Age Related Cognitive Decline

Question 1

What are the most common behavioural problems associated with geriatric patients

Answer 1

Dogs: destruction, toileting, vocalisation
Cats: altered interaction with owners, toileting, vocalisation, aimless activity

Question 2

What three things should be taken into account when taking a history for age related CD?

Answer 2

• is age the main factor?
  
  • age of onset
  • change of severity of problem with age
• link with age related medical disorders
  
  • change in locomotor (arthritis)/sensory ability(blind deaf)/water intake(diabetes)
• context of behaviours
  
  • normal behaviours in an abnormal context with CD

Question 3

How many dogs and cats show signs of age related CD?

Answer 3

> 50% dogs 16yrs+

50% cats 15yrs+

Question 4

Give examples of the possible medical differentials for geriatric cases.

Answer 4

Sensory deficits 
CV disease 
Pain 
Neuro 
Endocrine 
Metabolic 
GI
Urinary tract

Question 5

What is CCD similar to in humans?

Answer 5

Alzheimer’s type dementia

Question 6

Outline the histopathology of CCD.

Answer 6

B amyloid plaques in cortex and hippocampus
Genetic predisposition
Decrease in brain mass

Question 7

What is the pathology associated with CD?

Answer 7

Increased free radicals -> oxidative damage (lack of protection by mitochondria)
Vascular insufficiency (fibrosis) -> neuro hypoxia
NT abnormalities: ^DA, vAch, v5-HT, vNA
Link with sub clinical HOA axis deregulation
-lack of cortisol suppression due to exogenous dexamrthosone steroid

Question 8

What are the 4 main categories of behavioural change?

Answer 8

Disorientation
- delay or lack of recognition of people/places/things
Change in interaction with owner/dogs etc.
Sleep/wake cycle disruption
Break down of house training

Question 9

What is the best broad treatment plan?

Answer 9

Combination therapy to SLOW decline not prevent it or reverse it:

• behaviour therapy
• drug
• dietary aids

Question 10

What is the most important thing to to aim for when helping geriatric CD patients?

Answer 10

Predictability in social interactions

Question 11

What does mental stimulation cause physiologically?

Answer 11

Neuronal growth factor production

Question 12

Give 4 examples of drugs used for CCD.

Answer 12

Selegiline
Nicergoline
Propentofylline
Clomipramine

Question 13

Which kind of dogs have a longer life expectancy?

Answer 13

Smaller breeds

Question 14

What is selegeline said to be useful for?

Answer 14

“Problems of emotional origin”

Ie. all behavioural problems!

Question 15

What is the dosing regime for Selegeline?

Answer 15

Once daily

- effects seen in 3 weeks

Question 16

What are the actions of selegeline?

Answer 16

1. ^synaptic monoamines, esp DA (amount of MAObs will increase with age naturally)
2. Enhanced catecholamine activity
3. Prgress of neurodegenerative disease slowed

Question 17

How may selegeline have a neuroprotective effect?

Answer 17

> v concentration of free radicals by enhanced activity of superoxide dismutase
may alter apoptosis process
may promote synthesis of nerve growth factors

Question 18

How do nicergoline and propentofylline function?

Answer 18

^ blood flow to brain by ^ CVS function and vasodilation

Nicergoline also neuroprotective - reversing existing damage and increases metabolic activity in nerve cells

Question 19

When is clomipramine (clomicalm) contraindicated in older dogs?

Answer 19

• heart problems
• epilepsy
  Used when behaviours are related to anxiety

Question 20

Why may essential fatty acid supplements not be healthy?

Answer 20

Dietary supplements on top of a balanced diet -> ^ free radical damage

Question 21

How may nutritional support prevent cognitive decline?

Answer 21

Cognitive ability improved with dietary supplement of broad spec anti-oxidants

• rapid effect
• more marked for more cognitively demanding tasks
• no effect on functioning of young dogs (as oxidative stress accumulates with age)

Question 22

What does Hills b/d complete diet contain?

Answer 22

Mitochondrial cofactors and antioxidants

Question 23

What supplement is available to potentially assist with age related cognitive decline?

Answer 23

Aktivait

- antioxidants and essential fatty acids

Question 24

Which factors impact the prognosis of age related cognitive decline?

Answer 24

• duration of clinical signs
• severity
• medical problems
• quality of life

> treatment aims to improve quality of life, not prolong it