Jo Giese is an award-winning radio journalist, author, teacher, community activist, and global traveler.
Wellness: Health Care
For dogs with Alzheimer's confusion may reign as light falls
October 31 2013
A slice of Oregon forest, a fragrant eight-foot noble pine, reigns over our living room in Southern California. I drape the boughs with a final string of lights—silly plastic teddy bears I’ve had for years—and step down from the ladder. It’s growing late on a Sunday afternoon. Our favorite Frank Sinatra carols are playing, scalloped potatoes are bubbling in the oven and the sun is going down over the Pacific Ocean. I’ve been looking forward to this: relaxing in front of the fire, the room lit only by the tree. I should have known better.
Recently, as the days shorten and the curtain of light falls earlier—at four o’clock, now three—Fromer, our 15-year-old Yorkie, goes bonkers! It’s as if the dark sets him off. Now he’s on the floor between my husband and myself, and his ballistic barking drowns out even the roar of the surf.
Five months ago he was diagnosed with terminal renal failure, and given two weeks to live. The vet said I should consider myself his hospice worker. (I don’t know about you, but a hospice worker to a dog was a new one for me.) I gave him subcutaneous fluids, fine-tuned his medications and administered pot roast aromatherapy. By October, my little hospice patient was skipping through the house. The vet cautioned me that Fromer still had renal disease; he was just “temporarily stabilized.”
So, our days were OK; the evenings were something else.
Like a young child squalling over a bogeyman only he can see, at night Fromer got spooked. On this December evening, I forego the pleasure of enjoying the room lit only by the Christmas tree, and switch on every light inside and out. He seems to calm down, but he is licking his paws so feverishly they will be raw if he keeps it up. His tommy- gun barking starts again. Night has turned him into Fromster-the-terrorist-terrier, an impossible-to-please elderly relative.
I poke at the embers to keep the fire from dying out, while Fromer totters off, whimpering in and out the dog door—flap! flap! out, flap! flap! in—the rest of the evening. Until we pack it in and head upstairs. Then he peters out.
When I originally mentioned these symptoms to Stephen Ettinger, our vet, I didn’t get much satisfaction. Dr. Ettinger is an internist, cardiologist and co-author of The Textbook of Veterinary Internal Medicine, said, “Maybe it’s neurological, or he’s cold, or it might be his eyesight.” He reminded me that Fromer’s eyes were failing, making it harder for him to see when the light goes. He didn’t offer any therapeutic help to deal with the situation.
By accident, I stumbled on a Newsweek article (Jan. 31, 2000), “Coping with Darkness,” revolutionary new approaches in providing care to people with Alzheimer’s. The article described how Alzheimer’s patients can become increasingly agitated at the end of the day, and how light is especially important to them in the late afternoon and early evening. Although Fromer hadn’t been diagnosed with Alzheimer’s—dogs also suffer from this disease—the early nights of winter had brought on a behavior in my dog that exactly matched the symptoms of some Alzheimer’s patients.
Now I had a name for what I’d been observing: sundowning. And a definition: According to Harvard Medical School, Department of Psychiatry, sundowning is a syndrome in Alzheimer’s patients of recurring confusion and increased agitation in the late afternoon or early evening. A sundowner is a patient who sundowns.
One antidote to sundowning is increasing the light to eliminate frightening shadows. Except increased illumination only helps patients with intact vision. That explains why flooding rooms with light did not soothe my geriatric friend.
This is now our second Christmas without Fromer. As I untangle those silly teddy bear lights, I remember those awful winter nights, and wonder what I might have done differently.
A half-dozen vets I have spoken with since then say they have never come across sundowning in veterinary literature. They offer replies similar to Allen M. Schoen’s, D.V.M., author of Kindred Spirits, “I am not familiar with the syndrome.”
Until I reach Nicholas Dodman, Director of the Behavior Clinic at Tufts University School of Veterinary Medicine. Dr. Dodman says, “I think you’ve struck on something.”
He explains that this behavior has sort of been recognized but under the global term of sleep disturbance, which is one-quarter of the diagnostic criteria for canine Alzheimer’s. “Did Fromer have canine Alzheimer’s?” asks Dodman. “I would say from what you’ve told me—I never examined him—almost certainly, yes. Since sundowning is a part of Alzheimer’s in people, why wouldn’t it be in dogs as well?”
Johnny Hoskins, a small-animal internal medicine consultant with a specialty in geriatrics and pediatrics, agrees. “I believe dogs go through similar changes as humans as they age.” Dr. Hoskins explains there are certain triggers in older animals when they start having behavioral–mental changes. “In your animal the trigger just happened to be when it was getting dark.”
Dodman says this is the first time he’s heard of this association with dogs and the day/ night junction. He thinks it’s helpful because it adds another layer of detail to nocturnal disturbance syndrome. “It makes it easier for people to recognize and it’s a very clear- cut sign: As light is fading, some dogs, not all dogs, because not all dogs do everything with any disease, but some dogs with canine Alzheimer’s may, when light falls, become even more confused, and upset, and that can lead to this hysterical behavior: barking, pacing, inconsolability. Sundowning. I think that’s a very nice addition to the canine Alzheimer’s syndrome, which previously was just painted as a late-night, throughout the night, problem.”
Dodman explains that vets don’t have a good handle in this area. “They know there are sleep disturbances. But what precisely are they? Vets think that means when the owner goes to sleep at night the dog wakes up and barks and paces. Sundowning makes it more subtle, and more akin to the human syndrome, and it sounds perfectly reasonable.”
Now that we have a definition and a basis for diagnosis, is there a treatment in the canine population? Dr. Hoskins cautions that since there are so many neurotransmitters in the brain, a dog owner should not expect that one single medication will handle all the behavioral-mental changes in his animal. It’s way too late for Monday morning quarterbacking with Fromer, but perhaps others who are currently caretaking an elderly dog will find that these medical suggestions (see sidebar) can make sundowning more understandable and less of a downer.
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