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Canine cognitive dysfunction
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Canine “dementia” is becoming more common as our pet population ages; this article reviews the signs, differential diagnoses and treatment for such cases.
Beverley M. Wilson
BVMedSci, BVM, BVS (Hons), PgC(SAM), GPCert(SAM), MSc, CCAB, MRCVS. Animal Behaviour, Cognition and Welfare Group, Dept of Life Sciences, University of Lincoln, UK
Dr. Wilson graduated from the University of Nottingham in 2012 and spent time in general practice (both private and charity clinics) whilst also undertaking a post-graduate certificate in small animal medicine. She subsequently obtained her Masters in Clinical Animal Behaviour from the University of Lincoln and is currently undertaking a residency in Veterinary Behavior with the European College of Animal Welfare and Behavioral Medicine. She is also a Certified Clinical Animal Behaviorist for dogs.
![Wilson B.](/sites/default/files/images/media/image/vf-333-article-6-gb-beverley-wilson.png)
Daniel S. Mills
BVSc, PhD, CBiol, FRSB, FHEA, CCAB, Dip. ECAWBM(BM), FRCVS. Animal Behaviour, Cognition and Welfare Group, Dept of Life Sciences, University of Lincoln, UK
Professor Mills graduated from the University of Bristol in 1990 and spent several years in UK charity practice, where he was responsible for setting up behavior clinics. He then worked in private mixed practice before moving into academia. He was the first person within the UK to be recognized as a specialist in veterinary behavioral medicine by the Royal College of Veterinary Surgeons (RCVS) and the EBVS European Veterinary Specialist. He was awarded RCVS Fellowship in 2016 in recognition of his contribution to the field.
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Key points
- Canine Cognitive Dysfunction (CCD) is a common problem in elderly dogs, but it can be managed to improve the welfare of both patients and owners.
- Early recognition and intervention is key to an improved prognosis for CCD.
- Many conditions can mimic CCD, so it is important to consider a range of medical differentials and comorbidities when assessing possible cases.
- Combining several management options (such as environmental or diet changes and nutraceuticals) have been shown to be the most effective treatment for CCD.
Introduction to CCD
Canine cognitive dysfunction (CCD) is a form of dementia affecting geriatric dogs (1) and although it cannot be cured, the clinical signs can be managed and the prognosis improved with early detection and intervention (2),(3). The condition is probably more common than is generally recognized (4) as dog owners often attribute the signs to part of the normal aging process and/or believe they are untreatable (5), and so do not discuss their concerns with their veterinarian (1). Indeed, it has been estimated that somewhere between 22.5-68% of elderly dogs express at least one sign of cognitive dysfunction (1),(3),(6), although this does not mean they necessarily have CCD, as the signs may be associated with other issues such as chronic pain. Accordingly, CCD is an important disease for veterinary professionals to be aware of, and it should be proactively discussed with owners in order to improve the health and welfare of elderly pet dogs (Figure 1). This article will consider the key signs, diagnosis and differentials of CCD, and discuss treatment options and the outlook for the condition.
![vet focus journal fig 1](/sites/default/files/images/media/image/vf-333-article-6-gb-figure-1.jpeg)
Figure 1. Owners may think that their dog is simply showing a normal aging process, so the clinician should be proactive in discussing possible signs of CCD during any consultation.
© Shutterstock
Presentation and etiology
CCD is a condition of older age, and therefore occurs in geriatric patients; it is commonly reported from 11 years of age, although this varies with the size of the dog and the typical life expectancy of the breed. In some studies females are reported to be more likely to be diagnosed with CCD (1). However, castrated male dogs and smaller dogs are believed to be more prone to demonstrating signs of CCD, and castrated dogs may deteriorate more rapidly (6).
The behavioral signs of CCD are frequently described using the acronym DISHA (7) (Table 1), but the acronyms DISHAA and DISHAAL may also be used, with the additional A standing for anxiety or apathy, and the L for learning (7),(8). Regardless of the preferred acronym, it is important to appreciate that there are wider emotional issues in many cases relating to temperament, mood and immediate emotional responses, such as depressive states, poor frustration tolerance or increased attention seeking, in addition to the more classic avoidance responses associated with anxiety. Table 1 reviews the classic signs relating to DISHA and important differentials to consider. Dogs vary enormously in the reported signs in the initial stages, with no consistent pattern evident (9), so early detection can be challenging. However, CCD is a progressive disease and so further signs are commonly reported over time, which means it is important to monitor these cases from the first time a sign is noticed, even if a diagnosis is not made at that time. Indeed, many owners may only seek support from the veterinarian when particular signs are causing a problem for either the dog or themselves. For example, a sudden loss of a previously known behavior (e.g., recall when off lead), house soiling (Figure 2), significantly reduced activity/interaction with the owners, or night-time waking. In these cases, the owner’s focus is on the behavior problem, but it is essential to appreciate that the issue may be more complex due to the potential role of underlying neurodegenerative changes associated with CCD. The importance of thorough history taking during consultations cannot be overstated, as many owners may be unaware of important signs or may not appreciate that they can be addressed, often assuming the changes seen are part of an inevitable aging process. Senior pet health checks and routine appointments (such as for vaccinations) provide an opportunity to actively ask an owner about signs of CCD.
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