Canine Cognitive Dysfunction

November 14, 2019
nmoy

I frequently hear clients say his or her dog is just getting older, and that is why they have started peeing or pooping in the house, seem confused, get grumpy easily, or have lost their hearing.  If this article does nothing else I hope it makes you stop and think maybe your dog is not just getting old, maybe there is something more going on.

Canine Cognitive Dysfunction (CCD is the dog equivalent to dementia.  CCD affects at least 14% of senior dogs, but less than 2% of dogs with CCD are officially diagnosed by their veterinarians2,3.  Numerous studies have shown there are significant similarities between CCD and human Alzheimer’s Disease (AD)1,2.  Both CCD and AD are progressive incurable degenerative diseases of the brain, known as neurodegenerative disorders.  Current research suggests CCD and AD are in-part caused by the accumulation of excessive amounts of a protein called β-amyloid in the brain tissue and its blood vessels1,2.  The amount and location of β-amyloid deposition correlates with the severity of clinical signs seen in dogs with CCD1,2.  Studies have also shown dogs with CCD have less brain mass, i.e. nerve cells within the brain have died or shrunk.  This brain atrophy is likely due to oxidative stress and free radical damage, caused in part by inflammation generated by the presence of β-amyloid proteins within the brain1,2.

The most common signs seen in dogs with CCD follow the acronym “DISHA”.  The acronym stands for Disorientation in familiar environments, Interaction changes with people and other animals, Sleep-wake cycle disturbances, House-soiling, and Activity level decline2,3,4.  CCD is a diagnosis of exclusion, other causes for the signs must be eliminated before a dog can be said to have CCD.  Multiple diseases mimic the signs commonly associated with CCD. The chart below outlines the common signs seen with each letter in DISHA and other diseases that could cause those signs.2,3,4

DISHA Clinical Signs Diseases That Cause Similar Signs
D Disorientation in a Familiar Environment · Excessive Vocalization (barking, howling, yelping, whining)
· Acting Fearful or Anxious
· Trying to Hide
· Acting Lost or Confused
· Getting Stuck in a Corner
· Vision Loss
· Hearing Loss
· Pain
· Anxiety
· Brain Tumor
I Interaction Changes · Not Greeting Owner When They Come Home
· Not Jumping Up On the Owner
· Not Getting Excited
· Aggression Toward People or Other Animals
· Avoiding the Owner
· Not Wanting to Be With Their Family
· Arthritis
· Pain
· Anxiety
· Seizure Disorder
· Brain Tumor
S Sleep-Wake Cycle Disturbances · Awake At Night or Restless At Night and Soundly Sleeping During the Day
· Panting At Night
· Yawning A Lot During the Day
· Tossing and Turning A Lot At Night or Cannot Seem to Get Comfortable
· Pain
· Hormone (Thyroid, Adrenal) Disorders
· Kidney Disease
· Liver Disease
· Brain Tumor
H House-Soiling · Urinating or Defecating in the House
· Urinating or Defecating in Unusual Locations
· Kidney Disease
· Liver Disease
· Stroke-Like Episode
· Vision Loss
A Activity Level Decline · Decreased Play-Time with People and Pets
· Decreased Interest in Toys
· Fearful or Phobic of Going Outside
· Unusual Vocalization
· Hormone (Thyroid, Adrenal) Disorders
· Heart Disease
· Anxiety
· Pain

To diagnose CCD your veterinarian will likely discuss the most common signs seen with CCD to see if they fit your dog’s symptoms, run baseline blood work (checking red and whites cell counts, chemistries, and thyroid level), and run a urinalysis. Your veterinarian may also recommend chest or abdomen x-rays, an abdominal ultrasound, blood pressure, or special eye tests to rule-out other common diseases.

Once your pet has been diagnosed with CCD a plan will be discussed to delay progression.  Remember this is a progressive degenerative disease, and unfortunately your pet will continue to worsen.  The goal of treatment is to provide excellent quality of life for as long as possible.  Diet, medication, nutritional supplements, and possibly holistic options and the categories generally used to treat CCD.  The table below provides further information for each category.1-4

Environmental Modifications · Environmental modifications enrich the dog’s daily experience and stimulate the brain delaying nerve loss.
· Increase activity daily. Even a simple 15 minute walk a day can provide great benefit both physically but also mentally.
· Increase social interactions with other people and pets to reduce anxiety in new situations and reinforce positive experiences.
· Cognitive training can include using puzzle toys with treats, puzzle food bowls, and scent work (training your dog to identify different smells).
Dietary Modifications · The goal of dietary modification is to increase the amount of antioxidants (Vitamin A, Vitamin C, Vitamin E, Selenium, Zinc, L-carnitine), lipoic acid, omega 3 fatty acids (DHA and EPA), and usable energy for the brain (Medium Chain Triglycerides or MCT).
· The primary options are prescription diets formulated for brain health (e.g. Hill’s b/d) or home-made diets can be formulated with the help of your veterinarian.
Pharmaceuticals Selegiline · Improves sleeping, housetraining, and activity levels.
· Side effects include restlessness, agitation, vomiting, disorientation, and diarrhea.
· Many drugs and foods can interact with selegiline.
Memantine · Reduces signs and progression of dementia
Gabapentin · Reduces nerve pain and anxiety and improves nighttime sleeping.
· Side effects are generally limited to sedation for the first 2 weeks of therapy but potentially long-term.
Supplements Phosphatidylserine · Improves brain function and may improve memory, learning and social behavior.
SAMe · Potent antioxidant and mood stabilizer.
Apoaequorin · Aids in learning and attention tasks.
Alpha-casozepine · Reduces anxiety and aggression.
Melatonin · Reduces anxiety and encourages sleep if given before bedtime.
Valerian Root · Reduces anxiety and encourages sleep if given before bedtime.
Pheromone · DAP (Dog-Appeasing-Pheromone) or Adaptil can be used to reduce anxiety.
· Available as a plug-in or collar.
Senilife · Combination product specifically for dogs aimed at reducing inflammation and improving brain function.
· Primary ingredients include: phosphatidylserine, membrane phospholipid, ginko biloba, Vitamin E, Vitamin B6, resveratrol.
Activait · Combination product specifically for dogs aimed at reducing inflammation and improving brain function.
· Primary ingredients include: phosphatidylserine, omega 3 fatty acids, Vitamin E, Vitamin C, l-carnitine, alpha-lipoic acid, coenzyme Q, selenium.
Holistic Therapies · Acupuncture can reduce pain and anxiety, as well as improve nervous system function.
· Chiropractic adjustments can reduce pain and stimulate nervous system function.
· Chinese Herbal Therapy can be used to reduce the common signs seen with CCD.
· Ozone therapy can reduce oxidative and free radical damage.
· Cold Laser Therapy can reduce pain.
· Diffusing lavender can help reduce anxiety.
· Reiki can reduce anxiety.

While CCD is a frustrating and potentially devastating condition for your pet there are numerous options to manage signs and improve quality of life.  Your veterinarian is an excellent source of information and guidance for treatment.  Monitoring your dog for the common signs associated with CCD is crucial for early detection.  The earlier the disease is diagnosed, the earlier treatment can be started, and the bigger the impact on disease progression.

References

1. Fast, R, Schütt, T, Toft, N, Møller, A, and Berendt, M 2013, An observational study with long-term follow-up of canine cognitive dysfunction: clinical characteristics, survival, and risk factors, Journal of Veterinary Internal Medicine, Volume 27, pp. 822-829.

2. Benzal, A and Rodríguez 2016, Recent developments in canine cognitive dysfunction syndrome, Pet Behavior Science (Open Access Journal), Volume 1, pp. 47-59, Available at: rng.org.au/wp-content/uploads/2014/09/CCDR-scale-revised.pdf [Accessed 28 Apr. 2018].

3. Sieber, L 2017, Management of dogs and cats with cognitive dysfunction, Today’s Veterinary Practice (An Official Journal of the NAVC), Volume 7(9), Available at: http://todaysveterinarypractice.navc.com/management-dogs-cats/  [Accessed 20 Apr. 2018].

4. Landsberg, G 2014, Senile pets: do dogs and cats get Alzheimer’s, Proceedings from British Small Animal Veterinary Conference.

Lisa Pinn McFaddin, DVM, GDCVHM, CVSMT, CCOAC, CVA, CVFT

Independent Hill Veterinary Clinic

Medical Director

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