Compendium June 1999 20TH ANNIVERSARY Small Animal/Exotics

PANEL REPORT ON bond that frequently exists between

senior cats and their owners.
The objectives of the AAFP/AFM

FELINE SENIOR Panel Report on Feline Senior Health

Care are to promote the longevity
and improve the quality of life of se-

HEALTH CARE nior feline patients by recognizing

and controlling health risk factors,
detecting disease during the preclin-
ical phase, correcting or delaying the
According to surveys conducted by the American Veterinary Medical Associa- progression of existing disorders,
tion Center for Information Management, the percentage of owned cats 6 years and improving or maintaining resid-
of age and older has risen from 24% in 1983 to just over 47% in 1996—nearly ual function. These guidelines are
a twofold increase in 13 years. By designing and delivering individualized, com- designed to aid practitioners in de-
prehensive feline senior health care programs, veterinarians have the opportunity livering consistently high-quality
to positively impact the lives of a large and growing population of feline patients care to their senior feline patients by
and owners. establishing a minimum standard of
care. It is important that the pro-
gram be individualized specifically
Although the aging process in- must be adept at managing and for the needs of each patient; in
duces complex and interrelated monitoring chronic disease and, if some situations, the components
physiologic changes that frequently possible, preventing disease progres- may be more complex than those
complicate the health care manage- sion. As in pediatric patients, thera- detailed here. From the cat owners’
ment of geriatric cats, age itself is not py and maintenance care must be perspective, the program must be af-
a disease. For this reason, manage- tailored to meet changing needs. fordable, manageable, and consis-
ment decisions should not be based However, senior patients are
solely on the age of a patient. Many more likely to experience mul-
conditions that affect older cats can tiple medical problems simul-
be acceptably controlled, if not cured, taneously.
so that the quality of an older cat’s Veterinarians must carefully
life can often be significantly im- evaluate the risks and benefits
proved by appropriate and timely of treating a given condition
medical intervention. while considering its impact on
Changes in senior cats occur across coexisting problems. In addi-
a fairly wide age range. Whereas tion to medical decision-mak-
many cats begin to show clinically ing, family and ethical issues
significant changes between 7 and often come into play in the
10 years of age, most do so by 12 management of senior feline
years of age. Because geriatric disor- patients. Management of these
ders tend to be chronic and progres- patients must include special
sive, veterinarians treating older cats consideration of the strong
Editor’s Note: This is part I of a condensed version of the Panel Report on Feline Senior Health Care presented by the American As-
sociation of Feline Practitioners (AAFP) and Academy of Feline Medicine (AFM). Panelists included James R. Richards, DVM
(Panel Co-Chair); Ilona Rodan, DVM (Panel Co-Chair); Gerard K. Beekman, DVM; Mary E. Carlson, DVM; Thomas K.
Graves, DVM; Elyse M. Kent, DVM; Gary M. Landsberg, DVM; Jeanne M. Pittari, DVM; and Alice M. Wolf, DVM. Reviewers
included C. A. Tony Buffington, DVM, PhD; Dennis J. Chew, DVM; Leslie L. Cooper, DVM; Robert M. DuFort, DVM;
Sandee M. Hartsfield, DVM, MS; Collin E. Harvey, BVSc, FRCVS; Rosemary A. Henik, DVM, MS; Debra F. Horwitz, DVM;
Francis A. Kallfelz, DVM, PhD; Sandra Manfra Marretta, DVM; Dennis M. McCurnin, DVM, MS; Elizabeth P. Noyes, DVM,
PhD; Gregory K. Ogilvie, DVM; Margaret A. Scherk, DVM; Linda M. Schoenberg, VMD, PhD; James H. Sokolowski, DVM,
PhD; and Charles A. Williams, DVM. The entire document is available from AAFP; call 1-800-204-3514 for copies.
Small Animal/Exotics 20TH ANNIVERSARY Compendium June 1999

tent with their philosophy. The term
senior is more acceptable to clients
and implies preventive or “wellness”
care, which improves the quality
and length of life of older cats.
SENIOR HEALTH
CARE PROGRAM
Initiation of a senior health care
program is recommended for cats
starting between 7 and 11 years of
age and should continue throughout
life. Components of a feline senior
health care program include regular-
ly scheduled office visits during
which a complete medical and be-
havioral history is gathered, a sys-
tematic physical examination is per-
formed, and appropriate diagnostic
tests are evaluated; vaccination and
parasite control; and client educa-
tion.
Regularly Scheduled
Office Visits
Semiannual office visits are rec-
ommended because changes associ-
ated with aging and disease progres-
sion in senior cats can occur within
a relatively short time. Cats with sig-
nificant disease often appear healthy,
and frequent serial comparisons of
historical and examination findings
assist in the early detection of dis-
ease. Regularly scheduled visits also
allow implementation of other as-
pects of the senior health care pro-
gram.
Complete Medical History
Owners of older cats often notice
health problems or behavioral
changes but consider them to be
age-related or untreatable and there-
fore not worthy of reporting to the
veterinarian. For example, an owner
may erroneously attribute inappro-
priate elimination behavior, changes
in activity, or an alteration in eating
or drinking habits to age, not recog-
nizing that such changes may be as-
sociated with disease. Because changes
may be subtle or insidious in onset,
specific questions should be asked of
owners. A questionnaire is an excel-
lent means of ensuring that all po-
tential problems are addressed. A
monthly checklist can also be pro-
vided to owners to help them recog-
nize health problems.
Information about past and cur-
rent medical problems, lifestyle, lit-
terbox use, and the cat’s environment
should be sought. All prescription
and nonprescription medications
currently being administered should
be recorded, and any adverse reac-
tions should be noted. All foods be-
ing fed, including nutritional sup-
plements and treats, should be noted,
along with any changes in eating
habits (including the amount con-
sumed) and body weight.
Systematic Physical
Examination
A thorough physical examination
should include a systematic evalua-
tion of all organ systems, with par-
ticular attention paid to those com-
monly affected by disease in senior
cats. If behavioral changes were not-
ed in the history, a neurologic ex-
amination should be performed.
Weight should be recorded at each
visit. However, the body condition
score (Table I) is a more accurate de-
terminant of lean body mass, and its
evaluation is encouraged. Almost ev-
ery aging cat not receiving regular

TABLE I
Feline Body Condition Score

Score Classification Characteristics

1 Very thin Ribs: Easily palpable with no fat cover
Bony prominences: Easily palpable
Abdomen: Severe abdominal tuck
2 Underweight Ribs: Easily palpable with minimal fat cover
Bony prominences: Easily palpable
Abdomen: Obvious waist, minimal abdominal fat palpable
3 Ideal Ribs: Palpable with slight fat cover
Abdomen: Well-proportioned waist, minimal abdominal fat
pad
4 Overweight Ribs: Difficult to palpate, moderate fat cover
Abdomen: Little or no waist, abdominal rounding, moderate
abdominal fat pad
5 Obese Ribs: Very difficult to palpate, thick fat cover
Abdomen: Distended with extensive fat deposit, no waist
Fat deposits over lumbar area, face, and/or limbs

G U I D E L I N E S
Compendium June 1999
dental care has some dental or perio-
dontal disease. A thorough oral ex-
amination without sedation is usual-
ly sufficient to determine whether
sedation or anesthesia is warranted
for a more detailed oral examina-
tion. The use of an examination form,
a copy of which can be provided to
the client, is encouraged.
Diagnostic Testing
Selected diagnostic tests per-
formed at appropriate intervals may
facilitate the detection of disease in a
preclinical stage, allowing early me-
dical intervention that may delay
disease progression. For example, re-
nal disease in older cats is of-
ten subclinical during its early
stages, and owners may be un-
aware of subtle changes in
their cat’s appetite, thirst, or
urination habits. In such cases,
detection of disease in the ab-
sence of laboratory data is dif-
ficult. Likewise, such other
common senior diseases as hy-
perthyroidism can be detected
earlier by routine laboratory
screening. Routine testing also
provides trend information for
individual patients. For screening
procedures to be most useful, they
should be tailored to the patient,
sensitive enough to detect early dis-
ease, minimally invasive, and cost
effective.
Indiscriminate diagnostic testing
of senior patients with no clinical
signs can have drawbacks. For a
number of reasons, even healthy an-
imals occasionally have abnormal
test results and erroneous interpreta-
tion of values outside the normal
range may lead to incorrect diagno-
sis and inappropriate therapy. Con-
versely, abnormal individuals may
have test results within the normal
range. As more tests are added to
the profile, the likelihood that a
healthy animal will receive an ab-
normal test result increases. Proper
interpretation of diagnostic test re-
G U
20TH ANNIVERSARY
sults requires integration of the pa-
tient’s history, clinical signs, and ex-
amination findings. Baseline or
trend data can be especially helpful
in these cases. Recognizing potential
test interferences and methodologic
idiosyncrasies will further improve
interpretation of test results.
Senior Cats without Clinical
Signs of Disease
Based on the frequency of certain
diseases in the older cat population
and the goal of early intervention,
selected diagnostic tests should be
performed annually (most conve-
niently at every other office visit) in
cats with no clinical signs of disease.
Diagnostic tests should consist of a
minimum of the following: a com-
plete blood cell count (including
hematocrit; erythrocyte count, in-
dices, and morphology; leukocyte
count; differential leukocyte count
evaluated by cytology; total protein;
and platelet count); creatinine (pre-
ferred over blood urea nitrogen as a
screening test because it is less influ-
enced by nonrenal factors; however,
thin older cats often have false de-
creases in serum creatinine because
of decreased muscle mass); serum
potassium; serum glucose; total thy-
roxine (T4; determined by radioim-
munoassay); alanine aminotrans-
ferase; and alkaline phosphatase.
Feline leukemia virus (FeLV) anti-
gen and feline immunodeficiency
virus (FIV) antibody testing should
I D E L I N
Small Animal/Exotics
be included for cats whose infection
status is not known or for cats at
risk of exposure. A complete urinal-
ysis should include physical evalua-
tion (color, turbidity, and specific
gravity), chemical evaluation (pro-
tein, glucose, bilirubin, occult
blood, and pH), and microscopic
examination of the urine sediment.
The sample should be collected by
cystocentesis.
The Panel was divided regarding
whether blood pressure should be
routinely determined in senior cats
with no clinical signs. Panelists not
in favor reasoned that hypertension
is usually secondary to disorders that
would be revealed by other
test results or examination
findings. Because blood pres-
sure is affected by environ-
ment and stress, concern arose
over the harm that may be
done if a nonhypertensive cat
is treated inappropriately. Pan-
elists in favor of routine mea-
surement reasoned that the
procedure is noninvasive and
usually simple to perform, and
even though primary hyper-
tension is believed to be rare,
its true incidence is not known. In
addition, because hypertension is
frequently associated with hyperthy-
roidism and renal failure, blood
pressure determination at the initial
visit may preclude the need for an
additional visit should screening
tests confirm the presence of either
of these common diseases of senior
cats.
Senior Cats with Clinical
Signs of Disease
In cats with clinical signs of dis-
ease, selected diagnostic tests should
be performed at each semiannual
visit, although the frequency of test-
ing and the choice of tests may vary
depending on the individual needs
of the patient. At a minimum, semi-
annual tests should include the fol-
lowing: a complete blood cell count
E S
Small Animal/Exotics 20TH ANNIVERSARY Compendium June 1999

(including hematocrit; erythrocyte
count, indices, and morphology;
leukocyte count; differential leuko-
cyte count evaluated by cytology;
total protein; and platelet count); a
complete biochemical profile (in-
cluding albumin, blood urea nitro-
gen, creatinine, serum glucose, ala-
nine aminotransferase, alkaline
phosphatase, γ-glutamyl transpepti-
dase, total bilirubin, sodium, potas-
sium, chloride, calcium, phospho-
rus, total carbon dioxide, and anion
gap); and total T4 (determined by
radioimmunoassay). It is important
to fill tubes completely in order to
accurately assess total carbon diox-
ide status; otherwise pseudometa-
bolic acidosis will be diagnosed. It is
also important to centrifuge and
separate the serum promptly.
FeLV antigen and FIV antibody
testing should be included for cats
whose infection status is not known
or for those at risk of exposure. A
complete urinalysis (collected by cys-
tocentesis) should include physical
evaluation (color, turbidity, and spe-
cific gravity), chemical evaluation
(protein, glucose, bilirubin, occult
blood, and pH), and microscopic ex-
amination of the urine. Blood pres-
sure measurements should also be ob-
tained at least semiannually in senior
cats with clinical signs of disease.
Vaccination and
Parasite Control
Vaccinations should be adminis-
tered based on individual risk assess-
menta and in compliance with local
laws. Fecal analysis and parasite con-
trol should be undertaken for indi-
viduals at risk of exposure to inter-
nal and external parasites.
Client Education
Clients aware of senior changes
and the benefits of preventive inter-
vention are more likely to seek vet-
erinary attention and comply with
recommendations and suggested di-
agnostics. Knowledge that many be-
havioral changes and abnormalities
are caused by underlying medical
conditions that may be corrected or
controlled is of extreme importance.
Owners should be instructed to
watch for changes in behavior; atti-
tude; activity; mobility; food and
water consumption (including how
the cat consumes the food, because
cats with painful mouth conditions
often chew on one side, drop food,
or exhibit chattering teeth); urina-
a
A condensed version of the AAFP/AFM
Feline Vaccination Guidelines was pub-
lished in the August 1998 (Vol. 20, No.
8) issue of Compendium. For a copy of
the entire document, call AAFP at 800-
204-3514.
tion and defecation (volume, fre-
quency, and location); and body
weight. They should also monitor
for vomiting, diarrhea, grossly visi-
ble or palpable masses, skin changes,
coughing, sneezing, odors, breathing
difficulty, and sleeping position (cats
with breathing difficulty may only
sleep in sternal recumbency).
Dental care and grooming needs
should be discussed during the con-
sultation. Nutritional advice should
be tailored to the patient and will
depend on the cat’s current diet and
health status; client preferences and
economics should also be taken into
account. Because screening tests for
specific types of cancer are not avail-
able in veterinary medicine, owner
awareness is especially important in
early cancer detection (see Common
Signs of Cancer in Animals). Early
detection is of the utmost impor-
tance for treatment success but may
be complicated by concurrent chron-
ic illnesses or by the owner attribut-
ing warning signs to advancing age.
Client education can be streamlined
and reinforced with written materials.
SELECTED CONSIDERATIONS
The following select points may
not be widely known or followed. By
no means are these points meant to
encompass all aspects of the disease.

Hyperthyroidism
Common Signs of Cancer in Animalsa Serum total T4 is the recommend-
ed first-line screening test for hyper-
■ Abnormal swellings that persist or continue to grow thyroidism. Some hyperthyroid cats
■ Sores that do not heal have serum total T4 levels within the
■ Weight loss normal range (usually moderate to
high normal). In such cases, a tri-
■ Loss of appetite
iodothyronine (T3) suppression test,
■ Bleeding or discharge from any body opening thyrotropin-releasing hormone (TRH)
■ Offensive odor stimulation test, free T 4 analysis
■ Difficulty eating or swallowing by equilibrium dialysis, or thyroid
■ Hesitation to exercise or loss of stamina radionuclide uptake can aid in the
■ Persistent lameness or stiffness diagnosis. However, free T4 levels
may also be elevated in cats with
■ Difficulty breathing, urinating, or defecating
nonthyroid illness (e.g., alimentary
aDeveloped by the Veterinary Cancer Society. lymphoma), and measurement of
free T4 is not recommended as a sin-

G U I D E L I N E S
Compendium June 1999
gle screening test. A combination
test of serum total and free T4 might
be advantageous. The TRH stimula-
tion test has been associated with sig-
nificant side effects following TRH
administration.
Hyperthyroidism is associated
with increased renal blood flow and
increased glomerular filtration rate.
As a result, hyperthyroidism may
mask underlying renal disease. The
glomerular filtration rate will de-
crease following treatment of hyper-
thyroidism regardless of the treatment
modality. Therefore, in addition to
routine posttreatment monitoring,
renal parameters should be evaluat-
ed 1 month following initiation of
therapy. If renal failure is known to
exist concurrently with hyperthy-
roidism, the treatment of choice is
oral antithyroid medication used at
the minimum effective dose. Renal
parameters should be closely moni-
tored during therapy with antithy-
roid medication.
Chronic Renal Failure
The normal feline kidney has ex-
ceptional concentrating capacity,
and the endpoint that indicates an
adequate population of functional
nephrons to prevent clinical signs of
renal failure is not known with cer-
tainty. Experimental studies suggest
that cats retain considerable urine
concentrating ability even with dra-
matic reduction in renal mass; con-
sequently, renal insufficiency may
not be accompanied by isosthenuria.
Some cats with renal insufficiency
have urine specific gravities greater
than 1.035. Still, determination of
urine specific gravity—a measure of
renal tubular function—is necessary
to differentiate prerenal from prima-
ry renal azotemia. Significant pro-
teinuria in the absence of occult
blood and/or leukocytes in the sedi-
ment suggests glomerular leakage
and can occur before there are
changes in urine specific gravity,
blood urea nitrogen, or creatinine.
G U I D
20TH ANNIVERSARY
Potassium depletion is common
in senior cats, especially those with
renal insufficiency. Potassium-re-
plete, nonacidifying diets should be
fed to help control hypokalemia. Al-
though oral potassium supplementa-
tion of all cats with chronic renal
failure has been advocated by some,
there is currently not enough evi-
dence to support such a recommen-
dation. However, oral potassium
supplementation is recommended
when serum potassium levels fall be-
low 4 mEq/L. Potassium gluconate
or potassium citrate can be used to
correct hypokalemia, and either will
correct or prevent such associated
effects as hypokalemic myopathy, re-
duced renal function, and anorexia.
These supplements also provide an
alkalinizing effect and may limit pro-
gressive renal injury.
Regular testing for and correction
of the following abnormalities
should be included in any long-term
monitoring of chronic renal failure:
hypertension, anemia, azotemia, hy-
perphosphatemia, hypokalemia, aci-
dosis, dehydration, pyuria, bacteri-
uria, and proteinuria (as a marker of
progression).
Decreased urine specific gravity
predisposes cats to bacterial urinary
tract infections. Urine culture and
sensitivity testing is indicated in cats
with low specific gravities because
E L I N
Small Animal/Exotics
urinalyses do not always detect these
infections. Pyelonephritis requires a
minimum of 4 weeks of appropriate
antimicrobial therapy.
Chronic renal disease in many
cats can be successfully controlled
for months or even years. Treatment
options to consider in the manage-
ment of chronic renal failure include
prescription diets low in phosphorus
and protein; H 2 blockers such as
famotidine to reduce nausea, increase
appetite, and control vomiting (cats
may be nauseous even if they do not
vomit); intravenous fluids for de-
compensated chronic renal failure;
client administration of subcuta-
neous fluids at home; antihyperten-
sives such as amlodipine; erythro-
poietin; intestinal phosphate binders;
potassium supplementation; calcitri-
ol; and sodium bicarbonate.
Hypertension
Systemic hypertension in cats is
usually secondary to chronic renal
disease or hyperthyroidism. Approx-
imately 65% of cats with chronic
kidney disease have elevated sys-
temic blood pressure; hypertension
associated with this disease requires
long-term antihypertensive therapy.
Hypertension associated with hyper-
thyroidism does not require long-
term antihypertensive treatment if
the hyperthyroidism is corrected.
Less likely causes of hypertension
include anemia, hyperadrenocorti-
cism, and primary hypertension.
Indirect systolic blood pressure
measurements are reliable and non-
invasive and can be obtained in the
clinic via the Doppler method. b
Multiple measurements (at least five
readings) are recommended. Most
veterinarians believe that treatment
should be instituted if systolic blood
pressure is higher than 170 to 190
mm Hg. Blood pressure should be
taken prior to venipuncture, with
b
Doppler Flowmeter Model 811, Ultra-
sonic Doppler Flow Detector, Parks
Medical Electronics, Aloha, OR.
E S
Small Animal/Exotics
the patient as free of stress as possi-
ble. Using a headset and inflating
the cuff slowly can minimize fear in
the patient. Accurate placement of
the cuff and selection of the correct
cuff size are important in achieving
valid measurements.c Limb and cuff
size used should be noted in the
medical record.
The clinical signs of hypertension
are usually caused by damage to tar-
get organs with a rich arteriolar sup-
ply (e.g., ophthalmic, renal, cardiovas-
cular, and cerebrovascular tissues).
Ocular signs include retinal hemor-
rhage or hyphema, retinal detach-
ment, and blindness. Hypertension
may worsen existing kidney
disease by causing a continued
increase in glomerular filtra-
tion pressure. An acquired car-
diac murmur can be secondary
to hypertension, and compen-
satory cardiac hypertrophy can
occur. Cerebrovascular hemor-
rhage can result from severe
hypertension, causing seizures,
ataxia, or sudden collapse.
Therapeutic agents include
β-blockers, angiotensin-con-
verting enzyme inhibitors, and calci-
um-channel blockers. Amlodipine
has been used with wide success and
minimal side effects in the treatment
of feline hypertension.
Cancer
Because of the popularity of cats
and the increasing age of the feline
population, the care of feline cancer
patients is becoming a major com-
ponent of many veterinary practices.
Recent advances in feline oncology
have improved treatment response
rates, prolonged disease-free inter-
vals, and increased survival times.
However, many cat owners and vet-
erinarians remain unaware that a
large percentage of cats with cancer
can be either cured or rendered free
c
Critikon Disposa-cufs, Johnson & John-
son (800-642-6748), two-pronged cuffs,
sizes neonatal 2 and 3.
G U
20TH ANNIVERSARY
of disease for significant periods of
time. In addition, advances in pal-
liative therapy and support often al-
low maintenance of a good quality
of life for cancer patients. It should
be recognized that most owners be-
lieve their cat’s quality of life is more
important than is the length of life.
Treatment of cancer can be ap-
proached with either curative or pal-
liative intent. Curative intent often
involves the use of such treatment
modalities as chemotherapy, radia-
tion therapy, surgery, and in some
cases, immunoaugmentive therapy.
Palliative therapy is designed to
improve quality of life without nec-
essarily increasing survival time.
Although tumor control is very im-
portant, support of the patient is
imperative, and because most feline
oncology patients are also geriatric
patients, attention must be paid to
such underlying conditions as renal
failure, dental disease, and cardiac
disease. In addition, treatment for
gastrointestinal (GI) disorders, de-
hydration, uremia, anemia, leukope-
nia, sepsis, and other conditions that
may be associated with the cancer
treatment itself must be provided.
Adequate pain management is an-
other essential component of cancer
patient care. Tumor invasion with
subsequent tissue damage is the
most common cause of pain. How-
ever, the treatment itself (e.g., sur-
gery or radiation therapy) can also
cause pain. Maintenance of appetite
with appetite stimulants and provi-
I D E L I N
Compendium June 1999
sion of instructions regarding care,
hygiene, and feeding are also impor-
tant.
Staging is the process of determin-
ing the extent of the primary tumor
and the presence of metastatic dis-
ease or paraneoplastic disorders such
as hypoglycemia, hypergammaglobu-
linemia, and hypercalcemia. Accu-
rate staging is necessary to deter-
mine the extent of the disease, direct
the course of therapy, and provide
information about the patient’s
prognosis and the amount of time
and money the caregiver will be re-
quired to expend.
In veterinary medicine, compas-
sionate care is the watchword
of oncology. Optimum care
requires the dedication of a
compassionate, informed, and
cohesive health care team,
which includes not only vet-
erinarians but also reception-
ists, animal health technicians,
veterinary nurses, and all ani-
mal care personnel. Feline
cancer patients usually have a
dynamic course to their dis-
ease, so regular and frequent
communication with caregivers is
essential.
Diabetes Mellitus
Serial blood glucose determina-
tion is the most accurate method of
assessing the appropriateness of in-
sulin type, dosage, and frequency of
administration. Urine glucose and
random blood glucose determina-
tions can be misleading and should
only be used in conjunction with se-
rial blood glucose curves and infor-
mation from the client. Subsequent
single blood glucose determinations
should coincide with peak insulin
activity as determined by previous
blood glucose curves. Further stud-
ies are needed to validate the clinical
application of fructosamine and gly-
cosylated hemoglobin in the man-
agement of diabetic cats. Clients
should be instructed to monitor ap-
E S
Compendium June 1999
petite, activity, attitude, water con-
sumption, and urine output. Some
clients can be taught to measure
blood glucose at home, thereby help-
ing reduce stress-associated hyper-
glycemia.
There are several causes of insulin
resistance in cats with diabetes melli-
tus. These include poor absorption
of subcutaneous insulin; antiinsulin
antibodies; infection, such as of the
urinary tract or oral cavity; concur-
rent illness, such as pancreatitis or
chronic renal disease; obesity; ke-
toacidosis; acromegaly; hyperadreno-
corticism; hyperthyroidism; gluco-
corticoid therapy; and progesterone
therapy.
Inflammatory Bowel Disease
Anorexia may be the only clinical
sign associated with inflammatory
bowel disease (IBD). IBD should be
considered after other causes of GI
disease have been excluded. The fol-
lowing criteria support the diagno-
sis: clinical signs consistent with
chronic GI disease; a thorough diag-
nostic evaluation (including feline
trypsinlike immunoreactivity, cobal-
amin, and folate) that excludes meta-
bolic disease and other primary GI
diseases; and the presence of signifi-
cant inflammatory cellular infiltrates
on histopathology with failure to
demonstrate other causes of gas-
troenteritis.
Definitive diagnosis requires eval-
uation of GI biopsy specimens ob-
tained via endoscopy or laparotomy.
The typical histopathologic finding
in IBD is increased infiltration of
the lamina propria by lymphocytes
and plasma cells. IBD may be pres-
ent in conjunction with cholangio-
hepatitis and/or pancreatitis.
BEHAVIOR PROBLEMS
Although primary behavior prob-
lems may develop in older cats, the
possibility of an underlying medical
condition should first be considered.
Therefore, it is imperative that the
G U I D
20TH ANNIVERSARY Small Animal/Exotics
Feline Resources
American Veterinary Medical Association
800-248-AVMA (2862); www.avma.org
American Association of Feline Practitioners
800-204-3514; www.avma.org/aafp
Cornell Feline Health Center
607-253-3414; web.vet.cornell.edu/public/fhc/FelineHealth.html
American Animal Hospital Association
800-883-6301; www.healthypet.com
The Delta Society
800-869-6898; www.petsforum.com/deltasociety
history be complete and compre- pacity to adapt diminishes.
hensive so that all emerging behavior It is generally believed that, as in
and health problems can be identi- humans and dogs, the cognitive
fied. Disease, dysfunction, or neo- abilities of cats tend to decline with
plasia of virtually any organ system, age. Alzheimer-type pathology, in-
sensory or cognitive decline, en- cluding diffuse β-amyloid plaques
docrine dysfunction, and conditions within the brain and its vessels, has
leading to increased pain or de- been identified in older humans,
creased mobility can all contribute dogs, and cats. Although atheroscle-
to changes in behavior. rosis is rare in cats, the brains of el-
Behavior problems may not be derly cats may become chronically
exhibited until numerous stimuli hypoxic as a result of decreased car-
combine to “push” the pet beyond a diac output, anemia, conditions that
certain threshold—or medical condi- lead to hypertension (e.g., hyperthy-
tions may lower the threshold. For roidism and renal disease), and non-
example, a fearful cat may not ex- lipid arteriosclerosis. With age comes
hibit aggression until it is in pain cerebral atrophy, ventricular dilation,
(e.g., from dental disease) or less a decrease in the number of neurons,
mobile (e.g., from musculoskeletal and an increase in glial cells. In fact,
disorders). Cats with sensory decline it may be extremely difficult to dif-
may be less reactive to stimuli but ferentiate physiologic from patholog-
may startle more easily when the ic changes and normal function
stimuli are finally detected. Soiled from cognitive dysfunction.
litterboxes secondary to polyuria There are multiple neurochemical
may cause litterbox aversion, which changes associated with aging in a
may lead to inappropriate elimina- number of species, including a fall
tion. Patients with pain secondary in serotonin levels, an increase in
to arthritis may have difficulty get- monoamine oxidase B leading to a
ting to or into litterboxes. Many cats decline in dopamine, a decrease in
do not mark territory even if ex- cholinergic activity, a decrease in
posed to intruding cats but may be- catecholamine activity, and a possi-
gin to do so when a condition such ble adrenergic increase, leading to a
as hyperthyroidism develops. Older further reduction in cerebral perfu-
cats may become more sensitive to sion. There is also increased produc-
environmental change as their ca- tion and decreased clearance of free
E L I N E S
Small Animal/Exotics
radicals.
A diagnosis of cognitive dysfunc-
tion generally requires the presence
of one or more of the following be-
havioral changes in the absence of any
physical causes: decreased reaction
to stimuli, confusion, disorienta-
tion, decreased interaction with the
owner, increased irritability, slow-
ness in obeying commands, alter-
ations in sleep cycles, decreased
responsiveness to sensory input, in-
creased vocalization, and problems
performing previously learned be-
haviors. Although there are no drugs
currently licensed in North America
for the treatment of cognitive dys-
function in cats, drugs that help to
normalize neurotransmitters that
may have become depleted (such as
dopamine or serotonin), as well as
those that improve cerebral blood
flow, hold some promise. The use of
other mood-altering drugs, behavior
modification techniques, and modi-
fications to the pet’s environment
may also be required to control or
resolve behavior problems in older
cats. For example, a cat that can no
longer gain access to its litterbox
may need the litterbox relocated or
adjusted so that the cat can climb in
and out and assume an appropriate
elimination position. Similarly, cats
that eliminate more frequently may
require more frequent litter cleaning
or additional litterboxes.
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