could save him straight away. And so, John, my friend, came along with these and he said, Look, this will do.
Do them for them. While he made new steps, You can see they really like them. This is little Sheba IB.
This is more like, and then these are the the new steps, which I didn't put the one of mt on it. For some reason, I put the one with sheer on, but you can see nice big steps so the cat can get onto a step and stop. Rest, step and stop, and each step goes, be below under the above steps so no cat could sleep slip through.
So that's the ideal way to, to make them. Interestingly, cats don't like BP like ramps makes perfect sense. I don't, I'm disabled, and I find trying to Yeah, because of back problems causing, weak and poor proper reception on my right side.
And I find walking on ramps really disorientating because the proper reception in my joints is all knocked out the whack. And I really think that's going to be the same thing with with cats. And certainly from my experience of my cats that they're really not so keen on ramps, they much prefer steps.
Consider adding light. Can help some of them. And then this is my friend John's house.
He has SMEs. And you can see he has made sure that the cats can get into their favourite places. All sorts of things.
This is another one of my, my friend's house is that there's a little cat up there, and amazingly, she can get up by using this. This is my sister's bed so that she's got for her cats to get to the bed. It again, John's house.
This is a lookout post used to be The cat could do this. And now we've got lots of steps. And then this little guy is was 21 in this picture.
She liked to sleep up here, and she's got little steps to help her get home. So all of those can really help. Oh, it said scratching posts.
The other thing about scratching posts, you can get horizontal ones that are made of corrugated cardboard or stuff together. Those can really help elderly cats because as the arthritis gets worse and remember, their claws don't retract properly, and they get older so they get long to nails, which capture in everything. And they can't stop them properly because of the arthritis in their elbows, so the cardboard ones can can help and make it easier.
It also means that either you or the owner has got to be able to trim your toenails, this one resting places, making sure their safe and warm. Most cats don't want to go out. They can't get out of a cat flap.
It's too difficult, and they find it too challenging to be outside. Maybe they used to be top cat, and now another cat but maybe they live and it was a baby. Is now kind of using their home their garden as a litter box, so it's too challenging.
But if they do want to go out, this is Sarah Ky's Beautiful Cat. This is Hobie. He just liked to go and sit out literally for 5 10 minutes, and so should go and sit out with them.
This is my friend Catherine Martin's house, and she's got cat. Step up and it's reinforced. So this is cat proof.
Cats have a little, Scottish fold cat last summer. And fabulous garden, another one of my owners. This is a A ramp so her Siamese can get to the to the top onto the shed.
This was my beautiful Mort. Like he used to come out on lead. So all sorts of things, the way to facilitate an outdoor access that's safe.
Yes. The Kio is perfect. Obviously, this is one that's only just been made without before they put all the enrichment.
What about food? You know, we've got that really lovely study in in cat in dogs. Well, what about cats?
We've got this study looking at antioxidants and the cats, which have the antioxidants compared to Not then they live longer, which is great. And this one's using hills. JD, and 50% had improved mobility, not the diet diet designed for over 70% had improved coordinate we got we got AAA BD by default.
And then there are these different supplements that some of them really do appear to be helpful. But we don't have any studies other than one with Sammy, but it's not brilliant. Study.
What about medicines, then? Well, zilch. Ery digest.
Yes, it's worth trying the anine, which is It's black cup of tea as well. It reduced house soiling and signs of stress in 30 of 33 cats. That's worth considering.
Then you've got Everybody wants to try the, CBD oil. Of course, most studies and the concentration that you can buy is very, very low. People would want to try it.
Trazodone certainly works with cats to reduce anxiety, and, can be useful for getting to the the vet's gabapentin as well. And gabapentin, is also a really good painkiller. Pregabalin Bont should be on the market very soon.
It's apparently not as good for pain, but it's better to reduce anxiety. There's antidepressants, et cetera, as well. If the cats get really bad, if they've got a problem with sleeping, then melatonin can be very useful.
And then I mentioned these drugs already. And certainly there are no studies. So there was one study S.
It was a positive study, very difficult to to to, follow. And one on which I did, which was positive, that the cats that were on this, had fewer signs of of dementia. They need to publish in, so there are the the different doses that can be used.
This was Mum's drug cupboard at the end, and it shows looking after these guys. It's it's not cheap, But there's all sorts of things that we can do to help. I think it's really help.
It's really important that we help the owners to know when the time is right to let the cat go. And I find introducing the concept of euthanasia early and say, but now we don't need to talk about it. I just want you to think that we're gonna need to consider it, but not yet.
Just so it's in their mind and ask them to start a calendar. This is just a calendar, and then each day they use get these stickers, Amazon or other suppliers. You get green smiley faces, yellow neutral faces and red miserable faces, and you put you make a decision over all for each day, and you put the sticker on the calendar date, and it means it's a really good, easy visual way of seeing.
Actually, things are getting worse. We haven't had a really good day for over two weeks. There are, pet bereavement services, particularly, the Blue Cross is excellent.
A cat's protection one pa to listen is also very, very good, because some of our owners, many of our owners, they don't have Children or their Children are are long gone. And the the cat was their soul mate was their life companion, and they are going to go through grief. Any other cats, dogs in the household are gonna grieve, too, but some owners find it harder than than others, just dependent on life, experience and and everything else.
So it's important to offer up those services. And then create a plan for a good death. Send pull prints or this was a print for some owners want CLO clipping co clippings.
I really like bereavement cards with a little packet of Forget Me, not seeds in them. I think that's really nice. I've done bereavement services twice.
Well, it's important. This was a card that I got sent when I lost Mort, which says a Winnie is a Pooh and Piglet that says how lucky I am to have something that makes saying good bye so hard makes me cry every time that com and I love that boy. And, I still have him here, his his skeleton last resting place of beloved mortal like in my Yeah, I know he was supposed to be for teaching the students about arthritis.
He's got terrible arthritis, but he's too fragile. So travelling in to work wasn't on toes fell off, so it was like, OK, you're going to stay here. This is one of Sarah Ky's, little books, and it's written with Vicky Hall, so eminent people to do this cat specialist and a cat behavioural specialist caring for an elderly cat.
This can really help. Owners of elderly cats. And, this was was Vicky's, soulmate cat.
So, there are all sorts of things you can do for elderly cats. This wasn't at all particularly focusing on the elderly cat clinics, but they have to put them in there. And, you know, we can really do a lot, but we need to understand the limitations of why the owners can't bring us those patients, to see us.
So we need to work with the owners. I hope that's been useful. And, you know where I am if you have any questions.
Thank you very much. Take care.