Canine Cognitive Dysfunction Syndrome

Research and innovations in Veterinary Medicine, such as preventative care, nutrition, and new treatments for previously life-threatening conditions, has significantly increased the average lifespan of our pets. With more pets living longer, we’re also seeing a higher prevalence of age-related cognitive changes that are not caused by other medical conditions. As our four-legged friends get older, their bodies will become weaker and less able to repair itself which sadly, also includes their brain function. Sometimes referred to as “Doggie Dementia” or compared to human Alzheimer’s Disease, Cognitive Dysfunction Syndrome (CDS) can be heart-breaking to watch as it takes hold of our pets. There are some treatments for CDS that may be helpful, but it is a condition that has only more recently become a focus of research and many treatments are still in development.

What happens to a dog with CDS?

Neurons serve to conduct information in the brain and throughout the body. As a dog ages, these neurons begin to waste away, making the ability to learn and recall memories more difficult. CDS is typically progressive and irreversible. As the dog’s brain function continues to decline, subtle behavior changes can become extremely disruptive or even dangerous for them or their families.

The abbreviation DISHAAL can help summarize the types of behavior changes commonly observed in dogs with CDS, but it's important to note that some of these changes can also be caused or associated with other medical conditions.

Disorientation – staring at walls or corners, getting trapped behind furniture that they previously navigated with ease, struggling to get around commonly used doors, getting lost in familiar surroundings, no longer responding to previously stimulating things like doorbells or food containers being opened

Interactions – spends more or less time with family or other pets in the home, unable to recognize family members, new or increased aggression, easily irritated

Sleep-Wake Cycles – sleeping more during the day, waking up in the middle of the night without cause and often paired with pacing, whining, barking, and/or howling

House Soiling – failing to alert family when they need to go, begins urinating and/or defecating in places they previously understood were off limits which may even occur right after being outside

Activity – restless behaviors such as wandering, pacing, or whining, less interest in activities they previously enjoyed such as play time, walks, or meals.

Anxiety – new or worsened separation anxiety, new phobias. Signs of anxiety can include shivering, licking, drooling, pacing, and a “wide-eyed” or “whale eye” appearance.

Learning – difficulty responding to previously understood commands, inability to learn new things

Who is affected by CDS?

According to a study done by Texas A&M College of Veterinary Medicine & Biomedical Sciences, “approximately 28% of 11- to 12-year-old dogs and 68% of 15- to 16-year-old dogs have CDS” and a similar study “found that 22.5% of dogs over the age of 9 years show cognitive impairment”. Any breed of dog can be affected by CDS but there is a slightly higher risk for smaller dogs since they tend to live longer than large dogs.

How is CDS diagnosed?

Cognitive Dysfunction Syndrome is a diagnosis of exclusion; meaning that all other possible causes are ruled out before concluding that CDS is the reason for your pet’s behavior changes.

There are many conditions that can share symptoms/behavior changes with CDS.

A dog that is painful from osteoarthritis or a soft tissue injury may not want to play like before. They may not respond to doorbells anymore because it hurts to get up and run to the door. They may become cranky or even aggressive because being touched by you or jostled by another pet in the home might be painful. They may not make it outside to potty because it’s too painful to traverse stairs or a doggie door. Decreased range of motion usually occurs alongside orthopedic and soft tissue conditions, further limiting their mobility and increasing the level of pain they experience.

A dog that is losing vision can appear confused and lost. They may struggle to recognize family members until they can pick up a familiar scent or hear a familiar voice. Dogs losing vision often rely on a consistent home environment and will memorize the layout of rooms and furniture to avoid collision. Even just moving some furniture around can make a blind dog completely lost in their own home. They may avoid going on walks or have separation anxiety because without their human to keep them safe, they are lost anywhere outside their home.

A dog suffering from a neurological condition may stumble and struggle to navigate previously simple obstacles like furniture, stairs, or doggie doors because they cannot move their body like they could before. They may start having accidents in the house because the nerve signals that control their bladder and bowels may be disrupted. It’s not uncommon for dogs to develop anxiety or restless behaviors just because they are frustrated that they cannot do what they used to.

Masses, both cancerous and benign, are always going to be high on the list as a rule out for CDS symptoms. Even if a mass isn’t malignant, it can still cause problems just by being there. For example, if a mass is located in the brain or near the spinal cord or major nerves, severe neurological issues can occur as the nerves are impinged upon and will progressively get worse as the mass grows.

To rule out these conditions, your veterinarian will begin with a thorough physical exam. There are some simple observations and manipulations that can help your veterinarian identify potential orthopedic or neurological conditions.

Routine comprehensive bloodwork and urinalysis is always recommended for seniors because it gives a quick snapshot of the bodily functions and can identify subtle changes before symptoms develop.

Radiographs (X-rays) are extremely helpful to get a general look at the organs, identify boney changes, and reveal any internal masses. If your dog is painful or agitated, sedating them for their radiographs is a kindness! Not only will they be less stressed, but since they won’t be fighting the positioning, the images will be of better quality and they are less likely to injure themselves or their medical team.

Depending on the physical exam findings, your veterinarian may recommend further diagnostics/treatment. For example, if a heart murmur is discovered or structural changes to the heart are identified in radiographs, an echocardiogram would provide more information as to the overall heart function and if medications are recommended. If severe periodontal disease is found, it may explain any difficulty with eating or pain related behavior changes and an anesthetic dental cleaning with extractions may be warranted to address pain and infection. If diabetes is revealed, dietary changes and additional lab work will be required as insulin dosages are established. Because some conditions are best managed with more specific training, equipment, and medications, your vet may recommend that your pet be evaluated by a veterinary specialist such as a neurologist, orthopedic surgeon, or internist.

How is CDS treated?

The primary focus should be to address any other conditions your pet is afflicted by as your pet’s symptoms may be significantly improved upon doing so. There is currently no cure for CDS, and potentially helpful treatments are limited but research is ongoing. It may be worth trying the following treatments as they may help improve symptoms and/or slow CDS progression.

Early research indicates that diet and exercise have the biggest impact on your pet’s brain function.

There are a few commercial diets available with promising feedback from owners of CDS patients such as the prescription formulas Purina Veterinary Diets NeuroCare and Science Diet B/D, as well as the over-the-counter formula, Purina Pro Plan Bright Mind. These diets include various combinations of antioxidants, fatty acids, and medium-chain triglycerides, which preliminary evidence indicates are likely to support brain health. If your pet is unable to make a diet switch, these nutrients can also be found in over-the-counter supplements, but be sure to evaluate these products carefully since supplements are not regulated like food or medication is.

Providing more mental stimulation can help reinvigorate brain function. Brain games that require a bit of problem solving can help exercise a “weak” brain. Examples include:

• Wrapping a favorite toy in a blanket or towel and inviting your dog to find it

• Placing high value toys or treats around a room for them to seek out

• Kong toys (freeze for more of a challenge), puzzle feeders (available in varying difficulty), and snuffle mats.

• Frequent cycling of toys; you can buy new ones or just switch them out every week, so they feel “new”. Variety is key!

• Teaching new or practicing old tricks. If new tricks are too difficult, practicing old tricks still gets the brain working.

  
  

Increased and varied exercise is also very stimulating when done with care and this is where Rehab can be an excellent tool!

At CROC, we frequently treat senior and geriatric pets with a wide spectrum of medical conditions, so our team is very comfortable handling dogs that need extra gentle care. Your pet will get calm and supportive interaction with a new group of people who will help them as novel exercises are introduced. Our approach addresses your dog’s entire body, not just the presenting complaint. In this case, it means that your pet’s diminished strength or arthritis pain will be treated alongside provision of mentally stimulating exercises. Teaching your pet to safely navigate our obstacle course will be a workout for their brain and their body, which will hopefully equate to a brighter and more confident demeanor at home. Unique experiences, like Hydrotherapy in our Underwater Treadmill, offer immense mobility benefits as well as tactile, auditory, and visual stimuli in a safe manner. Acupuncture is sometimes used for CDS patients since it can stimulate neurological function as well as relieve pain with minimal risk. To top it off, all CROC patients are prescribed “homework” consisting of massage, stretching, and exercises to do at home, further stimulating brain function as well as supporting the aging body.

What else can you do at home?

When we humans reach our golden years, we often look to make our home safer and more comfortable. The same can be said for our silver-faced pups and even more so for dogs affected by CDS. Ensure that your dog has a quiet and cozy “safe place”, similar to a den. A good quality bed is a must! Orthopedic memory foam is best since dogs at this age are almost guaranteed to have osteoarthritis and the discomfort that accompanies it. Some dogs just want a comfy bed to snuggle up in while others prefer a crate to use as a private space.

Make sure your home has flooring with good traction. Hard floors are very popular these days and while they’re great for keeping clean, many older dogs struggle with slick floors. A senior pup that is weak and contending with arthritis is more likely to slip and injure themselves. Placing rugs or yoga mats around your home can make it easier for your dog to safely navigate the house.

If there are stairs, balconies, or similar obstacles in the home, pet/baby gates can be a literal lifesaver.

For dogs with diminished vision, keeping the home environment consistent can help them avoid walking face first into walls or furniture. As a dog loses their vision, they often memorize the layout of their home and other commonly visited places, allowing them to get around even as they become blind. Sometimes, they can be so skilled at this that you could be fooled into thinking they can see! In these cases, rearranging furniture can have them completely lost in their own home, so if your dog’s vision is worsening, try to keep this in mind. They may also need better lighting, especially to get outside to go potty when the sun is down. Turning a dim room’s light on or even just using a flashlight to guide your dog can make a huge difference in their ability to make it outside to relieve themselves. Blind dogs may struggle to recognize their own family, so voices and smells become more important than ever. Make sure your blind dog knows you are approaching them before touching them, so they aren’t frightened by sudden contact.

When dogs are in a state of high anxiety or fear, a calm and patient family member can be a huge comfort.

For example, should your dog have an accident in the house, do your best to keep any frustration to yourself and instead give your pet gentle support. Dogs can feel frustration and even embarrassment in these situations because they know that what they did goes against a lifetime of training, but their body failed them in some way they couldn’t control. Helping your dog make it to the yard and making sure they are clean will go a long way toward bolstering their confidence. If your dog becomes stuck behind furniture or seems lost in their home, announcing your approach as you come to aid them can help reduce fear. Try talking to them in steady and mellow tones to let them know it’s okay and you’re there to help them.

If your dog is waking up during the night and pacing, whining, or howling, exercise and pain management may be enough to prevent this behavior, but sometimes prescription medications may be necessary. Make sure your dog is safely exercised every day and provided with adequate mental stimulation so that any excess energy is spent before bedtime. Rehab can be an immense help here! If physical and mental exercise isn’t sufficient, your dog may benefit from anti-anxiety medications or calming pheromones. You will need to discuss this with your veterinarian and finding the right medication, the right dosage, and/or the right combination of medications can take some trial and error. Try to be patient with your pup during this process and keep in mind that the first, even second or third plan, may not be the right one for you and your pet.

Possible Safety Concerns

Senior dogs can become less tolerant of certain interactions just because of pain or loss of vision, but dogs with CDS are often also contending with confusion, inability to recognize four- and two-legged family members, and increased anxiety.

It’s important to acknowledge that your dog may not only become a danger to themselves but can also become a danger to others.

Imagine going to pet your dog on an area of their body that you didn’t know was painful and your dog doesn’t realize who you are. A dog that is painful, scared, and surrounded by people they don’t recognize has a much higher likelihood of biting someone. It’s important to watch for any signs of fear aggression towards humans, especially children, as well as other pets they may share their hom e with. Some dogs are genetically predisposed to have a high prey drive, but have learned to live with the family cat, then one day they no longer remember the cat as belonging to their family so those genetics to hunt and chase kick in. Or they may prefer to avoid other dogs but made friends with their housemate, only to start fights with them once they can’t recognize them anymore.

Some of these things can be prevented despite your dog’s CDS. If your dog doesn’t recognize or no longer has tolerance for furry housemates, they may need to be kept separate using baby/pet gates. Children should be closely supervised or, if children are just visiting, it may be safest to keep your dog in another room during their visit.

Best Vs Worst Case Scenario

In a perfect world, no dog would suffer from CDS but since we cannot prevent it, we just have to do our best to manage. In the best-case scenario, your dog’s CDS symptoms are mild and easily manageable. They do not cause any significant impact to your or your dog’s life, nor are there any increased safety concerns.

The worst-case scenario is a sad one, but it is one that some pet owners face. If a CDS patient is suffering from their symptoms or is becoming a danger to themselves or others, euthanasia may be recommended. If your dog is living in a constant state of fear and anxiety despite your efforts, it’s time. If your dog is constantly soiling themselves, causing them to feel shame and you resentment, it’s time. If your dog is injuring you or other people, it’s time.

You and your pet should enjoy your time together. When your dog’s quality of life is declining or you are suffering from compassion fatigue, it’s a good time to speak with your veterinarian and make plans for the wellbeing of all involved. If things can be done to support good quality of life for you and your pet, that’s great! Of course, we want every good moment with our pet that we can get! But if you have exhausted your financial, time, or energy resources and still struggle to enjoy life with your pet, it’s okay to consider euthanasia. To learn more about evaluating Quality of Life for you and your pet, visit our in-depth article here.

Lean On Your Veterinary Team

Whether it’s our Rehab Team or your Primary Veterinarian, we veterinary medical professionals work in this field because we truly care about the health and wellbeing of your pet.

We see ourselves in you and consider each patient as if they were our own beloved pet, drawing on a wealth of knowledge and experience to help guide you.

We have all the tips and tricks to help keep life easy and pleasant for you and your pet, but we also have the compassion to support you when hard decisions need to be made. Our Rehab Team is happy to assist you both on this journey and hope to help you maximize the best parts of your relationship with your dog.