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Canine Cognitve Dysfunction Syndrome

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dieselsmom
GingerSnap
northernwitch
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Canine Cognitve Dysfunction Syndrome Empty Canine Cognitve Dysfunction Syndrome

Post  northernwitch 7/17/2010, 3:03 pm

Canine
Cognitive Dysfunction



Stewart MacKenzie


2005


Watching the decline of your pet’s physical and/or mental health after
years of vitality can be heart wrenching. We often have fond memories of
watching Fido playing fetch or watching Fluffy race around the house in
apparent glee. The concept of our pet’s senior years has changed
drastically. Old dog used to mean Fido was 7-10 years old. Now pets
are enjoying active healthy lifestyles well into their early teens, and it is
not unheard of dogs living into their mid to late teens, and even early
twenties! With the increasing life-span of cats and dogs due to advances
in healthcare, and nutrition, new health issues are moving to the forefront in
small animal practices everywhere. Where it used to be quite rare to deal
with senior pet issues in clinics, there has been a shift in the practical
dynamics of clinic work. Increasingly practitioners include senior pet
health exams as standard protocols, and the development of strategies to deal
with existing issues and in prevention to ensure a better transition for pet
and owner into their pet’s senior years. An area of great concern for
veterinarian and pet owner alike is the decline in a pet’s cognitive
functioning as they get older. Information will be relayed in the
following context; what is “canine cognitive dysfunction”, how does it occur,
and what are the prescriptive and non-prescriptive things that can be done to
help pets in their senior years.




Questions abound when owners first hear a diagnosis of “Canine Cognitive
Dysfunction Syndrome” (CDS). The first question usually asked is “Like
Alzheimer’s”? The answer is, yes; as dogs age, they can develop a
form of neurodegenerative disease that has many similarities with the age
relate cognitive disorder Alzheimer’s in humans. More specifically, “like
humans, canines naturally accumulate deposits of beta-amyloid (AB),
a type of protein plaque, in the brain with age. Further, canines and
humans also share the same AB sequence that first show as deposits
of the longer AB1–42 species followed by the deposition of AB1–40.
Aged canines like humans also show increased oxidative damage. As a
function of age, canines show impaired learning and memory on tasks similar to
those used in aged primates and humans. The extent of AB
deposition correlates with the severity of cognitive dysfunction in canines”
(Cotman etal 2002). Ultimately the term Canine Cognitive Dysfunction
Syndrome is now used to describe the above progressive neurodegenerative disorder
in senior dogs. It is generally marked by deficits in learning, memory,
perception and awareness.




There are other disorders that can result in some of the same signs and
symptoms, also seen in Canine Cognitive Dysfunction. Such disease
processes as “metabolic and endocrine disease, to painful conditions such as
arthritis or dental disease” (Lansberg 2004) can result in some of the same
behaviours as CDS, and it would be advisable to rule out any possibility that
these are the root cause. However, specific concerns of: house soiling,
disobedience, confusion about previously regular habits, anxious pacing and
panting (generalized anxiety) all indicate a primary concern of CDS.
Clinically, owners often describe pets with cognitive decline as having,
increased anxiety, a decrease in general hygiene and grooming habits, altered
appetite, decrease response to stimulus (such as going for a car ride) and
problems with learning and memory. These and other symptoms have lead
clinicians to adopt the acronym DISHA to describe the following conditions “Disorientation,
altered Interactions with people or other pets, Sleep-wake cycle
alterations, House-soiling and altered Activity level (Lansberg
2004).



With
clear symptoms and signs of CDS, we move to the next step, getting a definitive
diagnosis. Although of great clinical value in the diagnosis of CDS (not
many clinics have one), a Toronto General Testing Apparatus or TGTA is one way
to get a clear cut definitive diagnosis of cognitive impairment.
Generally, the TGTA tests an animal’s ability to recognize, remember and
choose objects based on similarities and differences, with the resulting proper
choice being reinforced with a desired food reward. It has been shown
that while young dogs have little problem learning this task, older dogs are
unable or have great difficulty in learning to recognize previously reinforced
articles. Fortunately, the average clinical practitioner can modify such
tasks in the clinical setting, and along with curiosity tests (a basket full of
toys, and the dog’s general interest and desire to explore and play with the
toys), assign them a level of functioning based on observed outcomes.
“Using memory tasks, old dogs can be separated into three groups: unimpaired,
impaired and severely impaired” (Lansberg 2004). Assuming there is a
definitive diagnosis of CDS, there are many different medically prescriptive
and non-prescriptive treatment options available.



The first type of treatment available to the aging
dog is in the area of nutrition, or what is commonly known as “dietary
therapy”. “Widespread oxidative damage, extensive production of free
radicals, and lowered vitamin E levels have all been identified in the brains
of dogs with dementia” (Lansberg 2004). It has been widely acknowledged
(Milgram et al 2002), that antioxidants, such as vitamins E, C and other
factors such as beta carotene, selenium along with mitochondrial co-factors
such as L-carnitine, and DL-alpha-lipoic act synergistically to improve antioxidant
defence, improve clearance of, reduce production and the effects of free
radicals. Free radicals are the toxic result of high rates of oxidative
metabolism. Levels of the above vitamins, minerals and co-factors can be
improved through the supplementation of fruits and vegetables in the dog’s
diet, or by using commercial preparations with these ingredients in them.
Interestingly there is also a new canine therapeutic diet available through
veterinarians produced by Hill’s Pet Nutrition specifically formulated to treat
CDS. Called Canine b/d®, “the diet’s efficacy was assessed using
neuropsychological testing procedures for more than 2 years” (Lansberg 2004),
and was proven effective in improving performance on a number of cognitive
tests.



The
second area of treatment available are those that are medically
prescriptive. Drugs such as Selegiline and Anipryl ® are MAO (monoamine
oxidase) inhibitors. While it is still not clear how these drugs improve
dogs with CDS, “enhancement of dopamine and other catecholamines in the cortex
and hippocampus is presumed to be an important factor” (Lansberg 2002).
Dopamine and Catecholamine levels in the brains of dogs with CDS are
significantly low. The use of the drug Anipryl ® has had promising
results. Pfizer, the makers of Anipryl ® recommend that the dosage for oral administration for the control of
clinical signs associated with CDS is 0.5–1.0 mg/kg once daily, preferably
administered in the morning. This is maintained
for a month and
then the dosage is adjusted accordingly until the desired balance/response is
achieved. It needs to be remembered however that there needs to be
sufficient amount of time taken to instill a significant noticeable response in
the dog.



Ultimately decisions about aging pets are never
easy to make. Living with an animal diagnosed with CDS can be heart
wrenching and difficult. While there are things that can be done to
alleviate some of the symptoms seen in aging pets, conditions may worsen, or
new problems due to aging can materialize. There is a wide choice of
treatments available to clients willing to spend the time to find the right
balance in treating their pet. It needs to be remembered that a dog’s
apparent misbehaviour is probably not intentional, but an effect of his condition.
While it is always desired that pets live full happy lives, with greater
longevity, cognitive dysfunction in aging pets will be increasingly seen in
clinics and by more practitioners. All involved need to be aware of the
options available to them in treating this disorder.



References:


Cotman, C. W. et al. 2002. Brain Aging in the Canine: a Diet
Enriched in Antioxidants



Reduces Cognitive Dysfunction. Neurobiology of Aging 23: 809–818


Borra’s,
D., Ferrer I., and Pumarola, M. 1999. Age-related Changes in the Brain of
the Dog. Vet Pathol 36:202–211.



Dimakopoulos,
A. C. and Mayer, R.J. 2001. Aspects of Neurodegeneration in the Canine
Brain. Waltham International Symposium: Pet Nutrition Coming of Age.



Lansberg,
G. 2005. Therapeutic Agents for the Treatment of Cognitive Dysfunction
Syndrome in Senior Dogs. Progress in Neuro-Psychopharmacology and
Biological Psychiatry 29: 471-479.



Milgram,
N.W. et al. 2002 Landmark Discrimination Learning in the Dog: Effects of Age,



and
Antioxidant Fortified Food, and Cognitive Strategy. Neuroscience and
Biobehavioral Reviews 26: 679–695.
northernwitch
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Post  GingerSnap 9/5/2011, 9:37 am

I was searching for info on Sammy and found this article. Good one, Blanche. For those of you who have gone through this with your older dogs, can you tell me how it presented and how you managed it?

What I'm seeing that's distressing me most with Sammy is mostly at night-- agitation, barking at nothing (he's always been a barker, but it's become relentless at night), difficulty settling down, aggression with Jackson, and last night he started trying to attack the French door-- pawing at the leaves that were sticking out from the bottom of it and gnawing at the bottom trim that divides the panes. He's also started balking at going down the stairs inside the house, although he doesn't seem to mind going down the stairs off the back deck, which are actually longer and steeper than the ones from the second floor. Luckily, he hasn't started having difficulty sleeping through the night-- once we go to bed and he gets to sleep, he's good.

When we saw the vet for his checkup, she and I weren't sure if it was true cognitive dysfunction or if he was just becoming a cranky old man because he hurts and he can't see. He does have hip dysplasia, and arthritis throughout most of his spine, and his already not-great vision in his remaining eye is getting worse. She suggested starting with getting back on glucosamine/chondroitin and fish oils (which I did) and vitamin E (which I honestly kind of forgot about until I started writing all this out.

So for those of you who have been through this, does this sound like what's going on? Or is he just a cranky old man? We think he might be around 11 or so, but don't know for sure.
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Post  dieselsmom 9/5/2011, 11:49 am

I'm no help on the cognitive dysfunction side, but am wondering if he's on a daily pain med because of his arthritis? Also, did the vet suggest anything like Vallium to help him settle at night? Kayla started getting restless at night - part of it was she was uncomfortable and part because night restlessness seemed to just be a part of the DM she had. After many weeks of this, I was at the end of my rope and the vet suggested a small dose of Vallium. It worked wonders to help her settle down at night. I wonder if something like that might help Sammy.
dieselsmom
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Post  Aussie Witch 9/5/2011, 1:13 pm

Excellent article. I have not had a dog develop this, and hope it stays that way.
Aussie Witch
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Post  lisamak 9/5/2011, 1:34 pm

Hi Ginger - sorry to hear Sammy's having a tough time. Vince has CDS, I dx'd it in April and got vet to agree Wink He is blind and deaf so walks in circles and bumps in to stuff already - so those symptoms weren't helpful. Basically, he started waking up first at 5 am, then 4, then 3...each time he woke up he'd want to go out and he'd want a pretty substantial snack (basically he thought it was breakfast each time he got up). He was also pacing (and barking) incessantly, but just after hours. He's considered a 'sun-downer". After about a week of this he was waking up at midnight and then every hour after that - I had absolutely no sleep for days and was truly glad he was deaf so he couldn't hear the horrible names I was calling him Shocked

I googled about alzheimer's as there wasn't anything else to point to. We tried valium first (we'd already been through melatonin), so when he'd wake up I'd take him out, give him snack and valium. No effect at all. Then he started to pee in the house - which in the 5 years since I adopted him he's never done. Not marking, just would walk right by you and pee on the rug. *That* is a huge sign of CDS so after 2 days of that I told vet I wanted a 'scrip for Anipryl. It only works if you start it really early and I didn't want to wait for it to be too late. Vet honestly thought it was cancer, based on his age and all that. I said whatever, its my $60/month to waste if its not CDS. The anipryl has been a huge success. We started seeing random good nights (again, no daytime symptoms, no dementia signs...yet) after about 2 weeks. After about 2 months we'd get 3 or 4 nights where he'd sleep 'til 4 and only wake once. Its now been 5 months and he's on Zeal from THK exclusively and he sleeps straight through the night most nights.

Now Sammy's having different symptoms - but the night-time agitation is a big part of CDS. Vince already was on THK and gets supplements so I didn't have the option to add anything else to the mix to try and help. Again, anipryl doesn't work on every dog and it only works if you catch it early. If I were you I'd talk more with the vet (if he/she is experienced with CDS) and start it. I get it at Drs. Foster & Smith. My vet is thrilled its working for Vince as for both vets in the practice its the first time they've tried it - and neither had much hope for it. Vince has always been a cranky old man (and he's got hip issues and arthritis issues and all that) but it was *impossible* to get him to settle, that's what I'd use as the distinction. There really was no way to appease him and get him to relax.

Good luck!
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Post  northernwitch 9/5/2011, 1:44 pm

Yes, the agitation, the wandering, the random barking (especially at inanimate objects) and the aggression are all indicators of CDS. And it can be tough to figure out when the dog is older, hearing and visually impaired and may have pain.

In humans, that night agitation is often called sundowning--as it most often starts to occur at sundown.

I've used Anipryl with my CDS dogs--and I've had two of them now.
northernwitch
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Post  GingerSnap 9/5/2011, 11:34 pm

Thanks for sharing your experiences. Lisa, is there something special about Zeal that makes it more appropriate for these guys? Raw? Fish-based? Grain-free? My guys get THK, but not usually Zeal. Between the cost, the gas that it gave Sammy, and the smell that I personally don't like, it's not my go-to food, but if it will help, I could switch back.
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Post  Renee 9/6/2011, 12:23 am

I just want to chime in and say that the muscle relaxers have been invaluable for helping Ichiro settle at night. It's not valium he is on, but it is similar. He used to be so restless at night and then I would be up all night too. He gets one every night with his dinner.
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Post  northernwitch 9/6/2011, 7:07 am

Ginger:
There are some supplements and dietary things that can be used for CDS--and yes, fish is considered good for CDS dogs. I can email you the information if you would like.

PM me your email addy and I'll send them on
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Post  PugLady3 9/6/2011, 9:57 am

Our 11 year old blind foster pug Mae was started on Anipryl about two weeks ago. She gets agitated easily, wanders/paces A LOT (sometimes peeing as she goes), barks A LOT for no apparent reason, wakes up very early or in the middle of the night & starts barking, sometimes gets stuck in corners, and will lash out out of the blue - usually at the other pugs but she's gone after our ankles a couple of times too. Her previous foster home thought that most of her behaviors were due to the blindness but the more we observed her once she was here, the more I was convinced that it was cognitive dysfunction. It's too soon to tell if the Anipryl is going to help since they say that it can take up to a month, but we're hoping!
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Post  lisamak 9/7/2011, 9:41 am

GingerSnap wrote:Thanks for sharing your experiences. Lisa, is there something special about Zeal that makes it more appropriate for these guys? Raw? Fish-based? Grain-free? My guys get THK, but not usually Zeal. Between the cost, the gas that it gave Sammy, and the smell that I personally don't like, it's not my go-to food, but if it will help, I could switch back.

Hi Ginger. Vince et al were already on raw, grain-free and I alternated between Primal, THK and Addiction. The saying 'fish is brain food' stuck in my mind after we won a free box of Zeal from THK and Vince started getting it exclusively. In addition to the regular benefits of the omega oils and all that, the vitamin D has been shown to improve cognitive function in humans in lots of studies (improve and / or lessen decline I should say).

Zeal is the most expensive, smelliest and messiest...and my husband hates it Wink But its working so I'll deal with the incidentals.
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