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Cognitive Dysfunction Syndrome

Most people think of this as a disease occurring in dogs, but cats can also suffer with this. 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 react. 

Cognitive dysfunction (CDS), sometimes referred to as dementia, as in humans, is directly related to brain aging. Deficits in learning ability and memory, as well as decreased responsiveness to stimuli, are symptoms of the disease. Some pet owners will simply say the pet is acting older. Studies have shown that 50% of cats over age 15 and 40% of dogs over 14, increasing to 68% at age 15, suffer from CDS.

Cognitive Dysfunction Syndrome is a diagnosis of elimination. A veterinarian may diagnose cognitive decline if a physical exam and lab tests do not show the animal’s behaviors to have a medical cause, such as cancer, diabetes mellitus, hypertension, hypothyroidism, Cushing's disease, hyperthyroidism, pain from osteoarthritis, or vision or hearing loss. Some behavioral problems can also mimic CDS. These include separation anxiety, aggression caused by pain, and poor housetraining.

Classic signs of CDS can be spelled out with the acronym DISHAA. The letters stand for:

Disorientation - the pet may seem lost or get stuck in corners or may have trouble locating food and water bowls

Interactions - alterations in interactions with owners, other animals, or the environment

Sleep cycle disturbances - howling, pacing, or crying in the middle of the night

House soiling - they may not remember how to get to the door that leads to the outside or may not be able to find the litter box

Activity changes - sleeping more than usual; and an increase in 

Anxiety - separation anxiety, fear in crowded areas or when around other animals, destructive behavior

Treatment for CDS is multimodal.

  • Try not to move furniture around too much in your house. Your pet may be having trouble with navigation if they are unable to follow memorized paths.
  • Try to keep your routine very similar every day. Try to keep bathroom breaks, meal times, and bedtime around the same time.
  • Continue with daily exercise and mental stimulation. Puzzle games, scent work, and environmental stimulation will help keep their mind sharper.
  • Continue to encourage your pet to socialize with other pets and people. This can help them maintain interest in the world around them.
  • Make dietary changes that support brain health. Increased omega-3 fatty acids have been shown to improve brain function. Treats high in omega-3's are also beneficial. In addition, l-carnitine may provide some benefit.
  • Supplement the diet with Vitamins E and C and antioxidants such as Sam-E and CoQ10.
  • Brightly colored fruits and vegetables contain flavonoids and carotenoids that function as antioxidants. These can include red, orange, and yellow peppers, butternut squash, pumpkin, red cabbage, blueberries, kale, broccoli, and parsley. 
  • Vitamin D deficiency has been associated with cognitive decline. Have your pet's vitamin D levels tested at least once every six to twelve months, even if you feed commercial diets. Many senior pets are vitamin-D deficient. Supplement if tests results are low.
  • CBD supplementation has shown to be helpful in many pets.

From a TCVM standpoint, cognitive dysfunction is primarily related to the Heart system since the Heart houses the mind. An imbalance in the Heart system leads to a Shen (mind) disturbance. There are two patterns seen in Traditional Chinese Veterinary Medicine:

1. Spleen Qi (energy) and Heart Qi Deficiencies with Phlegm Misting the Mind - poor nutrition, chronic illness, or environmental stress can result in Spleen Qi Deficiency. Reduced appetite or loss of interest in food and loss of muscle mass are common signs of this. Spleen Qi Deficiency is commonly accompanied by increased Dampness which leads to Phlegm. The Heart Qi becomes deficient over time, leading to poor memory and sleep disturbances.

These pets are progressively less responsive to their caretakers, pace and wander aimlessly, may get lost in corners and closets or under furniture, forget house training, sleep more, and lose interest in food. The tongue will be pale and wet. They have little anxiety and insomnia; instead they sleep more.

Herbal therapy may include Wen Dan Tang and Stasis in the Mansion of the Mind. Foods to supplement include Qi tonics (grass-fed beef, chicken, sardines, eggs, yams, carrots, squash, dates, figs, molasses, and microalgae) and neutral to slightly warming foods (grass-fed beef, bison, eggs, pork, salmon, sardines, carrots, cabbage, figs, sweet potato, Shiitake mushroom). Foods to avoid include foods that are too cold (duck, clams, yogurt, barley, millet, spinach, broccoli, celery, kelp, alfalfa, cucumber, pears, bananas, watermelon) and foods that are too hot (lamb, venison, shrimp, corn-fed beef, chicken).

2. Heart Yin and Blood Deficiencies with Qi/Blood Stagnation in the Brain - Improper nutrition, stress, and a weak body constitution can lead to this. Both Heart Blood and Qi nourish the Shen and when they are deficient, Shen disturbances such as anxiety, fearfulness, insomnia, and restlessness can occur. There is not enough energy (Qi) to move the Blood, so Qi and Blood become stagnant in the Brain.

These pets progressively become less responsive to the caretaker, pace and wander aimlessly, may get lost in corners and closets or under furniture, forget house training, sleep more during the day but less at night, bark, whine, howl or yowl especially at night, may howl or yowl for no reason, develop anxiety and separation anxiety, may seek cool or pant, may have warm ears, back, and feet. The tongue will be dry and may be red (Yin Deficiency) or pale (Blood Deficiency).

Herbal therapy may include Shen Calmer or Tian Wang Bu Xin Dan combined with Stasis in the Mansion of the Mind. Foods to supplement for Yin Deficiency include rabbit, duck, crab, yams, apples, string beans, watermelon, and pears. Foods to supplement for Blood Deficiency include beef, bone marrow, eggs, liver, heart, oysters, salmon, sardines, barley, beets, carrots, dark leafy greens, kelp, microalgae, dates, figs, and molasses. Hot foods to avoid include shrimp, lamb, venison, corn-fed beef, chicken, basil, and cinnamon.

Acupuncture can be helpful for either TCVM presentation.