Cognitive Dysfunction, Part III: Behavior Modification

In Parts I and II of this series, we have discussed what Cognitive Dysfunction Syndrome (CDS) is, and what medical treatments are available for it. In this section, we will discuss what an owner can do at home, through behavior modification, to help maintain his senior dog's aging brain.

One of the symptoms of CDS is alterations to the dog's sleep/wake cycle. Many of these dogs sleep all day and pace around the house all night, keeping owners awake. Attempts should be made to keep these dogs active and awake during the day. Take the pet for a walk, play games outside or inside the house. If the dog is active during the day, then hopefully he will be more tired and apt to sleep when the owner chooses to, also.

Another symptom of CDS is house soiling in a previously well-trained dog. Try to get the dog outside to eliminate on a very regular and perhaps more frequent schedule. Some of these older dogs forget what they went outside for, so taking them to a special toileting area can help them to remember their "duty."

It is well-discussed how protective "brain games" can be for human minds in protecting them against dementia. There are also "brain games" you can play with your dog (and it can be fun, even in a young dog!). These activities increase blood flow to the brain, which can be protective, even in a dog who does not exhibit signs of CDS.

• Find It! Have a family member or friend hold your dog in a room while you go into another room to hide a treat or favorite toy. Return to your dog, and tell him to find the treat. Start easy, and as your dog gets the gist of the game, make it more challenging.
• The Shell Game. Turn 3 cups upside down and place a piece of kibble or treat under one of them. Shuffle the cups around and have your dog "pick" one of the cups. If he selects the correct cup, then he gets the treat!
• New tricks. Teach your old dog a new trick. While there are many methods for trick training, clicker training is a method that is positive, hands-off, and stimulates the dog to think. Tricks for older dogs include: Walk backwards, speak, hand touch, touch a target, such as a plastic lid, circle right, circle left, play dead, shake hands, wave. The possibilities are endless!
• Take your dog for a walk. Walking off your property can be more than just exercise for the body, it is very stimulating for the brain. When a dog sniffs, he is reading the scent paths of all those who have gone before him - people, other dogs, cats, and wildlife.

Cognitive Dysfunction Syndrome, Part II: Treatment

There are multiple medical treatments that can help to alleviate, or at least slow to progression of signs Cognitive Dysfunction Syndrome (CDS).

Anipryl (selegiline hydrochloride) is the first and only drug approved by the FDA to control the clinical signs of CDS. Anipryl is a monoamine oxidase inhibitor that will help to decrease the breakdown of dopamine in the brain, not only making dopamine more available, but also reducing the dangerous, cell-killing free radicals that are produced during dopamine metabolism. Anipryl should not be used concurrently with tricyclic antidepressants (i.e., amitriptyline, clomipramine) or selective serotonin reuptake inhibitors (i.e., fluoxetine). Use with any product containing Amitraz (i.e., Preventic collar, Mitaban dip, Certifect) is also not recommended.

Hill's b/d diet contains antioxidants and omega-3 fatty acids to help protect brain cells from the dangerous free radicals that are generated by the breakdown of dopamine by monoamine oxidase B (MAOB).

S-AdenosylMethionine (SAMe) is a molecule naturally present in the body that is well documented for its effects on membrane fluidity, antioxidant cellular activity and the renewal of certain neurotransmitters in the central nervous system. This molecule is available in a neutraceutical form called Novifit. This form of SAMe is a specific salt that can penetrate the blood-brain barrier for increased efficacy in the brain.

Senilife is another nutritional supplement that is a proprietary mixture containing phosphatidylserine, pyridoxine, Ginkgo Biloba, resveratrol and vitamin E that can help to prevent cognitive decline.

neutricks is a new supplement that is supported by evidence-based research for healthy brain aging. This supplement contains apoaequorin, a jellyfish calcium-binding protein. This supplement was shown to improve learning, accuracy, and enhance attention.

These medical treatment options can be used singly or in combination. Please consult with your veterinarian what might be best for your dog if you suspect your dog has CDS.


Coming up next.. Part III: Behavior modification

Cognitive Dysfunction Syndrome, Part I: What is it?

Our geriatric dogs often suffer from a variety of physical ailments. If we are blessed enough to have our dogs live to an advanced age, they do inevitably become arthritic and lumpy, and some become affected by other chronic medical problems. Some older dogs also experience behavior changes unrelated to anything that can be found through physical testing.

Cognitive Dysfunction Syndrome (CDS) is a form of dementia in older dogs. Some of the clinical symptoms include:

• Disorientation: Wanders aimlessly, gets lost in a familiar house or yard, gets "stuck" in corners or under/behind furniture, stares into space, stands at the hinge side of the door to be let out, does not recognize familiar people, does not respond to his name, forgets why he went outside.
• Decreased interaction with family members: Seeks less attention, walks away while being petted, less enthusiasm upon greeting, or fails to greet family members at all.
• Altered activity and sleep patterns: Flipping of day/night activity/sleep cycles, increased wandering/pacing, vocalization (particularly at night) for no reason.
• Lapse in housetraining: Urinates indoors, has accidents inside soon after being outside, does not ask to go outside.

Many of these clinical signs appear very gradually - so much so that the owner is often unaware of the early subtle changes in behavior.

What causes CDS? Beta-amyloid is a protein toxic to neurons that accumulates in the aging brain; it may form plaques. This is similar to findings in the brains of human Alzheimer's patients. The exact role of beta amyloid accumulation in the development of cognitive dysfunction is not yet known, but its accumulation seems to lead to decreased neuronal function in the brain.(1)

Neurotransmitters are also altered during aging. Monoamine oxidase B (MAOB) is an enzyme that has been found to have increased activity in older dogs (2). In dogs with CDS, the increase is even greater than what is considered for a normal aging change. MAOB breaks down dopamine, a neurotransmitter. In humans, dopamine affects brain processes that control movement, emotional response, and ability to experience pleasure and pain. Also, metabolic processing of dopamine results in release of cell-killing free radicals.

A study at the University of California-Davis found that 62% of 11- to 16-year-old dogs showed signs in at least one category of CDS (3, 4).

CDS can make a dog's life lonely, separated from family members who cherish their older dog's companionship. It can be as hard on family members as it is on the dog.

Coming up next.. Part II: Treatment

References:
1. Cummings BJ, Head E, Afagh AJ, Milgram NW, Cotman CW: Beta-amyloid accumulation correlates with cognitive dysfunction in the aged canine. Neurobiol Learning & Memory 1996 Vol 66 (1) pp. 11-23.
2. Campbell S, Trettien A, Kozan B: A noncomparative open-label study evaluating the effect of selegiline hydrochloride in a clinical setting. Vet Ther 2001 Vol 2 (1) pp. 24-39.
3. Neilson JC, Hart BL, Ruehl WW: Cited in Hart BL, Hart LA: Selecting, raising and caring for dogs to avoid problem aggression. JAVMA, 210(8):1129-1134; 1997.
4. Ruehl WW, Hart BL: Canine Cognitive Dysfunction. In Psychopharmacology of Animal Behavior Disorders (Dodman NH, Schuster L, eds.). Boston: Blackwell Scientific, 1998; pp. 283-304.