Cognitive Dysfunction
Written by Dr Jeanette Wilson
Cognitive Dysfunction (CD) is a neurodegenerative condition that results in decline of conscious mental activities including the ability to think, learn and remember.
There are many similarities between CD (diagnosed in pets) & Alzheimer’s (diagnosed in humans). The main differences between these two diseases are that in most cases CD will not affect the patient’s ability to eat & drink. Also, in most cases CD will not result in a decreased life expectancy. Patients with CD tend to have a prolonged course of disease that requires increasing care over time.
CD is a disease that effects both dogs & cats. The prevalence is hard to determine because CD is a diagnosis by exclusion. This means many diagnostic tests such as blood work, x-rays, ultrasound and advanced imaging are performed to rule out other disease processes that can present with similar clinical signs. The most common clinical signs observed with CD include: disorientation, altered interactions & engagement, disruptive sleep & wake patterns, house soiling and anxiety. The most common reported clinical signs in dogs are anxiety, night walking & vocalization. In cats we more commonly observe vocalization & house soiling.
This can be a challenging disease for both the pet & family, due to profound behavioral changes. These changes in behavior disrupt the relationship between the pet & family. A hospice consultation can provide support to both the pet diagnosed with CD & family. The veterinarian can discuss the current concerns & observations and give supportive care recommendations. No two pets are the same, therefore supportive care options may differ based on several factors including 1.) how advanced the disease process is, 2.) the other underlying concerns or diseases that are affecting the pet, 3.) response to previous & current medications. A thorough review of a patient’s history combined with a detailed discussion with the family allows the best recommendations to be made.
A Multimodal approach to CD tends to be the most supportive in helping to slow active progression. This refers to using different treatment modalities in combination. Traditional Chinese Veterinary Medicine offers supportive modalities such as acupuncture, herbal medicine, food therapy and Tui-na (massage). At hospice consults, family members can be taught to do acupressure, massage & Qi-Gong at home as part of their pet’s daily supportive care plan. Mental Stimulation can also be VERY important! We want to give the brain a constant workout including new smells, sounds and tactile changes. For some pets creating a “sensory pathway” inside or outside that contains surfaces such as foam, sand, mulch or smooth pebbles can stimulate a positive thought process. Environmental modification can be an important part of supportive care as it helps to keep our pets safe. Non-slip flooring, easy access to food & water bowls as well blocking stairs with baby gates are suggestions to help our pets navigate through the home environment with the least challenge possible. Many pets with CD are observed to have anxiety and products such as Adaptil & Feliway can help reduce these concerns. Music is another option that can provide enrichment as well as reducing anxiety.
Pharmaceutical products and supplements are available that can help to support brain health and slow disease progression. NutriHerbs are pet products that are a combination of western pharmaceuticals with herbal medicine and if started early enough, before CD clinical signs are observed, these products can prevent brain lesions associated with CD.
It is important to note that there is a subclinical phase of CD, which means brain changes have been documented before clinical signs are observed. Prevention including good lifestyle choices and supplements could delay the onset of the clinical phase. When patients are experiencing the clinical phase of CD, which means they are displaying the common clinical signs listed above, management can be challenging and requires a multimodal approach. When a pet is experiencing clinical signs associated with CD and these changes appear to be affecting quality of life, a hospice consultation can be an opportunity to explore the supportive care options that are most appropriate and set the pet & family up to be the most successful.