The winter years: Managing pets with cognitive dysfunction

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As pets live longer lives, the likelihood that they'll suffer from age-related neurodegenerative disease also increases. In one international survey, an estimated 14.2% of older dogs suffered from canine cognitive dysfunction (CCD).1 The study also found that only 2% of the dogs with clinical signs consistent with CCD had been diagnosed as such by a veterinarian.

The important thing to remember, says Julia Albright, DVM, DACVB, who spoke at a recent Fetch dvm360 conference, is that CCD can be diagnosed through simple questions about the pet's behavior during veterinary appointments.

Using the acronym DISHAA, created by Gary Landsberg, DVM, DACVB, DECAWBM (companion animals), take a history at each veterinary appointment to help to identify changes in the pet's behavior and cognitive functioning, Dr. Albright says. If you don't ask, the pet owner may not think to bring up behavior changes because they chalk them up to “normal aging.”

DISHAA stands for:

> Disorientation

> Interactions (changes in how the pet interacts with owners)

> Sleep-wake cycle alterations

> House soiling

> Activity level changes

> Anxiety level changes

Behavior changes like sleep-wake cycle alterations and house soiling are the ones that bring pet owners in to see Dr. Albright most often when signs of CCD begin to become more severe. “Pet owners can deal with the other stuff, but they can't deal with a lack of sleep,” she says.

While there's no cure for CCD, there are ways to intervene medically and behaviorally, Dr. Albright notes: “We can perhaps slow the progression-there are things that can be used to improve cognitive functioning and quality of life.”

Medical management

The most important thing to do, Dr. Albright says, is to keep on top of any medical issues the pet may be experiencing in addition to CCD by pushing for twice-yearly veterinary visits. “You can explain that if the 14-year-old pet is only coming to the veterinarian once a year, that's like you going to the doctor every four or five years,” she says. “That's not acceptable in a geriatric patient.”

Antioxidants, either through diet or supplements, are also important for these patients. Vitamins A, C and E can be used individually, but for maximal effect they need to be given together, Dr. Albright says. Fatty acids and L-carnitine are good for muscle maintenance in these patients as well. Several diets containing a combination of these supplements may help support pets' cognitive functioning, Dr. Albright says, including Hill's Prescription Diet b/d. Purina Pro Plan Bright Mind and Purina Pro Plan Veterinary Diets NeuroCare are medium-chain triglyceride diets and offer a different mechanism for improving cognitive performance by allow the body to produce alternative fuel sources to glucose.

Situational anti-anxiety or sedating medications can be used in mild or stronger doses for problems such as nighttime waking. The first drug Dr. Albright usually reaches for with older animals is gabapentin. “It's really safe, it's anti-anxiety and it's got a pain-altering effect,” she says. She also uses trazadone with a number of her CCD cases, because she considers it fairly safe.

However, an increasing body of research is showing that benzodiazepines can hasten cognitive decline in geriatric people, Dr. Albright says. “It's not that I don't use them anymore, but I do warn the pet owner that we may be working on short-term quality of life and sacrificing longer-term cognitive health,” she says.

There are also maintenance medications to consider, such as selective serotonin reuptake inhibitors, which increase serotonin and decrease moderate anxiety. “Those are something you commit to giving every day,” Dr. Albright says. “They take weeks to take effect. It's not a good day, bad day kind of thing.”

The drug Dr. Albright is the most careful with is selegiline, an FDA-approved medication for CCD, because it has the highest risk of causing serotonin syndrome, she says. “I would never use another serotoninergic drug with selegiline,” she says. “And I don't prescribe it a lot because of this; I feel that these patients need to be on polypharmacy and it limits what I can prescribe.”

Environmental management

Mental enrichment is highly beneficial to CCD patients, Dr. Albright says. In fact, the more researchers learn about enrichment, the more she thinks it will be “prescribed” like a drug. Brain chemistry changes that occur after enrichment activities are similar to what happens in the brain when an antidepressant is taken. “You need to prescribe enrichment for all your patients,” she says. “Especially the older ones.”

Aromatherapy, pheromone therapy and classical music or white noise have all been shown to relax shelter dogs, Dr. Albright says. “I love white noise,” she says. “With older dogs in particular, with nighttime waking they're perceiving the same noises they've heard for the last five to 10 years in different ways. And it can now sound scary to them.”

Exercise can also be a vital component to managing signs of CCD. If a pet sleeps all day, it may not have a good night. “Even if you can't take them very far on a walk, they can still walk to the end of the block. Car rides or strollers, as silly as it seems, at least let them get out,” Dr. Albright says.

Puzzle toys or scent games can be beneficial for these pets as well. “It's a great form of enrichment because there's no training involved and it's working their brain without a lot of physical strain,” she says.

Wrapping up

Dr. Albright stresses that if a pet owner comes in and says they're not sleeping, you have to do something right away-that pet is on the fast track to euthanasia or leaving the home.

“You just can't be rational when you haven't slept. We've boarded dogs before [at our hospital] when the pet owner has come in and said they're frustrated and want to euthanize,” she says. “I say, ‘I'm not going to try to change your mind, I just want to make sure you're in your full faculties when you make that decision.'”

Veterinarians can help them make that best choice, she says.

Reference:

1. Salvin HE, McGreevy PD, Sachdev PS, et al. Under diagnosis of canine cognitive dysfunction: A cross-sectional survey of older companion dogs. Vet J 2010;184:277-281.