Don't draw a blank when it comes to dementia
Mindy Valcarcel, Editor, Medicine Channel Director
Mindy Valcarcel is the Medicine Channel Director for dvm360.com, Vetted and dvm360 magazine.
Many of your older canine and feline veterinary patients are likely showing signs of cognitive decline. Have you been checking up on this treatable condition?
Gary Landsberg, DVM, DACVB, DECAWBM, knows animal cognition. Not only does he offer behavior consultation services at the North Toronto Veterinary Behaviour Specialty Clinic in Thornhill, but he is vice president of CanCog Technologies, which tests products designed to improve cognition in dogs and cats for many companies. (The company has no stake in any of these products.) At his CVC Kansas City session on dementia in dogs and cats, he presented an overview about cognitive dysfunction syndrome (CDS), sometimes thought of as the canine and feline equivalent of Alzheimer's disease in people.
Not all dogs and cats will get dementia, but a lot will get some degree of cognitive decline, says Dr. Landsberg. In fact, several of your patients may be experiencing signs right now but their owners aren't reporting them since they think it's just normal aging. It's not! You can turn back the clock with many interventions, especially if it's caught early (more on that later).
If you're thinking, “Yeah, yeah, my clients will tell me if they see these changes,” consider this: The prevalence of canine CDS has been investigated in many studies, but one shocking study showed that in dogs 13 years of age or older, 87% of dogs under 15 kg had signs of cognitive dysfunction, and 100% (!) of dogs over 15 kg had signs.1
The prevalence in cats? A study by Dr. Landsberg and Dr. Kelly Moffat found that of 154 cats over the age of 11, 67 of the cats had signs of CDS; however, after removing cats with any underlying medical problems, the prevalence was 35% (48/154).2
Senior pet behavior questionnaire
Have your clients with senior pets fill out this questionnaire at every appointment to catch early signs of dementia in their pets.
Like many behavioral diseases, this is a diagnosis of exclusion. Dr. Landsberg says to rule out medical causes first and then other behavior conditions. But there is a specific set of signs that have been pinpointed for CDS, which have been grouped into the acronym DISHAA (learn more about this from Dr. Landsberg here):
> Interaction changes
> Sleep changes
> Activity level changes
However, these signs often go unreported unless veterinarians ask. In fact, a recent study showed that 85% of cases had not been diagnosed or reported.3 In dogs, Dr. Landsberg says the most common signs reported by pet owners are related to anxiety and disorientation including overattachment, an altered sleep-wake cycle, wandering or pacing and noise fears and phobias. By comparison, in cats, owners are most likely to report the cats' waking the owners at night, increased vocalization and inappropriate elimination.
A few diagnostic questionnaires have been validated for diagnosis, including the CAnine DEmentia Scale (CADES)4 and the canine cognitive dysfunction rating scale (CCDR).5 But these questionnaires are less sensitive in their ability to screen for all possible signs. You want to catch it early. Dr. Landsberg has a general questionnaire he hands out to clients that can raise red flags before the advanced signs appear. Click here to download the questionnaire.
The good news in pets-they are unlikely to advance to the point that they would die of the disease, as can people with Alzheimer's disease. And there are ways to intervene to slow further decline and bring back better brain function, especially if it is caught early, says. Dr. Landsberg. These take the form of drugs and supplements, diets and enrichment. Some selected options include:
Drugs and supplements:
- Phosphatidylserine and antioxidant supplement (Senilife-Ceva Animal Health)-dogs
- S-adenosylmethionine-dogs and cats
- Apoaequorin (Neutricks-Neutricks, LLC)-dogs and cats
- Prescription Diet Canine b/d (Hill's Pet Nutrition)-dogs
- Essential Care Senior (Purina)-dogs
- Pro Plan Bright Minds (Purina)-dogs
- Canine Mature Consult, Feline Mature Consult (Royal Canin)-dogs, cats
- Interactive toys
Dementia may not by on your mind every time you enter the exam room, but it should be in your older patients. The most important thing to remember, according to Dr. Landsberg: “Ask the owners, diagnose the condition early and get the pet on supplements and treatments as early as possible.”
1. Katina S, Farbakova J, Madari A, et al. Risk factors for canine cognitive dysfunction syndrome in Slovakia. Acta Vet Scand 2015;58:17.
2. Moffat KS, Landsberg GM. An investigation of the prevalence of clinical signs of cognitive dysfunction syndrome (CDS) in cats (abstract). J Am Anim Hosp Assoc 2003;39:512
3. Salvin HE, McGreevy PD, Sachdev PS, et al. Under diagnosis of canine cognitive dysfunction: a cross-secitonal study of older companion dogs. Vet J 2010;184:277-281.
4. Madari A, Farbakova J, Katina S, et al. Assessment of severity and progression of canine cognitive dysfunction syndrome using the CAnine DEmentia Scale (CADES). Appl Anim Behav Sci 2015;171:183-145.
5. Salvin HE, McGreevy PD, Sachdev PS, et al. The canine cognitive dysfunction rating scale (CCDR): a data-driven and ecologically relevant assessment tool. Vet J 2011;188:331-336.