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Applied Animal Behavior > Cognitive Dysfunction > Flashcards

Cognitive Dysfunction Flashcards

1
Q

What is Cognitive Dysfunction?

A
  • Cognitive functions include the mental processes of perception, awareness, learning, and memory, which allow an individual to acquire information about the environment and decide how to act
  • Cognitive dysfunction syndrome (CDS) is a neurobehavioral disorder affecting geriatric dogs and cats that is characterized by an age-related decline in:
    • Cognitive abilities sufficient to affecting functioning
    • Behavior changes that are not attributable to other medical conditions
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2
Q

What is the incidence of CDS in dogs?

A
  • Prevalence is extremely high
  • the older the dog the greater the prevalence
    • 28% in 11-12 years old
    • 68% in 15-16 years old
    • Nearly 100% of dogs >16 displayed at least 1 sign
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3
Q

Are there sex or breed correlations with CDS?

A
  • No sex or size correlations
  • No breed predilections
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4
Q

Why is CDS under-reported?

A
  • Short appointment times - contribute to the reason why clinical signs of CDS are often overlooked by both practitioners and owners
  • Owners may not notice subtle signs or think it is necessary to discuss them, especially if they suspect that nothing can be done
  • Better education of both clients and veterinarians is needed to increase the diagnosis of CDS
    • more dogs may then receive treatment
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5
Q

What is Canine Cognitive dysfunction syndrome (CDS)?

A
  • As dogs age, most body systems undergo physiologic and metabolic changes
  • These changes can manifest as behavioral issues, with the most common being:
    • Separation anxiety
    • Destruction
    • House soiling
  • Each body system can undergo differing metabolic and physiologic abnormalities that also overlap with each other
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6
Q

What is the appropriate Medical Evaluation for CDS?

A
  • Thorough physical examination
    • Neurologic examination
    • Orthopedic examination
    • Pain assessment
  • Appropriate diagnostic testing
    • CBC
    • Biochemistry panel
    • Urinalysis
    • Systemic blood pressure
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7
Q

What additional testing is may be needed depending on the clinical signs?

A
  • Radiography
  • Ultrasonography
  • Endocrine tests
    • Thyroid
    • Cushing’s
  • Magnetic resonance imaging and cerebral spinal fluid to assess for the presence of certain intracranial lesions/diseases that might mimic CDS
    • Inflammatory
    • Infectious
    • Neoplastic
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8
Q

What are some physical changes that could be mistaken for CDS?

A
  • Arthritis in joints
  • Spinal spondylosis
  • Decreased muscle mass (sarcopenia)
  • Nuclear sclerosis
  • Cataracts
  • Deafness
  • Decreased smelling ability
  • Decreased taste senses
  • Changes in digestion and respiration
  • Urinary incontinence
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9
Q

What are the similarities of canine CDS and Alzheimer’s?

A
  • Human patients often exhibit movement disorders, including restlessness, impaired gait, and tremors
  • Concurrent behavioral and neurologic signs in aging canine patients have also been documented
  • In a study of 21 dogs >7years
    • Those with CDS were 2x as likely to show neurologic deficits as dogs without CDS
  • Brains of Dogs with CDS have neuropathological lesions similar to those seen in people with dementia
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10
Q

What are the symptoms of Canine Cognitive Dysfunction Syndrome?

A
  • Decreased reaction to stimuli
  • Decreased exploratory behavior
  • Confusion
  • Disorientation
    • Cognitively impaired older dogs have higher locomotor activity and spend more time in aimless activity than young dogs (younger than 9 years)
      • The more severe the cognitive impairment, the higher both of these measures
  • Decreased interaction with owners and other dogs
    • Social responsiveness is primarily affected by age but is also influenced by severity of cognitive impairment
    • Young dogs
      • Engage in more physical contact with humans
      • Have more vocalizations in response to social isolation
    • Aged dogs spent more time near a mirror
      • suggests deficit in habituation to the reflection of a dog image
    • Irritability
    • Slowness in obeying commands
    • Decreased responsiveness to sensory input
    • Problems performing previously learned behaviors
    • Altered sleep-wake cycles
      • Radiotelemetry monitoring in elderly dogs
        • Sleep-wake patterns were dramatically altered
          • Increase in the total amount of time spent in slow-wave sleep during the daytime
          • Increase in the time spent awake during the night
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11
Q

What pathogenic changes are believed to contribute to CDS?

A
  • Decreased in gray and white matter
  • Reduction in number of neurons
  • Generalized gliosis
  • Degeneration of white matter
  • Demyelination
  • Neuroaxonal degeneration
  • Increases in ventricular size
  • Meningeal fibrosis and calcification
  • Presence of B-amyloid (AB) plaques
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12
Q

What are Amyloid Plaques?

A
  • Deposition of amyloid plaques in the brain parenchyma an the walls of the cerebral blood vessels can play a role
  • AB is a protein produced by the degradation of amyloid precursor protein
  • The prefrontal cortex is the first area affected, followed by the temporal cortex, the hippocampus, and the occipital cortex
  • Regardless of position, the amount and extent of AB deposits correlate with the severity of cognitive impairment
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13
Q

What affects brain health and vitality?

A
  • Free radicals - problematic because of the high lipid content of the brain
  • Decreased glucose metabolism
    • executive function and learning are affected
  • Reduced perfusion of brain tissue due to perivascular changes
    • brain consumes 20% of the body’s total oxygen
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14
Q

How does oxidative stress affect the brain?

A
  • The brain’s high percentage of polyunsaturated fatty acids and lower levels of endogenous antioxidant activity make it very susceptible to oxidative damage
  1. Cellular metabolic processes release reactive oxygen species
    1. Oxidative damage to proteins, lipids, DNA, and RNA
    2. Results in neuronal death
  • Normal activity of endogenous antioxidants balances the production of toxic free radicals
  • Protective mechanisms begin to fail with age
  • Oxidative damage ⇢ cognitive decline in dogs
  • An increase in oxidative end products in the brain of aged dogs correlates with more severe behavioral changes
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15
Q

What nervous system functional changes are seen in CDS?

A
  • Neurotransmitter function changes as chemical levels are altered
    • Depletion of catecholamine neurotransmitters
      • Monoamine oxidase
      • Serotonin
      • Dopamine
    • Decline in the cholinergic system
      • Acetylcholine
    • Increase in monoamine oxidase B (MAO-B) activity
    • Reduction of endogenous antioxidants
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16
Q

How is CDS diagnosed?

A
  • Diagnosis of exclusion
  • Although CDS is a diagnosis of exclusion, the presence of any of these signs as a new behavior in middle-aged dogs should create suspicion of CDS
  • Any 2 of these signs should raise a very high index of suspicion (DISHAA)
  • Owners may be slower to perceive
    • Reduced interaction with their dog
    • Confusion on the part of their dog
      • These are not as obvious as noting whether the dog paces all night or abandons established house-training
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17
Q

What is DISHAA?

A
  • D - Disorientation
  • I - Altered interactions
  • S - Sleep-wake cycle disturbances
  • H - Problems with house-training
  • A - Activity
  • A - Anxiety
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18
Q

Why is a Physical exam and medical workup essential?

A
  • May have underlying, treatable metabolic issues
    • These may be chronic and continue to contribute to the behavior issues, even if treated
  • Treat behavior issues after any medical issues have been addressed and treated
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19
Q

Why is Behavioral History important?

A
  • Identify motivation for the behavior
  • Circumstances that contribute to the occurrence of behaviors
  • Determine origin, duration, and progression
  • When and Where problem behavior occurs
  • Concurrent behavior issues
  • Who all are involved with animal on a daily bases
  • Who is involved when behavioral problem occurs
  • Routine interactions
  • Changes in routine
  • Pet-owner interactions
  • What happens in a 24 hour period
  • Aggression screening
20
Q

What are stereotypic repetitive behaviors?

A
  • Pacing, Rocking, swimming in circles, excessive sleeping, self-mutilation (feather picking and excessive grooming), and mouthing cage bars
  • These behaviors are usually new for the pet and seem to follow a very patterned execution
    • Ex: aging dog starts pacing with increased frequency (new behavior) and executes that behavior the same each time (set pattern)
  • Normally, a dog should easily be distracted from performing a new behavior by engaging it in another simple activity
  • The ability to distract the dogs separates new patterned behaviors from compulsive behaviors
21
Q

What is a compulsive behvior?

A
  • Performing an act persistently and repetitively without it necessarily leading to an actual reward or pleasure
  • A stereotypic behavior that becomes emancipated from the environment
22
Q

What are the goals of treating CDS?

A
  • Slow the progression of the disease
  • Maintain the quality of life for both the patient and family
23
Q

What is the treatment for mild to moderate CDS?

A
  • Conservative approach
    • Exercise
      • 2 x 20 minute outdoor walks per day
    • Commercial dietary supplementation with antioxidants as they remove free-radicals
    • Commercial diets
    • Interactive play and training
      • 30 min, 5x a week
    • Maintain a regular routine
      • keep consistent schedule
      • Don’t change up the environment
    • Food Puzzles
  • Aggressive approach
    • Pharmaceutical intervention
24
Q

What dietary supplements are available for CDS?

A
  • SAMe (Denosyl), Novifit (S-adenosyl-methionine) and milk thistle
    • Can eliminate free radicals in both the brain and liver
  • Gingko biloba
    • Increases blood flow to the brain
    • Other ingredients that may support brain health
  • Senelife
    • Reservatrol, vitamins E and B6, Phosphatidylserine, ginko biloba
  • Aktivaik
    • Phosphatidylserine, omega-e3 fatty acids, vitamins E and C, L-carnitine, a-lipoic acid, coenzyme Q, selenium
  • Proneurozone
    • Acetyl-L-Carnitine, Alpha Lipoic Acid, Spirulina, Soy lecithin, Omega-3 Fatty acids, Bioflavanol, Cranberry, Niacin, Cysteine, Bilberry, Vitamin E, Thiamine, Riboflavin, Rosemary, Sage, Vitamin B6, Folic Acid, Vitamin B12
25
Q

What commercial diets are available for CDS?

A
  • Purina Neurocare
    • Antioxidants
    • Rich in medium-chain triglycerides
      • Convert to ketones, may provide a secondary source of nutrition for the brain
  • Hill’s Prescription b/d diet
    • high in antioxidants
  • Royal Canin Canine Mature Consult
    • Antioxidants
26
Q

How should interactive play and training be added for CDS?

A
  • Teach an old dog new tricks
  • Behavioral modification is similar to approaches used for younger pets, but with some limitations or constraints
    • Padded surfaces for sitting and traction for movement may help
    • If the pet is in pain “stand” or “look” commands may replace frequent “sit” or “down” cues
    • Owners may need to adjust behavior signals used in training if sensory dysfunction is significant, including tactile cues or hand signals
    • More powerful motivators for learning may be needed, including the use of high-value food rewards
27
Q

How do food puzzles help with CDS?

A
  • Encourage mental facilitation, particularly in aging dogs that may not be mentally challenged and thus undergo daily cognitive decline
  • Providing regular mental stimulation and enrichment will help maintain cognitive functioning
28
Q

What Pharmaceutical intervention is available for CDS?

A
  • Laboratory results and current therapies should be considered before initiating pharmacologic treatment
  • Propentofylline (Vivitonin or Karsivan)
    • A xanthine derivative
    • Is licensed to combat dullness and lethargy in older dogs
      • Not available in North America
  • Nicergoline - not available in North America
    • Contains adrenergic antagonists
    • Increases blood flow in the brain
    • Enhances neuronal transmission
  • Memantine
  • Selegiline
29
Q

What is Memantine?

A
  • N-Methyl-d-Aspartate Receptor Antagonists
  • Binds to N-methyl-d-aspartate receptors in the brain and blocks the activity of glutamate
    • Excessive glutaminergic activity resulting in neurotoxicity is suspected in the pathology of dementia
  • Used in the treatment of moderate to severe Alzheimer’s disease
  • Used in dogs to treat compulsive behaviors
    • 0.3 to 1.0 mg/kg q12
30
Q

What is Selegiline?

A
  • MAO-B inhibitor
  • Is neuroprotective and has been shown to increase cognitive function in dogs
    • Antioxidant
    • Enhances catecholamines
  • Helps reduce changes in the sleep-wake cycle
    • Uses increased plasma levels of amphetamine to help keep dog awake during the daytime
  • Improved cognitive function usually seen in 2-4 weeks
    • Some dogs take up to 2 months
  • Changes my be subtle
    • Encourage keeping a journal/log of any noted behavioral changes
31
Q

What are the important contraindications and precautions for selegiline?

A
  • Don’t use in conjunction with:
    • Ephedrine
    • Other MOAI’s
    • Tricyclic antidepressants (TCA)
    • SSRI’s
    • Meperidine
    • Opioids
    • Amitraz: have MAOI inhibiting effects
  • Allow at least 14 days between stopping selegiline and starting a TCA, such as clomipramine
  • Allow at least 5 weeks between stopping SSRI’s such as fluoxetine and starting selegiline
  • Risk of DEATH if washout periods aren’t adhered
32
Q

What are some complimentary therapies for CDS?

A
  • Compression garments
    • Thundershirt
    • Anxiety Wrap
  • Pheromones
  • Aromatherapy
  • Herbal supplements
  • Acupuncture
  • Acupressure
  • Massage
  • Physical therapy
33
Q

What is the Prevalence of CDS in Cats?

A
  • 36% in a population of 11-21 year old cats
  • The incidence of behavior changes increases with advancing age:
    • 28% in cats 11-14
    • 50% in cats 15 and older
34
Q

What causes feline CDS?

A
  • Compromised cerebral blood flow
  • Chronic free radical damage
  • Numerous vascular changes can occur in the brain of old cats
    • Decrease in cerebral blood flow
    • Presence of small hemorrhages around the blood vessels
    • A form of arteriosclerosis
  • Chronic damage can eventually lead to disease processes similar to those seen in humans with Alzheimer’s disease
  • In humans and dogs, genetics, diet, and lifestyle choices have been shown to:
    • Influence the prevalence and distribution of neuropathologic changes (particularly amyloid plaques)
    • Affect the nature of the associated cognitive dysfunction
  • Although these relationships are still to be determined in cats, it is likely that they will be similar
35
Q

What are the signs of Feline CDS?

A
  • Most common behaviors seen in the 11-14 year old age group
    • Alterations in social interactions
  • Most common signs in cats aged 15 years and older
    • Aimless activity
    • Excess vocalization
  • Disorientation is often the first sign that owners recognize as cognitive decline in their older cats
    • Its estimated that disorientation occurs in a least 40% of cats aged 17 years and older
36
Q

What Disorientation is seen in Feline CDS?

A
  • Spatial disorientation - confusion about where they are
    • Becoming trapped in corners
    • Forgetting the location of the litterbox
    • Stares of fixates on objects or simply stares into space
  • Temporal disorientation - confusion about what time it is
    • Forgetting that feeding time has just occurred
37
Q

What are the symptoms of Feline CDS?

A
  • Changes in sleep-wake cycles
    • cat is awake when normally sleeping and vice versa
  • House soiling
    • Inappropriate urination and/or defecation
      • Eliminates in sleeping areas or by eating areas
      • Eliminates outside the litter box
  • Inappropriate vocalization
    • Loud crying at night
    • Anxious vocalizing is usually a plaintive meow
  • Altered interaction/relationships
    • Increased attention seeking
    • Increased aggression
    • Needs constant contact, becomes overdependent and clingy
  • Altered interest in food
    • Decreased appetite and less commonly increased
  • Decreased grooming
  • Changes in general behavior
    • Increased irritability
    • Increased anxiety
    • Decreased responsiveness
  • Changes in learning and memory
    • Forgetting commands
    • Forgetting previous litter box training
  • Changes in activity
    • Reduced activity
    • Aimless wandering or pacing
38
Q

Why are thorough medical exams and history important?

A
  • Common, notable, older cat diseases that could cause similar symptoms (not an all inclusive list)
    • Chronic Kidney disease
    • Hyperthyrdism
    • Diabetes Mellitus
    • Systemic Hypertension
    • Osteoarthritis
    • Deafness
    • Meningiomas (brain tumor)
39
Q

How can Feline CDS be managed with Environmental Enrichment?

A
  • Environmental Enrichment
    • Extra toys - rotated often
    • Increased time spent with cat
    • Increased interactions:
      • Play
      • hiding places
      • elevated sites
      • Puzzle feeders
    • Introduce changes gradually
  • Avoid placing food and water on high surfaces that elderly cats might find difficult to access
    • Or provide a ramp up to he surface
  • Raising food and water bowls up slightly from the floor
  • Provide several comfortable beds in easily accessible areas
  • Provide large, low-sided litterboxes or easy access
  • Provide soft litter
  • Let cats out by a door (if they go outside)
  • Provide Peace and quiet - time away from other pets and people
  • Avoid introducing new animals
  • Use pheromones to help reduce anxiety
40
Q

What changes should / should not be made with cats with severe CDS?

A
  • Cats with severe CDS will not be able tp cope well with environmental changes and so become stressed
    • Could exacerbate the signs of CDS
  • Changes should be kept to a minimum or avoided altogether
  • Some may even benefit from having their area of access reduced
    • Provide them with a single room with all their key resources
    • Helps them feel safe and secure
41
Q

How can Feline CDS be managed?

A
  • Environmental Enrichment
  • Dietary Supplements
  • Dietary Management
  • Prescription Medications
  • Adjunctive Options
42
Q

What dietary supplements can help with Feline CDS?

A
  • Many of them use Antioxidants as their key ingredients
  • Aktivait Cat
    • Phosphatidylserine is one of the active ingredients
    • A phospholipid
    • Used to come from cow brains, now made from cabbage or soy
    • It is part of the cell structure and is key in the maintenance of cellular function
    • DO NOT use canine form due to alpha-lipoic acid content
      • Toxic to cats
    • Novifit
    • Denosyl
    • Senilife
    • Reservatrol
      • A polyphenol that comes from the skin of red grapes and some other berries and peanuts
    • Proanthozone
      • Bioflavanol from grape seed extract, Manganese, vitamin E, Zinc, Cysteine, Selenium, Superoxide Dismutase (SOD), Vitamin A, Glutathione
43
Q

What commercial diets are available for feline CDS?

A
  • No specific commercial diets for cats like there are for dogs
  • Switch to diets higher in antioxidants
    • Nestle Purina Pro Plan Age 7
    • Hill’s j/d
44
Q

What prescription medications can be used for Feline CDS?

A
  • No drug has been licensed for the treatment of CDS in cats as of yet
  • Selegiline
    • 0.25 - 1 mg.kg PO SID
    • AAP supports the use of this drug
    • Beware of drug interactions
  • Propentofylline (not available in US)
    • 12.5 mg/cat PO SID
  • Buspirone
  • Fluoxetine
45
Q

What are the Adjunctie Options for Feline CDS?

A
  • Nutraceuticals
    • Zylkene
    • Composure
  • Pheromones
    • Feliway
  • Compression garments
  • Aromatherapy
  • Herbal supplements
  • Acupuncture
  • Acupressure
  • Massage
  • Physical Therapy

Applied Animal Behavior (13 decks)

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