Understanding Behavioral Changes in Aging Maltese Dogs

As Maltese dogs enter their senior years (commonly recognized around 8–9 years for this breed, with an expected lifespan of 12–15 years), owners often notice changes in temperament, activity, housetraining, sleep, and social interaction. In the Maltese, those behavioral shifts are especially important to evaluate because this toy breed has specific medical vulnerabilities — including [mitral valve disease](https://seniorpet.org/knowledge/cavalier-king-charles-spaniel-mitral-valve-disease "Mitral Valve Disease Guide") (MVD), luxating patella, cataracts, portosystemic shunt (PSS), [dental disease](https://seniorpet.org/knowledge/siamese-cat-dental-disease "Dental Disease in Senior Pets"), collapsed trachea, and white shaker syndrome — that commonly produce or mimic behavioral symptoms. This article explains how each of these conditions can change your Maltese’s behavior, outlines how veterinarians investigate them, and gives practical, actionable advice you can use at home and with your veterinary team.

Why Maltese may show behavioral changes as they age

Maltese are small, long-lived toy dogs. Their size, skull/jaw conformation, and genetic predispositions mean that medical problems that cause pain, discomfort, sensory loss, or metabolic brain dysfunction can appear relatively early and have an outsized effect on behavior. Common mechanisms linking disease to behavior include:

• Pain or mechanical impairment (luxating patella, dental disease) → decreased activity, irritability, avoidance of handling.
• Cardiorespiratory compromise (MVD, collapsed trachea) → reduced stamina, increased resting, coughing that can cause anxiety.
• Sensory loss (cataracts, vision decline) → startle reactions, disorientation, increased barking or clinginess.
• Metabolic encephalopathy (portosystemic shunt, severe dental sepsis) → confusion, circling, pacing, seizures.
• Immune-mediated or neurologic syndromes (white shaker syndrome, cognitive dysfunction) → tremors, altered sleep-wake cycles, confusion.

Because behavioral changes in an older Maltese can be the first sign of an underlying, treatable medical condition, always seek veterinary evaluation rather than assuming “just getting old.”

Common medical causes of behavioral change in senior Maltese

Below is a breed-focused summary of the key conditions and how they commonly present in behavior.

Mitral valve disease (MVD)

• Why Maltese owners should care: Degenerative MVD is the most common cardiac disease of small-breed dogs and often begins to affect behavior as it progresses. Even before overt congestive heart failure, decreased cardiac output and exercise intolerance produce lethargy and reduced interest in play.
• Behavioral signs: Reduced activity, reluctance to climb stairs or jump, more frequent napping, increased irritability when handled, coughing (worse during sleep or excitement) causing anxiety or avoidance of exercise.
• Veterinary testing: Cardiac auscultation, thoracic radiographs, echocardiography (definitive), blood pressure, baseline bloodwork. Medical therapy (pimobendan) has been shown to delay heart failure in preclinical disease with remodeling (EPIC trial, 2016) and is used under cardiology guidance.
• Owner actions: Track activity tolerance (distance, time), note coughing patterns, avoid strenuous exercise when coughing, use a leash and soft harness, weigh regularly to avoid [obesity](https://seniorpet.org/knowledge/golden-retriever-weight-management-obesity "Weight Management for Senior Pets"), and maintain scheduled cardiology rechecks.

References: ACVIM/consensus guidance on degenerative mitral valve disease and the EPIC clinical trial support early cardiology management of stage B2 MVD.

Luxating patella

• Why Maltese owners should care: Luxating patella (kneecap instability) is common in toy breeds and often appears by middle age. Episodes of sudden hindlimb “skipping,” stiffness, or lameness can lead to behavioral change.
• Behavioral signs: Sudden reluctance to jump or climb, hesitancy to exercise, irritability when the knee is manipulated, reduced play or avoidance of stairs, changes in gait that make the dog appear depressed.
• Veterinary testing: Orthopedic exam, palpation of patella, flexion/extension tests, orthopedic radiographs. Conservative management (weight control, physical therapy) for mild cases; surgical correction for severe or painful grades.
• Owner actions: Use ramps instead of steps, keep nails short, avoid high-impact play, provide non-slip flooring, and consider joint supplements after veterinary approval.

Cataracts and vision loss

• Why Maltese owners should care: White coats can make visual deficits harder to notice. Cataracts or progressive retinal disease can cause disorientation and increases in startle responses in aging Maltese.
• Behavioral signs: Bumping into furniture, reluctance to go into unfamiliar rooms, increased clinginess, hesitation on stairs, sleep disruption from being startled at night.
• Veterinary testing: Ophthalmic exam (vet ophthalmologist recommended), menace response, pupillary light reflexes, tonometry, and cataract evaluation for suitability for phacoemulsification.
• Owner actions: Keep furniture layout consistent, add night lighting in hallways, use verbal cues and scent markers, avoid rearranging rooms, consider ophthalmology referral for surgical correction if appropriate.

Portosystemic liver shunt (PSS)

• Why Maltese owners should care: Congenital extrahepatic portosystemic shunts occur more frequently in small/toy breeds including Maltese. Although usually detected younger, mild or compensated shunts may manifest or be recognized in senior dogs with intermittent neurologic and behavioral signs due to hepatic encephalopathy.
• Behavioral signs: Intermittent disorientation, staring into space, circling, increased sleepiness after meals, decreased appetite, vomiting, seizure activity, or sudden aggression/irritability.
• Veterinary testing: Routine bloodwork, pre-and post-prandial bile acids, ammonia, abdominal ultrasound (to visualize shunt), CT angiography for surgical planning.
• Owner actions: If you notice episodic neurologic signs, bring the dog to the vet promptly. Management includes dietary protein modulation, lactulose, antibiotics (as prescribed), and surgical correction when appropriate.

Dental disease

• Why Maltese owners should care: Toy breeds like Maltese are prone to dental crowding, periodontal disease, and tooth loss. Oral pain is a major, often under-recognized cause of behavior change in small breeds.
• Behavioral signs: Reduced interest in chew toys, dropping food, reluctant chewing, irritability when muzzle is touched, pawing at the mouth, bad breath, personality change (withdrawal).
• Veterinary testing: Oral exam under sedation/anesthesia with dental radiographs to detect root disease and periodontal pockets.
• Owner actions: Daily or frequent tooth brushing, water additives or oral rinses as recommended, regular veterinary dental cleanings with extractions as needed, analgesia after dental procedures. Use small-dog-appropriate toothbrushes and flavored toothpaste.

Guidelines: WSAVA dental recommendations and veterinary dental studies document systemic health effects of periodontal disease.

Collapsed trachea

• Why Maltese owners should care: Collapse of the tracheal rings is common in toy breeds and causes the classic “goose-honk” cough that can distress dogs and owners.
• Behavioral signs: Frequent dry, honking cough that may trigger anxiety, reluctance to go for walks, reduced activity, sleep disruption from coughing episodes.
• Veterinary testing: Thoracic radiographs, fluoroscopy, sometimes bronchoscopy. Management includes harness use (not collars), cough suppressants, anti-inflammatories, and in severe cases interventional stent placement.
• Owner actions: Use a soft harness; avoid airway irritants (smoke, aerosol cleaners), maintain ideal body condition, reduce excitement during walks, and follow veterinary cough management.

White shaker syndrome (steroid-responsive tremor syndrome)

• Why Maltese owners should care: White shaker syndrome is classically described in young to middle-aged small white breeds including Maltese. However, late-onset or recurrent tremor syndromes can occur in older dogs and can be mistaken for generalized age-related tremors or neurologic decline.
• Behavioral signs: Whole-body tremors, hyperalertness, circling, periods of agitation, decreased ability to perform learned tasks, changes in sleep-wake cycles. Tremors often cause anxiety and aversion to handling.
• Veterinary testing: Neurologic exam, rule-outs (infectious disease testing, metabolic panels), MRI in atypical cases. Treatment is typically immunosuppressive corticosteroids with a rapid clinical response in many dogs.
• Owner actions: If tremors are sudden or severe, seek veterinary care. Follow steroid dosing and tapering plans exactly, monitor for side effects (polyuria, polydipsia, appetite changes), and work with your veterinarian to plan long-term management.

Clinical descriptions: Multiple reports show rapid improvement on corticosteroids for classic cases of white shaker syndrome.

Cognitive dysfunction in the Maltese senior

Maltese that reach 8–9 years are entering an age where canine [cognitive dysfunction](https://seniorpet.org/knowledge/siamese-cat-cognitive-dysfunction "Cognitive Dysfunction in Senior Pets") (CCD) becomes more likely. CCD is analogous to human dementia and causes:

• Disorientation (staring at walls, getting stuck in corners)
• Altered social interactions (reduced interest in greeting family or increased clinginess)
• Sleep-wake cycle changes (more daytime sleeping, nighttime vocalization)
• House soiling or changes in learned behaviors
• Decreased activity and interest in toys

Important: CCD is a diagnosis of exclusion. Medical causes listed above (cardiac disease, metabolic disorders, sensory loss, PSS, infection, pain) must be ruled out first. Management strategies that have demonstrated benefit include environmental enrichment, diet (omega-3 fatty acids and medium-chain triglycerides where indicated), and selegiline (monoamine oxidase B inhibitor) or other medications prescribed by a veterinarian. Behavioral modification (consistent routine, cue training, interactive play) and safe environmental changes (non-slip flooring, ramps, night lights) can meaningfully improve [quality of life](https://seniorpet.org/knowledge/siamese-cat-quality-of-life "Quality of Life Assessment").

Reference: Clinical reviews and consensus recommendations (e.g., Landsberg et al.) emphasize multimodal management for CCD.

Practical, actionable steps for owners (daily to monthly)

Below is a practical plan owners can start today to detect, monitor, and mitigate behavioral changes in senior Maltese.

| Goal | What to watch for | Action (owner) | When to call vet | |---|---:|---|---| | Detect pain or lameness | Skipping, reluctance to jump, limping, shorter walks | Keep a short daily log of activity, use ramps, limit stairs | If limping >48 hours, acute pain, or worsening | | Monitor breathing/cough | Persistent honking cough, nighttime coughing, exercise intolerance | Use harness, avoid irritants, record episodes (time, trigger) | New or persistent cough, breathing difficulty | | Identify vision changes | Bumping, hesitancy, night anxiety | Keep furniture constant, add night lights, use verbal cues | Sudden blindness, rapid behavior change | | Screen for neurologic signs | Disorientation, circling, tremors, seizures | Note timing (post-meal, random), take short video | Any seizure, sudden disorientation, tremors | | Maintain oral health | Bad breath, drooling, dropping food | Brush teeth daily, offer dental chews approved for small dogs | Bad breath + appetite loss, or drooling/bleeding gums |

Practical tips:

• Keep a short video of any unusual behavior; video is invaluable for diagnosis.
• Weigh your Maltese weekly (small changes matter) and record appetite and stool quality.
• Use a soft harness for walks and a short leash to control excitement that triggers cough or collapsing episodes.
• Maintain routine: Cats and dogs both respond to consistent mealtimes, potty breaks, and sleeping locations.

Diagnostic approach — what to expect at the vet

A thorough workup will usually include:

• Full history (including onset, frequency, progression, and owner video)
• Physical exam including oral exam and neurologic screen
• Thoracic radiographs and echocardiography for suspected MVD/collapsed trachea
• Orthopedic exam and radiographs for patellar luxation
• Ophthalmic assessment for cataracts (referral to veterinary ophthalmologist if surgical options considered)
• CBC, chemistry panel, urinalysis, pre- and post-prandial bile acids for suspected PSS
• Abdominal ultrasound or CT angiography if PSS is suspected
• Dental radiographs under anesthesia for periodontal disease
• Neurologic imaging (MRI) if an intracranial process is suspected or to rule out other causes before diagnosing CCD or white shaker syndrome

Expect stepwise testing: veterinarians usually prioritize ruling out life-limiting or treatable medical causes first before making a diagnosis of CCD.

Treatment and long-term management strategies

• MVD: Medical management (pimobendan for appropriate preclinical patients, diuretics, ACE inhibitors when indicated). Regular cardiology monitoring.
• Luxating patella: Conservative management (weight, exercise modification, physiotherapy) for mild cases; surgical correction for severe or painful luxation.
• Cataracts: If vision loss interferes with quality of life, phacoemulsification by a veterinary ophthalmologist can restore vision; otherwise environmental adaptations and safety measures.
• Portosystemic shunt: Medical stabilization (diet, lactulose, antibiotics) and surgical correction in many cases yield good outcomes; early detection is key.
• Dental disease: Professional dental scaling and extractions as needed; strict home dental care to prevent recurrence.
• Collapsed trachea: Harness, anti-tussive therapy, anti-inflammatories, weight management; referral for stenting if refractory.
• White shaker syndrome: Corticosteroid therapy typically produces rapid improvement; long-term immunosuppression may be needed in some cases.

Medications and therapy should always be prescribed and monitored by your veterinarian. Small toy breeds like Maltese are sensitive to dosing errors — never give human medications without veterinary approval.

Environmental and behavioral adjustments at home

• Safety-proof the home: non-slip mats, ramps, and consistent furniture layout to help vision-impaired or cognitively impaired Maltese.
• Enrichment: short, frequent play sessions; food puzzles sized for small mouths; scent work and gentle training to stimulate cognition without overexertion.
• Sleep hygiene: night light in hallways, comfortable bed at ground level, and minimize nighttime disturbances.
• Social cues: use a consistent verbal signal for feeding, toileting, and walks. Praise and brief reward-based training help maintain engagement.
• Grooming: Maltese have long coats that can hide weight loss or stiffness — maintain regular grooming and watch for changes during handling.
• Safety with supplements: joint supplements (glucosamine/chondroitin) may help luxating patella but consult your vet for appropriate dosing and evidence.

When to involve specialists

• Cardiologist: confirmed or suspected degenerative mitral valvular disease (abnormal echo, murmurs, cough).
• Ophthalmologist: progressive vision loss, cataracts, or painful eyes.
• Surgeon: surgical correction for grade III–IV luxating patella or portosystemic shunt surgery planning.
• Neurologist: unexplained seizures, progressive neurologic decline, atypical tremors requiring imaging.
• Dental specialist: complex oral disease requiring extractions or root therapy.

Final words: monitoring and partnership with your veterinarian

Behavioral changes in an aging Maltese are a red flag, not simply “getting old.” Because Maltese have breed-specific predispositions — dental crowding, small airway susceptibility, patellar instability, and neurologic conditions such as white shaker syndrome or PSS — owners should take any sustained change seriously. The most important steps you can take are careful observation (and short videos), early veterinary evaluation, consistent home adaptations, and following a coordinated plan that addresses both the medical and behavioral aspects of your dog’s condition.

Early diagnosis and targeted treatment not only reduce suffering but often reverse or greatly improve behavioral symptoms — allowing your Maltese to remain engaged, comfortable, and happy throughout its senior years.

References and further reading

• ACVIM consensus statements on degenerative mitral valve disease and other small-animal cardiology guidelines.
• EPIC Study Group (2016) — effect of pimobendan in preclinical myxomatous mitral valve disease.
• Landsberg GM, et al. Reviews on canine cognitive dysfunction and multimodal management strategies.
• WSAVA Global Dental Guidelines and peer-reviewed veterinary dental literature.
• Case series and veterinary neurology reports on idiopathic steroid-responsive tremor syndrome (white shaker syndrome).

(Ask your veterinarian for copies of the specific journal articles or guidelines above; they can provide references tailored to your dog’s case and the most up-to-date recommendations.)