With geriatric veterinary medicine becoming increasingly important, we’re seeing our beloved friends enjoying a longer lifespan compared with previously. While this gift of more time is such a blessing, unfortunately, it has also led to other diseases becoming more prevalent. One of these disease processes is canine cognitive dysfunction syndrome (or CCDS), also sometimes referred to as canine dementia.
In the blog below, we’ll cover what CCDS is, how to recognise it, and what can be done to treat it, with an emphasis on the role of nutrition in managing cases of CCDS.
Canine cognitive dysfunction syndrome (or CCDS) – what is it?
CCDS is a degenerative, metabolic brain disorder that is associated with advanced ageing in dogs. Multiple metabolic, functional, and structural changes occur in the brain – and if these changes are severe, this leads to CCDS.
The disease, which affects dogs older than 8 years, is progressive in nature. With age comes an expected decline in cognitive function, as is the case with people, however, CCDS is considered cognitive impairment beyond what would be expected to occur with ageing.
CCDS is often compared to Alzheimer’s disease in people, given the marked similarities.
There are various mechanisms that have been identified and explored in great detail that contribute to both the development and progression of CCDS, which include:
What are potential risk factors for CCDS?
An association between thin body condition and an increased chance of cognitive decline has been identified. However, it is difficult to determine if the thin body condition is actually contributory to CCDS or if it is simply secondary to another condition or disease process. Dogs older than 8 years are more likely to have multiple disease processes, which can make it difficult to confirm a true association.
What are the clinical signs of CCDS?
How do we recognise cognitive dysfunction in our elderly dogs? Clinical signs are associated with gradual and progressive loss of cognitive functions. So, what we might see depends on the severity of the disease and can include problems with memory, attention, and trainability. Dogs with cognitive dysfunction may also appear disoriented, have changes in their sleep-wake cycle, and even show less interaction with pet parents and other animals in the household.
There is a very useful cognitive dysfunction syndrome evaluation tool that Purina Institute have on their website.
It’s handy for family veterinarians to go through the evaluation tool with pet parents of elderly dogs to assess for the possibility of CCDS and, if present, gauge the severity.
It can also be used to monitor the condition, and the recommendation is to go through the assessment every 6 months, to track response to treatment, such as nutritional intervention, and monitor for progression.
The tool – which looks at DISHAA (image above): Disorientation, social Interactions, Sleep/wake cycles, House-soiling, Activity, and Anxiety – assigns a score to each category, and the overall score is used to determine severity. We've provided a summary of the scoring below:
Scoring system (for each category) – 0 = none ; 1 = mild ; 2 = moderate ; 3 = severe
Score of 4-15 = mild CCDS
Score of 16-33 = moderate CCDS
Score > 33 = severe CCDS
This tool is also helpful when it comes to monitoring the condition, and the recommendation is to go through the assessment every 6 months, to track response to treatment, such as nutritional intervention, and monitor for progression.
How common is CCDS in the older dog population?
With advancing age, both the prevalence and severity of CCDS increase.
Depending on what study you look at, the prevalence of CCDS in elderly dog populations can vary between 14-60%.
How is CCDS managed?
Now that we’ve gone over some of the basics let’s look at how to manage dogs with CCDS. As is the case with humans suffering from Alzheimer's, the disease process is incurable and can only be managed; it’s important to stress this point because the goal is to reduce clinical signs where possible and delay or slow down further progression.
Management of CCDS requires several different therapies, which include:
1. Environmental enrichment
2. Nutritional intervention or targeted nutrition
3. Pharmacologic intervention (i.e., medication or drugs)
4. Complementary therapies – e.g., anti-anxiety treatments/medication (like calming pheromones) and compression garments such as the ThunderShirt® calming wrap for dogs depicted to the right can be useful adjunctive means of managing anxiety.
So, given we’re crazy about nutrition here, let’s elaborate on some of the nutritional strategies or specific ingredients that should be considered for dogs with CCDS.
1. Amino acids – particularly arginine, which is a precursor to nitric oxide, may help to improve blood flow in the brain.
2. Antioxidants – vitamins C and E may help to reduce oxidative stress. Vitamin E also improves cholinergic transmission and reduces amyloid lesions.
3. B vitamins – in general, these may support brain health and metabolism. In humans, B vitamin deficiency has been linked to cognitive dysfunction. However, more research is needed to determine if supplementation beyond that needed to prevent a deficient state can provide cognitive benefits.
4. Medium-chain triglycerides (or MCTs) are useful as an alternate energy source (both as ketones and MCTs) for the brain. Between 60-70% of the brain’s energy needs can be met by ketones.
5. Omega-3 fatty acids – DHA and EPA have anti-inflammatory activity, are neuroprotective, and promote cell membrane health.
Other dietary ingredients that can be used to reduce cognitive decline in dogs:
Apoaequorin - may have neuroprotective effects/properties.
DL-alpha-lipoic acid
L-carnitine
Phosphatidylserine - may improve memory, learning, and social behaviour.
S-Adenosyl-L-Methionine (or SAMe) - may improve activity levels and awareness.
What is the evidence for targeted nutrition?
So, what research is there to support that including some or all of these components in the diet of a dog with CCDS will help improve their clinical signs and delay progression of the disease?
The above study from Purina by Pan et al. showed that dogs with CCDS that were fed a diet containing a proprietary blend of MCT oil, omega-3 fatty acids, antioxidants, arginine, and B vitamins showed improvement in 5 out of 6 DISHAA categories within 30 days of starting the diet, and improvement in all 6 categories within 90 days.
Great, now what? Let’s look at what options are available if your dog has CCDS and, in addition to other management options, you’re keen to improve their diet to help manage clinical signs and slow down its progression.
Here are some commercial options that you might want to consider:
If you can’t find a commercial option that works, for instance, because you would prefer to feed a fresh, homemade diet, we do have some recipe options on our website for senior dogs, for use with our CompleteMe canine meal completer supplement.
Or, if the disease stage is more severe, and your dog has other nutritional requirements, we can also assist with a nutrition consult and formulate personalised recipes tailored to your dog’s needs.
Take-home message:
1. Canine cognitive dysfunction syndrome (CCDS) is a progressive condition that cannot be cured, only managed.
2. It is characterised by disorientation, changes in social interactions, sleep/wake cycles, and activity levels, and can also manifest in the form of house-soiling and even anxiety.
3. Managing CCDS relies on many different therapies, with nutrition playing a critical role in delaying progression.
Key ingredients include antioxidants, arginine, B vitamins, medium-chain triglycerides, and omega-3 fatty acids. Modifying the diet has been shown to really help.
References:
A double-blinded randomised dietary supplement crossover trial design to investigate the short-term influence of medium chain fatty acid (MCT) supplement on canine idiopathic epilepsy: study protocol
Aging Brain (Purina Institute):
Amyloid-beta plasma and cerebrospinal fluid biomarkers in aged dogs with cognitive dysfunction syndrome
Assessment of risk factors in dogs with presumptive advanced canine cognitive dysfunction
Canine cognitive decline and Alzheimer disease: clinical insights to solve a shared one-health problem
Canine Cognitive Dysfunction and Alzheimer’s Disease – Two Facets of the Same Disease?
Efficacy of a Therapeutic Diet on Dogs With Signs of Cognitive Dysfunction Syndrome (CDS): A Prospective Double Blinded Placebo Controlled Clinical Study
Evaluation of cognitive function in the Dog Aging Project: associations with baseline canine characteristics
Guardians’ perceptions of caring for a dog with canine cognitive dysfunction
Investigating Owner Use of Dietary Supplements in Dogs with Canine Cognitive Dysfunction
Management of Dogs and Cats With Cognitive Dysfunction
Nutrients, Cognitive Function, and Brain Aging: What We Have Learned from Dogs
Nutritional Intervention for Canine Cognitive Dysfunction
Recent developments in Canine Cognitive Dysfunction Syndrome
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