Canine Cognitive Dysfunction: Signs, Rating Scales, and What Helps
Some older dogs develop a dementia-like condition. The signs, the owner questionnaires vets use, what else it could be, and what the evidence says helps.
Written by thecanineledger
“Approximately 14–22.5% of dogs older than 8 yr suffer from age-related cognitive impairment.” That’s the American Animal Hospital Association, in its 2023 guidelines on senior care (AAHA, Managing Cognitive Dysfunction and Behavioral Anxiety).
The condition is called canine cognitive dysfunction (CCD). AAHA says its biology “is similar to Alzheimer disease in people.”
While the signs are easy to put down to old age, AAHA stresses that “treatment is more effective in the earlier stages”. This page covers the signs, how vets assess it, what else it could be, and what the evidence says helps.
1. The signs
Vets have long used the acronym DISHAA to group the signs. AAHA lists them as:
| Letter | Sign |
|---|---|
| D | Disorientation |
| I | Changes in social interactions |
| S | Changes in sleep-wake cycles |
| H | Loss of house training and other learned behaviours |
| A | Altered activity levels |
| A | Increased anxiety |
In dogs, AAHA says “the most common clinical signs include daytime sleeping and nighttime restlessness, decreased interaction, disorientation at home, and anxiety.” Others include not recognising familiar people, changes in appetite, and pacing.
AAHA adds that the signs “may not be recognized by clients in the earlier stages.”
2. What else it could be
CCD is often “a diagnosis of exclusion”, AAHA says. That means ruling out other causes first. The ones it names include “intracranial neoplasia, pain, and organ dysfunction”: a brain tumour, pain, or failing organs such as the kidneys or liver.
That’s why the first step is a full vet check, including a physical and neurological exam, blood tests and urine tests. AAHA says “An MRI of the brain is recommended to rule out structural disease.”
Pain matters here too. AAHA notes that anxiety in CCD “can also be related to chronic pain.” → Arthritis Treatment: What Works, From Weight to Medication
Our note: AAHA recommends an MRI, which is costly and needs anaesthesia. Many dogs may be diagnosed without one.
3. The rating scales
Because the signs build slowly, vets use owner questionnaires to measure them and track change. AAHA says they “are to be completed by clients at set intervals”.
Two are widely cited:
- The CCDR (canine cognitive dysfunction rating scale), developed by Salvin and colleagues. The large US Dog Aging Project used “a minimally modified version” of it (Yarborough et al., Sci Rep 2022).
- CADES (CAnine DEmentia Scale), which AAHA says “is predictive of the progression of cognitive impairment.”
If you’re worried, ask your vet whether they use one of these, and fill it in at home before the visit.
4. What the Dog Aging Project found
The Dog Aging Project assessed more than 15,000 US dogs. Its 2022 analysis found that “the odds of CCD increased 52% with each additional year of age.”
It also found that among similar dogs, “odds of CCD were 6.47 times higher in dogs who were not active compared to those who were very active.” That doesn’t show exercise prevents CCD. The authors note that the analysis “is not yet longitudinal”, so they can’t tell whether inactivity came first or followed the decline.
The study is funded by the US National Institute on Aging and private donations, and its authors declare no competing interests.
5. What helps
AAHA says “management and treatment of cognitive dysfunction are most effective when started early”.
| Option | What AAHA says |
|---|---|
| A licensed medicine | One drug is labelled for CCD. AAHA says it “is effective in up to 70% of dogs with cognitive dysfunction.” It can be dangerous with some other medicines. |
| Diets | Diets “high in antioxidants and medium chain triglycerides” have been “posited”, and worked best “when combined with environmental enrichment”. |
| Enrichment | Exercise, new toys, cognitive games, tasks and agility. |
| Supplements, acupuncture, other diets | “The quality and rigor of the research associated with other various supplements, nutraceuticals, acupuncture, and diets is limited.” |
| Treating anxiety and pain | AAHA says both “should be considered in the cognitively impaired patient.” |
We don’t name medicines or give doses. Your vet can explain what suits your dog and how it fits with anything else they take.
Our note: AAHA’s “one drug labelled for CCD” refers to the US. What is licensed elsewhere may differ.
Our note: We haven’t read a source on home tips such as night lights, keeping furniture in place and routines.
6. What we could not verify
| Commonly said | What we found |
|---|---|
| “Confusion is just old age” | It may be CCD, or another treatable illness. Ask your vet. |
| “Nothing can be done” | Not what AAHA says. Treatment works best when started early. |
| “Brain supplements prevent dementia in dogs” | Limited evidence, AAHA says. |
| “Exercise prevents CCD” | Not shown. Active dogs had lower odds, but the study can’t show cause. |
Sources
- American Animal Hospital Association: 2023 Senior Care Guidelines: Managing Cognitive Dysfunction and Behavioral Anxiety (professional body guidelines; industry-funded; read)
- Yarborough S, Fitzpatrick A, Schwartz SM, Dog Aging Project Consortium: Evaluation of cognitive function in the Dog Aging Project: associations with baseline canine characteristics (Sci Rep 2022; cross-sectional cohort; full text read)
Always confirm with your vet before acting on anything on this page.