Cognitive Dysfunction Syndrome


Let me tell you a story about Molly, one of the sweetest old golden retrievers you could hope to meet. Molly was my patient for the past 10 years, since she was about 5 years old. She had very attentive owners, who did obedience and agility work with her and four other dogs in the family. She was a healthy dog, apart from some arthritis and kidney disease in her teens.

Around age 15, which is old for a large-breed dog, she started barking randomly at nothing that the owners could see. She wasn’t interacting as much with family members and would sometimes just stare into space. This was all very gradual, but definitely a change for Molly. She became restless at night, not settling down and sleeping like the rest of the dogs and humans. She started barking at night and wasn’t responding to her name or other verbal commands. What was going on?

There are a number of conditions and diseases in older dogs that can lead to behavior changes. Many dogs have gradual hearing loss as they age and can become completely deaf. While deaf dogs don’t respond when you call them, they will look to you for hand signals and other signs to figure out what they should be doing. Older dogs can also develop cataracts and become blind. Rather than just staring into space, they usually continue moving around, using their other senses to figure out where they are.

Arthritis is very common in older animals, and can impact their mobility. They won’t necessarily complain about their aches and pains, but they may not jump up when they see you and may have a harder time getting comfortable when resting. Chronic problems, like arthritis and dental disease, can lead to increased irritability or fear of being touched.

Molly was being treated with pain and anti-inflammatory medications for her arthritis. She was getting chiropractic adjustments and acupuncture from certified veterinarians. She’d had dental work done, and her teeth were in good shape. She was on a prescription diet for her kidney disease, as well as a few medications to decrease protein loss through her kidneys, but none of those things should have caused such behavior changes. Her blood pressure was normal, and she didn’t have heart disease. Because other diseases were ruled out, I determined that Molly was suffering from Cognitive Dysfunction Syndrome (CDS), which is similar to dementia in humans. The signs of CDS have been described using the acronym DISHA.

D is for Disorientation . For Molly, this was wandering aimlessly outside and in the house. A dog (or cat—CDS can affect old cats too) will appear confused by their surroundings. Some dogs will go to the hinge side of the door when they need to go outside. Others will stare blankly at a wall or get stuck in a corner. Appetite can seem to decrease if the pet forgets where the food bowl is located.

I is for Interaction changes with family members. Molly started barking and being aggressive with other dogs in the family for no obvious reason. Some dogs become very anxious and clingy. They may need constant contact with their owner and follow them around the house. Other dogs with CDS stop greeting their owner at the door.

S is for Sleep-wake cycle changes . Prior to CDS, Molly would lie down by 10:00 p.m. and stay asleep until the owners got up the next morning. But as her CDS progressed, it could take hours to calm her down and get her to sleep, and then she’d wake up at 4:00 a.m. panting, barking, and wanting to go outside, at which time she would just stand and stare. She was also sleeping a lot during the day.

H is for House-training breaks . For a long time, Molly didn’t have any urine or stool accidents in the house, probably because the dogs in the household were let out frequently during the day. Some dogs with CDS will go outside, forget what they needed to do, then go back inside the house and urinate. Old cats may start urinating or defecating around the house.

A is for Activity level changes . Molly wandered aimlessly around the house. If another dog was lying in her path, she became agitated and couldn’t figure out how to walk around him. She would just stand and bark until the other dog moved. Many dogs will also have less interest in playing and cats will spend less time grooming.

Mental stimulation is very important for all pets, but particularly for those with CDS. Molly’s owners worked hard at keeping up her quality of life. They gave her several different supplements made for dogs with CDS. Daily walks and balance exercises on a disc kept her in shape. She played hide and seek games and was rewarded with treats when she found the owners. They also hid food or toys and told her to go find it. Feeding puzzles, where the dog has to paw at something to get the treat, were also useful.

To keep her occupied during the day and less likely to randomly bark, she got Kong toys filled with frozen peanut butter and plain yogurt. Stairs were blocked off to prevent her tumbling down them, and ramps outside were marked with essential oils to help her find them.

Bedtime was a source of anxiety for both the owners and Molly. I prescribed various antianxiety medications for her, some of which helped provide sedation. Her owners also used Adaptil, a pheromone spray with calming effects, and essential oils to help calm her. One owner would lie next to her at bedtime and use long stroking motions to relax her.

Acupuncture was also helpful for the anxiety, and she was calmer after those sessions. Molly’s CDS was managed for many months, and she celebrated her 16th birthday in style. But then she developed fecal incontinence and pooped randomly in the house. At that point her quality of life was compromised, and I euthanized her.

With dogs and cats living to very old age, CDS is becoming more common. There isn’t a cure, but it can be managed, improving everyone’s quality of life. If you think your pet is showing signs of senility, please talk with your veterinarian about treatments and medications. This is trial and error, but with love and perseverance, hopefully your pet can live a long and happy life, just like Molly.

Photograph by Brenda Eckhardt

Lori Scarlett, DVM, is the owner and veterinarian at Four Lakes Veterinary Clinic. For more information, visit .