Canine Cognitive Dysfunction Syndrome

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.

Canine cognitive dysfunction (CCD) is Alzheimer's disease in dogs. Use natural remedies to prevent and alleviate the symptoms of CCD.

Just like Alzheimer's disease in people, canine cognitive dysfunction affects mostly older dogs. It is the age-related deterioration of cognitive abilities characterized by behavioral changes in dogs not caused by a particular physical health problem or reaction to medication.
The exact cause of this syndrome is not clearly known. However, it appears that physical and chemical changes in the dog's body affect the brain function of the dog. Microscopically, abnormal protein accumulations can be seen within the brain of a dog with cognitive dysfunction, and its blood vessels become visible (as in people with Alzheimer's). Ultimately, the brain lesions interfere with proper nerve transmission, resulting in behavioral changes in the dog.
In a pet owner study, nearly half of all dogs aged 8 years and older showed at least one sign of canine cognitive dysfuntion syndrome.

Signs and Symptoms of Canine Cognitive Dysfunction
The top most common signs and symptoms of canine cognitive disorder include:
• Deafness
• Lethargy, weakness
• Excess sleep (sleeps a lot during the day)
• House-training problems (urinating at inappropriate places)
• Staring at the wall
• Restlessness
• Aggression because the dog cannot recognize his friends or family members
• Disorientation - the dog may wander aimlessly; may appear lost or confused in familiar places such as own house or yard; may get stuck in corners or under/behind furniture
• Poor coat

Conventional Treatment of Canine Cognitive Dysfunction
The drug Anipryl has been approved by the FDA for treating canine cognitive dysfunction. Most dogs are prescribed one tablet per day. While effective in some dog patients, the drug can cause some side effects in others, such as restlessness, disorientation, confusion, vomiting, increased thirst, anemia, stiffness and lack of appetite. If no side effects are shown, this drug has to be used for the lifetime of the dog.
Since the medication is rather expensive, if your older dog is showing signs of CCD, you may want to consider natural alternative remedies.

Natural Remedies for Canine Cognitive Dysfunction
Quite a few herbs and nutritional supplements can be used to help prevent and improve canine cognitive dysfunction. They include:
• Choline: Choline is an organic compound, classified as a water-soluble essential nutrient and is usually grouped within the Vitamin B complex. Choline is a "building block" needed to produce the neurotransmitter acetylcholine, responsible for mediating brain functions such as memory, intelligence and mood. A deficiency in acetylcholine is believed to be a contributing factor in senility in general and Alzheimer's disease in particular. A clinical study has found that choline supplementation was effective for reversing signs of cognitive dysfunction in both dogs and cats. Recommended dosage is 50 to 100 mg daily for a 50-pound dog.
• Ginkgo: The herb ginkgo is widely considered as an "antiaging herb". It has proved effective in treating Alzheimer's disease in both people and canine. Ginkgo enhances both long-term and short-term memory in puppies and senior dogs alike.
• Rosemary: Rosemary is another effective herb that can help prevent the breakdown of acetylcholine in the brain. In addition, rosemary is an important antioxidant.
• Bacopa: Commonly known as Waterhyssop, bacopa is an Ayurvedic herb and has been used for a long time in India as a brain tonic to enhance memory and concentration.
• Gotu Kola: This is a traditional herb of both Chinese and Ayurvedic medicine, and has antioxidant properties that can protect the body from damage by free radicals. It is particularly useful for memory problems and stress-related disorders.
• Flaxseed Oil: Flaxseed oil is beneficial for older dogs as it is an excellent source of Omega-3 fatty acids, the "good fats" that have anti-inflammatory properties and can reduce cholesterol and prevent blood clots.
Canine Cognitive Dysfunction - Natural Products
• Basic B Complex by Thorne Research: This contains the entire B-complex, including 80 mg of Choline citrate.
• Memoractiv by Thorne Research: This is a unique combination of various antiaging herbs and supplements such as Ginkgo, acetyl L-carnitine, and Bacopa. This is an excellent supplement for dogs with age-related decline in brain functioning.
You can get these supplements here:
Natural Vitamins & Supplements for Dogs & Cats at Only Natural Pet Store


Preventing Canine Cognitive Dysfunction
If you are the parent of an older dog (7 years or older), and you are concerned about the possibility of your dog developing canine cognitive dysfunction, please take action now! Prevention is better than cure. One of the most important thing to do is to minimize inflammation in older dogs (minimizing inflammation may prevent or decrease the incidence of CCD as well as many other disorders, including cancer).
Take these steps now to minimize inflammation and prevent CCD:
• Begin giving your dog choline and herbal supplements.
• Begin giving your dog anti-inflammatory supplements (flaxseed oil, antioxidants).
• Switch to a natural diet if you have not already done so.
• Minimize vaccinations.
• Minimize or stop using chemical flea and tick products. Switch to natural flea and tick products instead.

Source: http://www.natural-dog-health-remedies.com/canine-cognitive-dysfunction.html

I'm bringing this post back up because I need some pug expert opinions. Our foster/hospice pug Mae has been on Anipryl for a little over 2 months now because we suspected CCD. She is 11-15 years old (don't know for sure), blind, and will lash out at pugs or humans (or sometimes inanimate objects) for no apparent reason. She was in another foster home from March-May of this year and then we moved her to my house where the pugs are older & there's no kids/less activity. She's doing better than she when she first arrived but she still has to be kept separated 95% of the time. She will tolerate some handling - quick petting, face cleaning, eye drops - but she will start to growl & eventually snap if you take too long. The Anipryl doesn't seem to have made much of a difference and my husband & I starting to question her overall quality of life. She gets around fine, eats with gusto, and is otherwise healthy but something in that little brain of hers is just not right. She'll be fine one second and then the switch will go off and she's Cujo the next second. We've also tried a Thundershirt & Rescue Remedy but neither of those helped either - in fact, she seemed more agitated by both. Should I switch her to doggie Prozac or something along those lines? I don't want to give up on the cute little beast but we hate to see her so unhappy all of the time too.

Brenda:
I've found the Thunder Shirt can make dogs who are extremely touch sensitive worse. It's like their worst nightmare all over their body. It helps some dogs around fear issues, but I find the touch sensitive ones just get completely overwhelmed. And I've had dogs get more anxious and hyper active on rescue remedy--I've also seen that happen with Benadryl.

It might be worth trying a canine prozac--especially given that you don't have a ton of options and the Anipryl isn't impacting the behaviour. I figure you have nothing to lose by it. If it doesn't work or turns her into a zombie, then at least you know and you've tried it.

Poor little soul.

So sorry Brenda. I hope the prozac helps.

northernwitch wrote:Brenda:
I've found the Thunder Shirt can make dogs who are extremely touch sensitive worse. It's like their worst nightmare all over their body. It helps some dogs around fear issues, but I find the touch sensitive ones just get completely overwhelmed. And I've had dogs get more anxious and hyper active on rescue remedy--I've also seen that happen with Benadryl.

It might be worth trying a canine prozac--especially given that you don't have a ton of options and the Anipryl isn't impacting the behaviour. I figure you have nothing to lose by it. If it doesn't work or turns her into a zombie, then at least you know and you've tried it.

Poor little soul.

Blanche-thanks for the input on the Thunder Shirt. I was going to try one on Peachy, but she is very sensitive to touch. In fact, at PugOWeen, I asked Linda (the animal communicator) why she gets so upset when she hears beeping (like a truck backing up). I thought maybe it was something to do with her past. She explained to me that Peachy has a very sensitive nervous system and those sounds, and even touches are perceived differently on her body than other dogs. It made sense to me because I see that with my sensory integration kids that are on the spectrum. Linda told me the areas that Peachy enjoys being touched (head and back of ears) which I had suspected. Also, she said that the acupuncture helps the chi flow around the kidneys and bladder (problems she has had since beginning hospice). I had assumed the acupuncture was helping the arthritis, but apparently much more. I wonder if the shirt would help Bubba and his anxiety though.

I'm intrigued by the thundershirt for Sammy. He craves touch and is a big leaner, against people, furniture, deck railing, whatever is available. I do wonder if it might help him some.

GingerSnap wrote:I'm intrigued by the thundershirt for Sammy. He craves touch and is a big leaner, against people, furniture, deck railing, whatever is available. I do wonder if it might help him some.

The "hug" vest really works on some of my students. I forget which dog at BF had a thundershirt hanging on the door. It was the first cage on the right when you walked in the door at either Old Friends, The Clubhouse, or the Gardens.

I also happen to be fascinated by the fact that similar things work well for some of your sensory integration dysfunction kids. That somehow lends it more credibility in my book. Kind of like how acupuncture working for dogs helps me give it more credence in humans.

Salvador was on Anipryl, for over a year. It did help, but it doesn't stop the progression completely. He started growling and snapping at me, towards the end. If he didn't even recognize his momma, I took it as a sign that it was time.

I also work with special needs kids and deep pressure can help some of them.

Really, you have to go by your gut feelings, on her quality of life and if she enjoys the majority of her time.

I always said that Salvador would still be trying to eat, no matter what was wrong with him. He could have had a disabling stroke and he would make the effort to wolf down some food.

Candace wrote:Really, you have to go by your gut feelings, on her quality of life and if she enjoys the majority of her time.

She spends the vast majority of her time sleeping, so it's hard to tell if she's really enjoying much. She does like to get out in the yard to just wander around and smell things though. That's when I sense that she's the happiest. Oh, and treat time of course! Getting her outside is the hard part. Since she's blind and we have a few steps, she has to be carried so that's when she really goes into attack mode. Also when she's in an unfamiliar environment - that really gets her going. Anyone who saw her at Milwaukee Pugfest this year can attest to that!