Caring for Dogs with CCD: New Clinical Guidelines Released

Given that 44% of the canine population is considered geriatric, the American Animal Health Association (AAHA) published a set of guidelines in 2023 to support veterinary practices treating this demographic.

According to the guidelines, “The veterinary team’s role includes providing medical care and support to senior pets to maintain their quality of life, as well as supporting and educating clients on proper senior animal care and addressing any misconceptions about the aging process.”

While the guidelines are published for veterinary practitioners, there are still useful insights to glean for owners, since many of these recommendations may involve changing a dog's day-to-day routine at home ( i.e., environmental enrichment).

In summary, the guidelines encourage several adjustments when caring for geriatric canines, including adapting their environment, behavioral management, identifying multiple conditions that can compound with one another (or comorbidities), and medical and interventional therapies (as appropriate).

In this article, we will explore in more detail their section on the management of Canine Cognitive Dysfunction (CCD), which will be aided by additional research. As with any condition, particularly CCD, early recognition and proper care are essential for management and, more importantly, maintaining quality of life.

See our video summarizing these guidelines below:

Understanding Canine Cognitive Dysfunction

The pathological similarities between human Alzheimer’s disease and canine cognitive dysfunction are well-documented, with research in one area often informing the other. For instance, studies conducted by the Dog Aging Project (which has nearly 50,000 registered dogs) hope to use findings for translation into human research.

Some of these similarities include Beta-amyloid plaques, as well as structural abnormalities such as blood vessel fibrosis, cerebral atrophy, and astroglia hypertrophy. Mitochondrial dysfunction is also believed to play a role in these neurodegenerative conditions.

The clinical signs of cognitive dysfunction may be difficult to detect in its early stages. However, early diagnosis is critical for slowing its progression. The acronym DISHAA helps categorize the clinical signs: Disorientation, alterations in social Interactions, changes in Sleep-wake cycles, loss of House training and other learned behaviors, altered Activity levels, and increased Anxiety.

Diagnosing Cognitive Dysfunction

As a way to measure and document these processes, more concise behavioral diagnostic scales exist. This includes the Canine Cognitive Dysfunction Rating (CCDR) Scale, of which an adaptation of this scale is used in the Dog Aging Project, and the CAnine DEmentia Scale ,or CADES, which is mentioned in the AAHA's guidelines.

When taking these tests, the tests usually mandate a few points in time in which the criteria must be further assessed to judge whether symptoms have progressed. Although not mentioned in the guidelines, a monitoring tool such as a Tractive GPS tag (tractive.com) might help provide further data and evidence, such as changes in sleep activity.

Clinical Care of CCD

Pharmacological treatments, such as selegiline, can be prescribed by your vet, although drug interactions and side effects may sometimes exclude this option. The guidelines also discuss how anxiety, which is a common clinical sign associated with cognitive dysfunction, can be directly treated through veterinary consultation and, if necessary, prescription.

In addition, the guidelines also underscore the importance of weight management, receiving a healthy diet high in antioxidants, and administration of medium-chain triglycerides (MCTs).

The guidelines note while the research on other supplements and nutraceuticals is limited, these options may be worth exploring with veterinary guidance.

Finally, adapting your dog's environment to their condition is also important, as well as ensuring mental stimulation and exercise, both as a preventative tool and as part of a forward-looking plan. You can read our article on exercise for canine brain health here, and our article on enriching your dogs environment for CCD here.

MCTs: Neuroprotective Brain Fuel for Dogs

As mentioned above, the AAHA include MCTs in their set of clinical tools for CCD management, especially when combined with environmental enrichment. As noted from the body of clinical research on MCTs, the two MCTs supported by the clinical research are octanoic (C8) and decanoic (C10) acid (or C8 and C10 triglycerides in their dietary form).

In terms of the mechanism, since glucose metabolism in the brain is known to decline with the progression CCD, once consumed, C8 triglycerides are metabolized into ketones, providing an important alternative energy source to the brain. Some neuropathological events correlated to the decline in glucose concentration and metabolism include oxidative stress, neuronal cell death, acetylcholine, ATP, and cholesterol reduction.

In addition, C10 provides neuroprotective effects to the brain, which is important since chronic oxidative stress, mitochondrial dysfunction, and inflammation are known risk factors and pathologies. This is because C10 upregulates catalase (an enzyme responsible for reducing hydrogen peroxide) activity, which results in decreased oxidative damage and subsequent cell death.

Morever, C10 can aid in mitochondrial biogenesis via activation of the PPARγ receptor and its target genes involved in this process. Finally, C10 can also be important in attenuating neuronal hyperexcitability AMPA receptor modulation. Although further research is needed, brain hyperexcitability is poised to be further researched for animals and people with neurodegenerative diseases.

As it relates to cognitive function in dogs, a 2018 study showed that MCT-enriched diets improved 5-out-of-6 measurements of cognitive decline in dogs within 30 days of commencement, with significant improvement across all measurements after 90 days.

Furthermore, a 2021 study that examined the cognitive abilities of dogs with epilepsy showed significant improvements in spatial working memory, problem-solving abilities, and owner trainability secondary to the use of MCTs.

Veterinarians should advise patients to gradually introduce MCTs to their recommended dosage to minimize gastrointestinal upset.

Conclusion

Cognitive dysfunction is a prevalent condition amongst the geriatric canine population, impacting around 30% of dogs aged 11-12.

Since there are no silver bullets for CCD once it has progressed, understanding these clinical signs, early diagnosis, and measurement, as well as implementing appropriate management strategies, are all crucial for maintaining quality of life and healthspan.