Adapted from From notes by Susan and Michael Cain
What is Canine Cognitive Dysfunction ?
“CCD is a degenerative process similar to Alzheimer’s in humans,” explains Fanucchi. “Confusion, affected social relationships, changes in activity level, apathy, increased anxiety, compulsive behaviors, restlessness, fear of familiar objects and people, aggression, and changes in sleep-wake cycle as well as house soiling and excessive vocalizations are all symptoms.”
Although the human and canine brains are significantly different, their similarities are striking, with anatomical and physiological presentations of dementia and the disease’s practical impacts appearing almost identical in humans and dogs. More, dogs’ brains react to dementia treatments exactly as human brains do, making them ideal human dementia testbeds.
As with human dementia, causes of CCD are not well known. But accumulations of sticky proteins called beta-amyloid plaques around neurons, and the breakdown of neurons resulting in so-called neurofibrillary tangles, are considered leading causes. As in humans, both phenomena impact the brain by interrupting nerve impulse transmission.
According to Fanucchi, there are four distinct types of CCD.
Involutive depression, which may be caused partly by untreated anxieties, is similar to chronic depression in humans. Untreated anxieties seem to play a key role. Because some of the symptoms, such as house-soiling, often result in the dog’s confinement, both anxiety and symptoms worsen.
Dysthymia, or dystemic disorders, often involves loss of proprioception, and dystemic dogs often get stuck in corners and behind furniture. But there’s a more serious dimension to dysthymia, as sufferers sometimes bite. “If you interrupt a dog while he’s in a dystemic state, he can get mad and bite,” cautions Fanucchi.
The third type of CCD, ‘hyper-aggressiveness in old dogs’ is associated with dysfunction related to serotonin. Cortical tumors can also be involved.
“Dogs with this form of CCD lose their ability to communicate with other animals,” explained Fanucchi. “They bite first and warn second.”
The fourth form of CCD, confusional syndrome, involves profound decline in cognitive ability. Dogs with this form of dementia “just don’t seem to learn well in any form,” said Fanucchi, noting that confusional syndrome is the closest thing to Alzheimer’s in humans.
When we recognized the possibility of dementia in Mic, we began researching. We quickly discovered Eileen Anderson, whose book Remember Me? and website Dog Dementia: Help and Support are invaluable CCD resources.
Among Anderson’s many helpful tools is a CCD symptom checklist. But it comes with a warning.
“The most important thing to understand is that any apparent CCD symptom could also point to a serious – and perhaps treatable – medical condition,” Anderson stresses. The first stop, she emphasizes, is the vet.
Certified professional dog trainer Carol Byrnes, owner of Diamonds in the Ruff in Spokane, agrees.
“The first advice for out-of-the-norm behavior changes is ‘See your veterinarian for testing and possible medical intervention,'” she stressed.
But when standard tests reveal no medical cause for dementia symptoms, it’s time to consider CCD. However, dog owners may find that at least initially they’re on their own, as CCD is not yet widely understood in the veterinary community. Veterinary behaviorists and holistic veterinarians are particularly good options.
Prevention is the best medicine
While ongoing research offers hope, canine dementia is not yet considered reversible. However, CCD can be prevented and, failing that, its symptoms minimized.
As with humans, prevention in the form of lifelong holistic care is key. But at some point in every dog’s life, routine preventive care must be fine-tuned with the specific aim of preventing CCD. This involves the addition of anti-aging factors through diet and supplements. Such a regimen should be implemented prior to the onset of active CCD.
“It’s essential to begin treating CCD before its signs first manifest because CCD’s early symptoms are very subtle, almost unnoticeable,” stresses Fanucchi. Timing varies depending upon size, as larger dogs tend to live shorter lives.
“Begin giant breeds at age five, small breeds at ten, others in between,” explained Fanucchi.
According to Fanucchi, CCD treatment involves management of behavior and environments, enhanced diet, and medication. Its dual goals are slowing the disease’s progress and improving quality of life for dogs and their people.
“Behavior can be effectively managed by providing daytime activities and opportunity for play, and structured social interaction for physical and mental stimulation,” said Fanucchi. “Exposure to sunlight will help regulate the sleep-wake cycle. If they can’t walk anymore, use a wagon or a stroller. Anything to get them sunlight and stimulation.
Not letting the dog act elderly is vital, Fanucchi stressed. “Don’t treat the dog as old. Understand there are limitations, but don’t give up on that dog. You have to keep walking the dog – especially now.”
“Managing the environment is very important,” she emphasized. “Make it more predictable. You pet-proof the house just as you’d toddler-proof it.”
Specifics of each family’s circumstances are important, says trainer Carol Byrnes. “I help clients explore the specifics of the behavior and consider what may be happening from the animal’s point of view,” she said. “I help identify ways to establish routines and patterns that give the dog safety and help him feel secure, while allowing the people to manage their own daily routine. We look at ways to keep the dog mentally engaged and active and improve his quality of life.”
Providing adequate toileting opportunities is important, as old dogs can’t “hold it” as they did when they were younger. Diapers, pads, and waterproof bed and furniture covers can be helpful.
Nutrition options fall into two categories, commercial and food made at home from whole natural ingredients. Commercial foods focus on the addition of antioxidants for cellular-level health and medium-chain triglycerides for cognitive improvement. Only three manufacturers – Hill’s, Purina, and Royal Canin – offer prescription senior dog food.
Holistic veterinarian Thomas acknowledges commercial foods’ benefits but advises a different course.
“I don’t recommend heat-processed food for dogs. I recommend feeding a balanced, wholesome natural diet with the same beneficial supplements added.”
The pharmacological approach to CCD treatment also focuses on control of oxidation and enhancement of brain function. The antioxidant supplement SAMe has proven effective in both preventing CCD and moderating symptoms. Antioxidant nutritional supplements such as Denamarin, Silybin, vitamin E, Cholidin, and omega-3 fatty acids can be added to any diet, as can Solliquin, an amino acid that can reduce CCD-related anxiety. However, no supplement should be added to a dog’s diet except under a veterinarian’s guidance.
The drug primarily used to treat CCD by improving brain function is selegeline (Anipryl). A monoamine oxidase inhibitor (MAOI), it is thought to improve brain chemistry by reducing the breakdown of dopamine and other neurotransmitters.
A complement to conventional CCD treatments is offered by alternative therapies. Alternative, or Chinese, medicine is thought to operate consistent with quantum physics, on the molecular and atomic levels, by addressing energy imbalances.
“I encourage looking for alternative forms of treatment as well as the conventional,” said Thomas. “I prefer to treat this disease with acupuncture and Chinese herbs, supplements, diet modification, and energy medicine.”
In the end
If nothing else gets a CCD-affected dog first, the dementia will eventually force a very hard decision.
“When dogs’ bodily functions become so impaired that they lose quality of life, that’s when the hard call is made,” said Fanucchi. “It’s just a matter of time until they deteriorate to the point other systems fail. You don’t want to see your pet in this state – it’s very hard.”
“That is the toughest thing that a dog caretaker has to address,” agreed Thomas. “It usually comes down to what the caretaker defines as ‘quality of life.’ Veterinarians can often help because they are not emotionally involved and can explain how the situation is affecting everyone.”
Making this decision can be especially difficult in CCD cases as the animal is often healthy otherwise.
“It can be extremely difficult to consider euthanasia for a dog that is at a healthy weight, not necessarily in pain, and occasionally coherent,” said Eileen Anderson, who knows from personal experience how difficult this decision can be. She points to a tool that can help with this difficult decision: the Villalobos quality of life scale. Designed by veterinarian Alice Villalobos, it offers an objective means of inventorying quality-of-life details.
“Even those hesitant to do the numbers part will benefit from the Villalobos scale considering its unbiased presentation of the facts. It’s very helpful.”
Hope around the corner?
Alzheimer’s has never been reversed in human beings, but it may just have been in two dogs in Australia. Recently a team of veterinary and human medical researchers at the University of Sydney’s Brain and Mind Centre appear to have restored cognition in two CCD-suffering dogs using those animal’s own stem cells.
The procedure involves the growing of neural cells from skin cells and inserting them in the dogs’ brains. The two dogs have been rated as CCD-free based on independent application of the University of Sydney-developed CCD Rating (CCDR) scale. More, their owners report significant return of their animals’ old personalities and behaviors.
While obviously at a very early stage and with a miniscule sample, the procedure appears to offer hope for humans as well as dogs .
“I’m very confident that results from our trial, whether positive, negative or inconclusive, will be directly translatable to human patients,” the trial’s leader Professor Michael Valenzuela said.
Eileen Anderson offers perspective on this leading-edge research.
“The procedure is not to be undertaken lightly since it involves anesthetizing the dog twice and, well, brain surgery,” she said. “The good news is that two dogs with dementia have successfully undergone the procedure,” she writes on her blog. “When I first published my book in 2015, I wrote that there was no cure for canine cognitive dysfunction. That is still the case, but this fascinating research offers some hope.”
It really works
Judging by Mic, the approaches described here can work. A natural diet augmented by SAMe and other supplements improved his cognition. Thanks largely to acupuncture and Chinese herbs, his formerly debilitating physical deficits were controlled. Treatment eliminated his nighttime barking and, under supervision, his pack-mates tolerated him. He lived nearly two mostly happy and relaxed years after the onset of CCD.
But had Mic’s symptoms not improved, we would simply have followed Eileen Anderson’s golden rule.
“All that matters,” she says to anyone who will listen, “is to love the dog in front of you.”
Any of the following – and particularly significant changes regarding them – can be indicative of CCD:
– Confusion, especially standing in a corner, staring into space (‘zoning out’) circling behavior, and confusion regarding how to navigate doors, e.g.., standing on the hinge side or apparently not knowing how to go through them
– Affected social relationships
– Changes in activity level
– Increased anxiety
– House soiling
– Excessive vocalizations
– Compulsive behaviors
– Fear of familiar objects and people
– Changes in sleep-wake cycle