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Monday, February 15, 2016

Gabapentin in the Treatment of Dementia and Behavioral Disturbance



Dr. Marcotte is director of the psychiatric outpatient clinic Marcotte and Associates in Fayetteville, NC.
Acknowledgments:The author reports no financial, academic, or other support of this work.  


Abstract

Are there safe treatments for elderly patients with dementia and aggression? This article describes the use of gabapentin, a nonmetabolized antiepileptic drug, for control of aggression in the elderly patient with dementia. The drug’s relative safety and ease of use are demonstrated to assist in the control of aggressive behavior. The objective of the study was to determine the effectiveness of gabapentin in the acute management of behavioral disturbance in patients who had failed to respond to previous medications and had failed their nursing home placement.

Introduction

With the aging of our population, psychiatrists will increasingly be called upon to provide services to nursing homes, general hospitals, and families of loved ones with dementia and aggression. Although traditional and atypical antipsychotics are commonly employed in the management of aggression, antiepileptic drugs are being used with growing frequency.
Dementia is a major health concern today. It is expected that in the next 50 years, the worldwide population of people >80 years of age will increase by 6-fold, to 370 million.1With the aging of our population and enhanced life expectancy, the large number of baby boomers will shortly reach the ages at which dementia tends to occur, presenting a greater challenge to medical resources and the economic welfare of families.2,3 Those of us who have worked with families that maintain an elderly demented patient in their home are witness to the emotional stress and financial burden that caretaking involves. Factors that affect the family’s ability to care for an elderly relative in the home include incontinence, aggressive behaviors toward others, behaviors resulting in self-injury (eg, falling), or wandering from the premises.
Many nursing homes are equipped with devices that monitor a patient’s whereabouts (eg, anklet or door alarms). However, while nursing home staff may be familiar with patients who wander or are incontinent, they may not be equipped to handle aggressive behaviors that threaten staff members or other residents of the nursing home. Aggressive behavior, considered an immediate crisis within the patient’s home or the nursing home, frequently leads to psychiatric hospitalization. To maintain the possibility of having the patient return to the nursing home, families are often taxed with additional costs, such as paying for the vacant nursing home bed during the patient’s hospitalization in a psychiatric unit.
Patients with dementia hospitalized for other medical procedures in a general hospital have longer lengths of stay.4 Lyketsos and colleagues4 studied 823 patients in a general hospital and found that the average length of stay for patients with dementia exceeded that for patients without dementia by 4 days. There were higher costs of hospitalization and greater complications. Unfortunately, that study did not differentiate delirium from dementia. A substantial portion of those patients who exhibited demented behavior may have qualified for the diagnosis of delirium.5 Patients with a diagnosis of dementia who were admitted to a general hospital were found not to have higher rates of mortality in the hospital. Another study by Lyketsos and colleagues6 noted that of patients with dementia, 27% had apathy, 24% had depressive disorders, and 24% had aggression and agitation. Although apathy and depression were noted to have significant effects on the individual and earlier nursing home referral, a worse prognosis accompanied those patients who had aggression and agitation. Such symptoms also increased the cost of caregiver burden.7
Not only does aggressive and behavioral disturbance such as agitation lead to early nursing home placement, it can lead to expulsion from the nursing home. Behaviors that include aggression toward others result in more costly expenditure, greater morbidity, higher mortality, and increased financial burden.4,6 In addition, the symptoms of agitation and aggression become more significant and frequent as dementia becomes more advanced. Lyketsos and colleagues6 studied patients with symptoms of aggression and agitation and found that 13% had mild dementia, 24% had moderate dementia, and 39% had severe dementia.
The large expected increase in patients with dementia and aggression will produce significant burden for psychiatric hospitals and nursing homes.  Psychiatric care and management of aggressive symptoms must be obtained before the patient can return to the nursing home, even after the hostile behaviors have been ameliorated. Thus, length of hospital stay for general medical purposes is expected to increase.
This article examines the use of gabapentin in a traditional inpatient setting, including patients ≥65 years of age who were both demented and aggressive. Gabapentin, a relatively nontoxic, nonmetabolized, nonplasma-bound antiepileptic drug, was used in addition to a minimal amount of atypical antipsychotics. The results indicate that gabapentin offers a safe alternative to metabolized, plasma-bound antiepileptic agents.

Treatment

Recent treatment of behavioral disturbance with aggression in the elderly has included anticonvulsants, traditional antipsychotics, and novel antipsychotics. The use of anticonvulsants has a substantial advantage over antipsychotics; anticonvulsants are less anticholinergic, thus they are less likely to contribute to increasing dementia.8-16Anticholinesterase medications have been used to decrease the enzyme acetylcholinesterase to preserve acetylcholine (ACH) and increase mental acuity. Anticonvulsants have less impact on ACH and may be less harmful to memory, attention, and concentration in demented patients. There have been more reports of the use of gabapentin in the treatment of behavioral disturbance in the elderly.17-22 Gabapentin has a unique advantage because it does not plasma bind, displace other medications, or cause drug-medication interactions. Gabapentin is not metabolized in the body and 95% of the drug is excreted in the urine. This obviates problems associated with liver toxicity or other metabolic concerns in the cytochrome P450 system. Because it is excreted in the urine, excessive quantities of gabapentin can be accumulated in those patients with renal failure. Gabapentin doses must be reduced in such patients.

Method

Patients treated with gabapentin over 3 years (N=210) through a small community hospital service were retrospectively reviewed. Gabapentin blood levels were obtained from a small number of patients during the course of this study (BJ Wilder, MD, oral communication, 1996). All patients who underwent treatment with gabapentin were selected from this pool. Only patients ≥65 years of age were identified and those with dementia and behavioral disturbance were included in the study. Of the patients >65 years of age, 48 were identified and 13 were excluded. Although the 13 patients excluded from the study did indeed meet criteria for a diagnosis of dementia, they did not display sufficiently aggressive or disturbing behaviors to result in expulsion from a nursing home. Several of the patients had frequently experienced paranoid ideations, suspiciousness/distrust of others, and cognitive psychotic disturbance, but were not overtly physical or disruptive in their behavior. However, 35 patients were identified as having significant behavioral problems resulting in their expulsion from nursing homes. All patients in the study were treated with gabapentin throughout the course of hospitalization. During the course of treatment, ancillary medications were used (Table). Eleven patients had small-to-moderate dosages of risperidone, up to a maximum of 6 mg/day, added to their course of treatment. Most had much more modest dosages. Many of the medications patients were taking before hospitalization were withdrawn for the study.
 
Patient charts were reviewed by an independent research assistant who recorded frequency of the following behaviors: yelling, moaning, screaming, crying, and verbal or physical threats of aggression. Sexually inappropriate behaviors (grabbing, fondling, or sexually provocative comments) were also recorded.
Length of hospital stay was divided into the first and second halves of hospitalization. Each patient served as his or her own control. Charts were reviewed on each patient, and the number of aggressive events that occurred during each patient’s first and second half of hospitalization was recorded (Table).

Results

The average age of all 35 patients was 78 years, and the average length of stay in the hospital was 14.37 days. The number of aggressive events occurring in the first half of the hospitalization was 102; in the second half there were 34. Three patients accounted for 61.8% of the aggressive behavior in the second half of the hospitalization.
The data were analyzed by pairing each observation in the second half of hospitalization with an observation in the first half. The mean difference in aggressive events between the first and second samples was 1.94, with a standard error of 0.518. The probability of observing such a difference in aggressive behaviors by chance alone between the first and second observation period is less than .001. The value of the t statistic for this test was 3.747, thus we can say with 99.9% confidence that the behavioral change exhibited between the first and second half of the hospital stay was not a result of chance.
Although 17 patients accounted for 100% of the disturbing behaviors in the first half of the hospitalization, 11 patients accounted for all of the aggressive behaviors in the second half of hospitalization. Both frequency and intensity of aggressive acts diminished during the course of hospitalization for 16 patients. Only one patient had more events in the second portion of the hospitalization than in the first. Although 17 patients (48%) had aggressive behaviors that continued during hospitalization, 18 patients who had aggressive behaviors before hospitalization had no aggressive behaviors during either their first or second half of the hospitalization. This result is possibly associated with a good response to medication management or the result of hospitalization itself. All of the patients were managed with gabapentin throughout the entire course of hospitalization. Risperidone was the most common medication given as an add-on throughout hospitalization, although one patient received haloperidol. The addition of risperidone was employed in the 11 patients exhibiting aggressive behaviors. Other antipsychotics, antidepressants, and benzodiazepines were avoided. The use of risperidone does not account for the positive results in this study because only 11 of the 35 patients took risperidone during the study. Six of the 11 patients had no aggression in both halves of the hospitalization, whereas 5 exhibited aggressive behaviors in the first half and 4 continued to be aggressive in the second half. The total number of aggressive episodes for the risperidone- and gabapentin-treated group was 30 in the first half and 11 in the second. These figures represent a 36% reduction in aggressive behaviors, whereas in the gabapentin-treated group there was a 30% reduction (102 aggressive events occurred in the first half of hospitalization and 34 in the second).

Discussion

It is highly likely that the removal of a patient from his or her environment and the placement of that patient in a hospital with staff who are highly trained to manage aggressive behaviors does have a salutary effect on the diminishing aggression in a patient with dementia. This may contribute to the fact that 18 of the patients had no disturbing behaviors in the first half of their hospitalization. It is also possible, however, that medication management at the inception of treatment in the first hospital stay could account for some of the diminishment in aggression.
This was a retrospective, open-label study of gabapentin. As such, it is limited to noncontrolled conditions. Although the data were retrospectively examined, results must be replicated in a controlled, blind experiment.

Conclusion

The use of gabapentin in demented patients with aggressive behaviors has been shown to be effective in the management and control of aggressive, hostile symptoms. Gabapentin had no substantial side effects other than mild sedation in one patient,4 who tolerated only 300 mg/day secondary to renal insufficiency with elevated serum urea nitrogen levels and increased creatinine clearance, both of which were in the abnormal range. One other patient could tolerate only 600 mg due to sedation. Both patients were noted to have sedation on higher doses. No adverse events (eg, falling) were noted in the treatment cohort. Aggressive behaviors have a substantial impact on caregivers, and can lead to expulsion from nursing homes and mandatory psychiatric hospitalization. Gabapentin represents a safe medication for elderly patients with dementia and aggressive behaviors. This study employed an average gabapentin dosage of 1,400 mg/day in an elderly population (mean age=78.8 years), demonstrating the drug’s effectiveness in high dosages without any deleterious side effects other than mild sedation. The use of antipsychotics, such as risperidone, did not substantially improve aggressive behaviors more than gabapentin.  PP

References

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4.     Lyketsos CG, Sheppard JM, Rabins PV. Dementia in elderly persons in a general hospital. Am J Psychiatry. 2000;157:704-707.
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6.     Lyketsos CG, Steinberg M, Tschanz J, Norton MC, Steffens DC, Breitner JC. Mental and behavioral disturbances in dementia: findings from the Cache County study on Memory in Aging. Am J Psychiatry. 2000;157:708-714.
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Use of gabapentin in the treatment of behavioural and psychological symptoms of dementia: a review of the evidence.

Abstract

Behavioural and psychological symptoms of dementia (BPSD) have been defined as a heterogeneous range of psychological reactions, psychiatric symptoms and behaviours that may be unsafe, disruptive and impair the care of a patient in a given environment. To date, there are no US FDA-approved drugs or clear standards of pharmacological care for the treatment of BPSD. The novel antiepileptic agent gabapentin is being increasingly considered for use in the geriatric population because of its relatively favourable safety profile compared with other classes of psychiatric medications. Gabapentin has been administered to several geriatric patients with bipolar disorder and patients with dementia. It has also been reported to be successful in the treatment of a 13-year-old boy with behavioural dyscontrol, a finding that suggested a possible role for gabapentin in the treatment of other behavioural disorders. The purpose of this review was to find evidence for the use of gabapentin in the treatment of BPSD. To this end, a search was performed for case reports, case series, controlled trials and reviews of gabapentin in the treatment of this condition. The key words 'dementia', 'Alzheimer's disease' and 'gabapentin' were used. Searches were performed in PubMed, PsycINFO, Ovid MEDLINE, Cochrane Library and ClinicalTrials.gov. The search revealed that there are limited data on the efficacy of gabapentin for BPSD in the form of 11 case reports, 3 case series and 1 retrospective chart review; no controlled studies appear to have been published to date on this topic. In most of the reviewed cases, gabapentin was reported to be a well tolerated and effective treatment for BPSD. However, two case reports in which gabapentin was used in the context of agitation in dementia with Lewy bodies questioned the appropriateness of gabapentin for all types of dementia-related agitation. The dearth of available data limits support for the off-label use of gabapentin for the treatment of BPSD. Furthermore, controlled studies should be conducted before gabapentin can be clinically indicated for the successful treatment of BPSD.

Monday, February 1, 2016

Pets and bvFTD - Choosing the Right One is Important.

Gracie!
Dogs Rule! Cats ...not so much.

It has been nearly a year since my last update, so this post is a little long. I am not even going to try to cover all that happened the past year. Instead I plan to go into a lot of detail about a dog or two. Pets are very important for people with bvFTD.

There is no particular reason why I have not written. It seems that every time I was going to write something I found something else to do instead. The first part of last year I was busy gardening, and just doing everyday stuff. We went on a nice little vacation at a cabin in Ohio's Amish Country. Of course we took Gracie with us. She has been my Service Dog for the past 2 years, and has gone everywhere with us. It wasn't long after that when the computer that I use to write for this blog suffered a catastrophic hard drive crash. I don't think it really suffered much because it was quick. I couldn't afford to replace it for a few months, so that gave me another excuse not to update the blog. I won't bother to do it on my phone. I keep in touch regularly with my close friends on both Facebook and Twitter, so it isn't like I was a complete hermit. Then it was time for the holidays, and things got really busy.

Gracie loved playing in the snow.
In early November Gracie had a major stroke. She had always been deaf, and knew sign language very well. Gracie knew around 70 or so signs, and would learn a new one quickly as needed, or just figure out what you wanted. She understood signed sentences. Her stroke left her not only deaf, but also totally blind. She recovered well from the stroke, and within a couple weeks was getting around the house very well.

At the end of November we had a 10 day vacation planned. The vacation was a Christmas present from my boys. Gracie was doing well enough that with a team of skilled caregivers she would be fine until our return. She was given wonderful and loving care while we were away. The day before our return from New Orleans Gracie had another stroke. When we returned the next day Gracie did not recognize us. She didn't respond to much of anything for a couple of days. Then she bounded up to us and said “Hello!” Once again she had made a remarkable recovery from a stroke. She was a little wobbly, but still doing very well considering she had recently had two strokes.
This is one of my favorite pictures of Gracie. She had a sense of humor!

We got a new computer for Christmas, so here I am writing again. Around Christmas Gracie had a series of about 3 severe strokes, and several smaller ones a few days apart. Each time she would recover after a couple days, but was a little weaker and more wobbly. She did not appear to be in any pain, but was sometimes very confused. She still loved her scoobie-snacks, and had learned a bunch of new signs by touch since she couldn't see. She even played with Cindy when she was feeling better. Every time we thought it was going to be time for her last visit to the vet, she would recover, and let us know that it wasn't her time just yet.

Since early November when she went blind we had been leading her to the back steps outside so she would not accidentally fall off the edge of the deck. She still managed to go outside as long as she was able to walk.
Gracie loved silk scarves,
and would choose the one she wanted to wear.

On New Years Day Gracie was on the floor next to the couch between Cindy and I having a good time. She reviewed all her new touch-signs (sit, stay, down, hug, scoobie-snack, etc.). She was her fat dumb and happy self. Then about 3 PM she tilted her head way up pointing her nose at the ceiling. She had another huge stroke. It came on very suddenly. She had a seizure that lasted a few minutes, and then woke up for a while. She wanted to be held. She couldn't stand up, but she did manage to crawl over to Cindy when she sat on the floor next to her. Around 7 PM she had another seizure which only lasted maybe a minute, but seemed to be more severe than the first one. Poor Gracie never woke up after that. She died around 2 AM on January 2nd, 2016 surrounded by her loving family.

Wherever Gracie went she was the center of attention, and loved it.
Gracie was more than a pet, or a Service Dog. She was a full member of our family, and truly “My best girl.” Gracie will always own a piece of our hearts.

With my bvFTD my emotions are blunted. I do not feel things the way I remember I used to feel. If emotions were colors, all of those bright vibrant hues I used to experience have now turned to washed-out pastels. Well, I can tell you that I definitely felt the loss of my best friend and companion and caretaker. The loss of Gracie was the most intense feelings I have felt in years.


Gracie owns a place in our hearts.
It was rough for both Cindy and I with Gracie gone. There was a emptiness in our house, and in our hearts. After some long discussion we decided not to wait a long time to get another dog. We both wanted a large dog, and we definitely wanted to have a rescue. We really did not want a puppy, and were expecting to have to put in some work and training. We both feel that there are so many wonderful animals out there in need of a loving home it is shameful not to help them. We were not in any rush. Finding the exact right fur-baby can take some time.

Cindy started looking online at rescue organizations within a couple hundred miles of Swanton. After a few days of seeing what she was finding, I also started looking. Did you know that about 80% of the animals in shelters are pit bulls? I have nothing against the breed except that I personally think they are butt-ugly! We were looking into a couple of Great Pyrenees, and even a Bernese Mountain Dog. They all seemed to be older dogs that had some behavioral issues from severe abuse that we did not want to deal with. After a couple weeks we went to look at a Shar-Pei. The poor dog was unresponsive, and seemed dumb as a rock. Definitely not for us!

Then Cindy saw an ad on Craigslist or somewhere in Michigan for a 3 year old Cane Corso Mastiff named Maggie that needed to be re-homed. Her family had moved, and expanded from her owner and 2 children to include a fiance and another 2 children. With parents working, school, and 4 children doing all the usual activities the owner felt she was spending way too much time in her crate. For some reason Cindy had a good feeling about it, and convinced me to take a look. We made an appointment for Saturday January 16th to meet and greet.

I have always owned rather large dogs, mostly German Shepherds. Of course Gracie was 110 pounds of silky coated Akita. I had always wanted a Mastiff, but had shied away from the breed because they tend to drool, and are not the brightest crayon in the box. I had never even heard of a Cane Corso Mastiff. I did some research, and was very impressed with what I found out. Like all Mastiffs they are guard dogs. They were also bred to hunt large game independently such as wild boar or bear. (Just like Akitas!) Compared to other Mastiff breeds the Cane Corso is reported to be more intelligent, more adaptable, and more athletic and agile. They are a large breed weighing about a hundred pounds or so. Many have cropped ears a practice that I am not very fond of.

Saturday finally arrived, and we were excited to go see her. We had no expectations, and really both felt it was a little too soon for another dog. We also knew that when looking for a rescue, or in this case a re-home, you had to be flexible with the timing when the right animal comes along. We got a late start, but made the 3 hour drive up into Michigan only getting lost once. I drove, and used the
GPS in the Jeep as always. I did not take my pills because I was driving. Sometimes they make me a little sleepy a few hours after I take them. I felt good, and was having a good day. We found the house easily.

This is Maggie. She is a Cane Corso Italian Mastiff.
When we got there , Maggie, and her owner, Kate, were just going back inside from a walk. We pulled in while they were in their attached garage. We got out of the Jeep to the sound of a large dog barking a serious warning to stay away. She was doing her job as a watch dog, and a guard dog. We approached, and she seemed to calm down a little as we spoke to both her and Kate. Every time we moved to get within about 5 feet of them she would lunge and snap, trying to bite. Even after I fed her a treat, which she accepted, she tried to bite. I finally realized that we were standing right outside of the garage entrance, and both Kate and Maggie were inside. She was guarding the entrance, and wouldn't allow us in. I suggested we go inside the house, and see how she acted.

Once inside, Maggie plastered herself up against Kate, and lunged and snapped every time either Cindy or I came near. After observing her for a few minutes, I realized that we were not seeing overt aggression, but rather very aggressive protective behavior. Maggie kept herself between us and Kate, and would not let us approach. She would sit, stare aggressively, then lunge, growl, and snap. She was putting on a very impressive show of doggie intimidation. Unbeknownst to poor Maggie I once had a 120 pound white German Shepherd that was too vicious to be a junk-yard dog. I recognized her aggression as different, more of a warning.

I also have bvFTD, so of course I asked Kate for her leash so I could just take her away from Kate and her protective stance. I figured I would probably get bitten in the process, but if we were ever going to get anywhere we needed to get Maggie away from her owner.

I took her leash, and was met by a snarling, growling, snapping, lunging Mastiff. She grabbed my hand, and I instantly knew she was controlling her bite. It was just hard enough to hold me. I knew from my shepherds not to pull away, but rather to push. I pushed my hand into her mouth, and smacked her on the head, and yelled “NO!” She dropped my hand, and I jerked her leash, said “Come!” and started to walk her across the room. She grabbed my hand again with a lunging snarl, and I smacked her again, and said “No!” I continued to walk her around the room. No more growls or snarls. She walked. She sat. She came when I called her. She was very wary, but fine. I scratched the back of my hand on her back teeth when I shoved it into her mouth, so my hand was bleeding a little. Had I not done that she would never have broken the skin because she was trying to be careful not to hurt me in spit of all the lunging-snarling-growling intimidation display.

She calmed right down, I walked her back over to Kate, and then away again. She sat next to me as we talked. She was still very wary, but attentive, and aware of everything that was going on. She was still very wary of Cindy, and still wanted to protect Kate from her. After a few lunges, and snaps, and smacks, Cindy was able to walk her around the room. Maggie actually seemed to be a little afraid of Cindy. Maggie was sitting by Kate again, and suddenly decided Cindy had come too close to her owner. She gave her a stare, then lunged. She caught us all by surprise, and pinched Cindy a good one on her hip. Cindy was a little shaken up, but soon recovered

(Now before you small dog owners get your panties all in a twist I want to clarify. Sometimes for a dog over 60 pounds or so it is necessary to smack them in the head to get their attention. When excited they will often ignore treats, and commands, and everything else. A smack, not hard enough to hurt them, and not as a punishment, but enough so it makes them pay attention to you, works wonders. For the rest of the time a scolding, or jerk on a leash or collar is plenty of correction. Oh! And for the record, your family is NOT a dog pack, and you do not need to be some weird alpha-dog. That's just dumb, but is making somebody lots of money.)

At this point I was pretty sure that this dog was too attached to its owner to be re-homed. She was overly protective, and obviously had some severe aggression issues. We sat talking, and Kate and I made Maggie sit next to me instead of her. Cindy took her for a few walks around the room, and then when she came back she sat leaning against me instead of Kate. What? None of us expected that.

Cindy took control of her, and walked her around a few times without incident. Cindy spent some time with Maggie having her walk, and sit, and stay, and come. Maggie was still wary, but doing whatever Cindy requested. While Cindy and Maggie were doing that we were also talking with Kate. We learned that Maggie had been very aggressive to Kate's ex-husband, and would not allow him to come within a few feet of her. She was fine with the rest of the family, and did well with children. That explained a lot to me about her behavior. She had learned that she was allowed to be aggressive to some people sometimes especially when she thought she was protecting Kate.

Maggie on the ride home with her head on the center console.
After a while, I looked at Cindy, and said, “What do you think?” I fully expected Cindy to say no because Maggie had bitten both of us at first meeting. This was a dog with some serious aggression issues, and would need some remedial socialization. To my surprise, Cindy said yes. Arrangements were made, goodbyes were said, and I took Maggie out to the Jeep. Maggie jumped right in. Kate hardly cried at all. It was obvious that Maggie had a very loving family.

The ride home was long, and uneventful. Maggie spent most of the ride with her head right between us looking out the front window. She kept nuzzling, and kissing our ears. She finally laid down with her head on the console. She is so big that when she is in the back of the Jeep her front end is still in the front seats.

When we got home, we let her into the house. We let her loose to sniff around, and explore. She went everywhere, and stuck her nose in everything. There was lots to explore. She was very excited, and seemed happy. We relaxed, and watched some TV. Maggie was very well behaved. Many scoobie-snacks were involved to make her feel welcome. We did all the normal new-dog things like showing her her food dish, and water, and where to go outside. When it was time for bed, Maggie came upstairs with us. She slept on her bed on the floor next to us. She snored almost as loud as my friend Walter.

Maggie was a little excited at first.
Over the next few days Cindy and I worked on developing Maggie's trust. It came quickly. Within a couple days her favorite spot became the end of the couch cuddled up to Cindy. Her other favorite spot is on the other couch cuddled up to me. Even as I write this her head is in my lap. Maggie is wonderfully affectionate, and wants very much to please. She is doing very well, and adjusting better than I ever would have expected.

After the first week, we had some company over for dinner. In preparation I purchased a soft muzzle for her. I had read in her Vet's notes that she used one for her doctor's visits, and tolerated it well. I tried it on her a few times to get her used to it before our company arrived. She did not seem to mind it at all. When they got here we were ready with her leashed and muzzled. She ran to meet them. She was of course barking, but her tail was also wagging in greeting. At various times within the first 20 minutes or so she did lunge a few times, but was quickly corrected. I had our guests tell her, “No!”, and scold her. She listened, and learned. She is learning that is not appropriate behavior.

By the time we sat down to dinner, Maggie just laid on the floor behind my chair. She wanted to be close to us, but was no longer wary of out house-guests. Overall she did much better than we expected. I think she has realized that she does not need to be so protective. We kept the muzzle on her for her safety, but after the first half hour she didn't need it. That said, she is still an alert watch dog. She investigates any strange sounds, and barks to warn off any would-be
Hard to believe that 2 weeks ago
Maggie was chomping on my hand.
intruders – especially cats!

It has been exactly 2 weeks today, and Maggie has filled the emptiness in our house. She has already become a part of our family. By the way she whines whenever either one of us leaves the house, and greets us both with much butt-wagging and slobbery kisses when we return, I guess we have become a part of hers, too.

I don't know if Maggie will be able to be socialized well enough to become my service dog, but she is already my companion dog ...that is when I can pry her away from Cindy.
Maggie! Welcome to our family.

Some days are better than others, and right now most days are still pretty good.

(Please click on an ad before you leave, and help buy Maggie a scoobie-snack.)







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I said all that, so I could say this:
For the person with dementia, a pet:
  • Offer affection and “unconditional love.” It’s amazing how a cat on the lap or a friendly dog with a wagging tail evokes a smile and positive response.
  • Provide an opportunity for meaningful chores. Having a daily “job” gives you a sense of purpose and a sense of accomplishment when the chore is accomplished.

  • Introduce fun into your life.
  • Provide sensory stimulation. Having an animal in your lap to pet, or to be by your side provides comfort and may even reduce agitation and anxiety.
  • Support opportunities for socialization. People like to talk about their pets. Most of us talk to our pets.
  • Offer an excuse to get outside. People with dementia spend too much of their time indoors. Walking the dog provides for an excuse to get outside.
While having a pet provides for many benefits, use common sense to assess whether you or yours are able to care for the pet. You may find a “lower maintenance” pet more appropriate like a fish aquarium or birds. Har! Worst advice ever! Just try petting your fish, or having it sit in your lap. I suggest pets that are warm and furry!