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What is Canine Cognitive Dysfunction?

Canine cognitive dysfunction (CCD) is a disease related to the aging of a dog’s brain, leading to changes in awareness, affecting the dog’s learning and memory, and decreasing their responsiveness to their surrounding. This condition in dogs has been compared to human patients with Alzheimer’s disease or dementia. Although the initial symptoms are mild, they gradually get worse over time at a rate which can not be considered normal aging.

At what age does cognitive decline start to occur?

CCD is common in older dogs, generally occurring after nine years of age. By the age of 16, it is estimated that 68% of dogs will be affected by CCD. In other words, nearly two-thirds of dogs over 15 years of age have some form of doggie dementia. Clinical signs of mild cognitive decline are found in nearly one-third of dogs over the age of 11 years.

Equally important is the number of cases of cognitive decline in dogs that go undiagnosed. It is anticipated that approximately 14% of the dog population over eight years old will demonstrate some form of CCD. Less than 2% have been formally diagnosed with this medical condition. Many dog parents may assume that changes in the dog’s cognitive abilities are a normal part of aging. This isn’t true. The symptoms of CCD far exceed what can be considered normal aging. CCD is a progressive condition and will worsen as your dog ages.


Disclaimer: I am writing this article after researching the topic. However, I am not a veterinarian. I have provided some resources at the end of this article that you can use, but please, if you suspect your dog may be affected by canine cognitive dysfunction, consult with your veterinarian.

What causes cognitive dysfunction in dogs?

The exact causes of CCD are unknown, but the same changes that cause problems for aging people are likely to also cause problems for our aging dogs. Scientists are studying CCD and its similarities to Alzheimer’s in people. New developments are constantly coming to light. We know that as our dog’s age, the cells die as the brain atrophies. This especially affects the area of the brain responsible for memory and learning (the cerebral cortex) and coordination (the cerebellum). Research has also found an abnormal protein (beta-amyloid) building up in the dog’s brain. This protein buildup has been shown to cause decreased nerve signalling in the brain. Dogs with a sedentary lifestyle or underlying conditions such as epilepsy seem to be at a higher risk of developing CCD.

What are the clinical signs of Canine Cognitive Dysfunction?

Often, mild cognitive impairment is first noted by owners as unusual behavioural changes. For example, an owner may notice that their dog is less responsive, less engaged with them, or appears confused or disoriented. A common behaviour change reported is increased activity at night. Dogs will not necessarily display all of these signs.

The clinical signs of cognitive dysfunction an owner may recognize include:

  • Wandering
  • Going to unusual places
  • Getting lost in a familiar environment
  • Repetitive walking around the house or in circles
  • Altered sleep patterns (a)
  • Pacing, often at night
  • Getting stuck trying to navigate around objects or stuck in corners
  • Restlessness
  • Anxiety
  • Newly developed separation anxiety or noise phobia (b)
  • Disorientation/confusion
  • Unable to find the door to the outside
  • Urinating/defecating in the house when previously housetrained
  • Less interaction with owners
  • Not recognizing familiar people, animals or cues
  • Less interest in eating, playing, walking and socializing
  • Loss of appetite
  • Waking up in the night; increased daytime sleeping
  • Increased vocalization, often at night
  • Can’t locate food dropped on the floor
  • Forgets where the water or food dishes are located
  • Not wanting to play and being less engaged in general
  • Staring blankly at the walls
  • Inactivity

I have shared two resources at the end of this article that you can complete and share with your veterinarian.

(a) Altered sleep patterns and CCD in dogs

Changes in sleep-wake cycles are a common sign both in Alzheimer’s and CCD. Increased nighttime activity may have other attributing factors that need to be ruled out, including:

  • Arthritis pain, causing an inability to settle/get comfortable at night.
  • Vision loss may affect the dog’s internal clock.
  • An increased need to urinate due to diabetes or Cushing’s disease.
  • Generalized anxiety.

Not only are changes to sleep cycles disruptive for the dog, but they can have a significant negative impact on the family’s quality of life. Increased pacing, vocalization and restlessness are all often observed. The family can also feel frustrated and upset at not being able to comfort their dog, particularly when their dog vocalizes when in pain or confused.

(b) Sudden onset of separation anxiety and noise phobias

If a dog presents with separation anxiety in their senior years, CCD needs to be ruled out. Desensitization training should be deferred until a diagnosis of CCD is ruled in or out. You can find more information on separation anxiety in the senior dog in my blog, Treating Separation Anxiety in Older Dogs.

How is canine cognitive dysfunction diagnosed?

A thorough history of your dog’s health needs to be provided to your veterinarian, including details of when the changes started and details of what you are observing. If you are aware of any possible triggering events, this can also be helpful. Complete one of the questionnaires provided at the end of this article to provide your veterinarian with more history. Your vet will complete a physical exam to evaluate your dog’s overall health and cognitive functions. Blood tests, thyroid testing, ultrasounds and X-rays may be done to rule out other diseases that may lead to behavioural changes associated with CCD.

Since there is no conclusive test for diagnosing CCD, most of the history-taking and testing performed is to rule out other possibilities.

History taking

During the history taking, your vet will rely heavily on the information you provide. Your vet will ask questions about your dog that include the following:

  • Eating and drinking habits
  • Current medications or supplements
  • Recent changes in the home environment
  • Signs of sickness include vomiting, diarrhea, coughing, lethargy, etc.
  • Behaviour changes (when they started, what you observe and if the behaviour is staying the same, getting better or worse)

If you suspect your dog has CCD, provide your vet with some videos of your dog when they are acting abnormally. This will be helpful for your vet to see the behaviour, as dogs often act very differently in the vet clinic.

Physical exam and medical tests for CCD in dogs

Your vet will do an exam and might recommend additional testing to rule out other causes similar to CCD or may worsen its effects. Some of these tests include:

  • Complete Blood Count (CBC) – This test looks for signs of infection and anemia.
  • Blood chemistry – A blood chemistry panel can reveal evidence of other diseases such as liver disease (which can sometimes affect mental ability) or diseases such as diabetes or Cushing’s disease, or chronic kidney disease, which can lead to an increase in housetraining problems.
  • Urinalysis – Rule out urinary tract infections in dogs.
  • Thyroid screening – Rule out hypothyroidism, which impacts metabolism and can manifest with neurologic signs.
  • Other diagnostic testing may be recommended, such as X-rays, CT scans, or MRIs.

Canine cognitive dysfunction rating scale

The diagnosis of CCD is not straightforward. Other medical conditions present in a similar way to CCD. Plus, since there is no definitive test for CCD, a diagnosis is made by eliminating other possibilities. See the resources section for more information on several evaluation tests.

What are the CCD treatment options?

There is no cure for canine CCD. However, some treatments may slow the progression of the disease and relieve some of the dog’s symptoms, including several things you can do at home to help your dog. Unfortunately, CCD is a progressive condition. The progression differs in each dog. Medications, treatments, and at-home changes can help to slow the progression of CCD and improve your dog’s quality of life.

Tips for at-home care

Making your dog comfortable at home will help improve your dog’s quality of life. Here are five tips to help your dog:

1. Establish a daily routine.

In general, most dogs thrive on routine. This is even more so if they develop CCD. Getting up, eating, walking, and going to bed at a set time can be reassuring. Plus, the dog has a better idea of what to expect.

2. Help your dog enjoy appropriate physical exercise.

Getting outside for exercise is great for a dog’s sense of well-being. What this looks like will vary based on your dog’s physical condition. Some dogs may be okay to explore a new neighbourhood, go hiking, or visit a new park. Other dogs with physical limitations may enjoy some time spent outdoors in a familiar space with you. Watch your dog for signs of pain or tiring, and let them take frequent breaks to sniff or rest.

3. Give your dog appropriate mental enrichment.

In addition, dogs with CCD can benefit from enrichment. This can take a variety of forms:

  • A “sniff-ari” (i.e. sniffing safari) is where your dog can leisurely take in all the scents around them. Allow your dog to go at their pace and give them the time to sniff whatever they choose.
  • Teaching your dog a new trick (because old dogs can learn new tricks!). Just take into account any physical limitations your dog may have.
  • Give your dog puzzle toys where they have to lick, roll, chew, or sniff to access the treats. Having several of these puzzle toys allows you to rotate them so that your dog gets a ‘new’ one each day. Just be sure to monitor the activity to ensure that is actually enriching for the dog. if you notice your dog not engaging with the toy or getting frustrated, perhaps this isn’t the best activity for them. Check out my blog on enrichment activities for the anxious dog for more ideas.
  • Providing new toys to play with.
  • If your dog is dealing with vision or hearing loss, teaching them new cues, such as hand signals or auditory cues, can be helpful.

4. Keep your dog safe.

Keep your dog safe by:

  • Closely supervising them in new or unfamiliar areas.
  • Ensuring your dog is wearing an ID tag and is microchipped. Since your dog can become disorientated more easily, they may not always be to find their way home.
  • Puppy-proofing your home by preventing access to areas that may be dangerous, including swimming pools, slopes, or steps, if your dog is disorientated easily.
  • Keep your dog on a leash or in a fenced yard to prevent them from straying.
  • Giving your dog a zen room. This may be a space where your dog can retreat for some peace when feeling overwhelmed.

5. Help your dog sleep well.

Disruption during the night is one of the most difficult aspects of CCD, as the impact on the dog and the humans can be severe.

  • Establish a nighttime routine that includes a late-night walk so your dog can pee before bed. This will help prevent accidents and reduce your dog’s crying to go out in the middle of the night. Additionally, a nighttime routine will help your dog know that it is bedtime.
  • Provide your senior dog with an orthopedic bed to avoid putting pressure on arthritic joints. Having a bed that is easy to get in and out of is also helpful and will prevent them from tripping or falling.
  • Keep a light on so that if your dog does get up in the night, they can navigate without bumping into furniture.

Other treatments your veterinarian may recommend include:

  • Dietary changes: Your dog may be on a specific therapeutic diet designed to help. These diets contain ingredients such as antioxidants, fats and fatty acids that may protect and promote healthy brain cells.
  • Dietary supplements: Your veterinarian may recommend dietary supplements rich in antioxidants.
  • Medications: Your veterinarian may recommend medications that improve your dog’s cognitive function. Some veterinarians may suggest trying herbal therapies and acupuncture. These methods have the potential to help affected dogs, but they have not been well-studied in dogs with CCD.
  • Additional options: Some dogs may benefit from anxiety-reducing compression garments such as a ThunderShirt. Dog Appeasing Pheromone (DAP) products may also be helpful. There is limited research on their effectiveness, but they may be helpful in some cases.

What is the prognosis for senior dogs with canine cognitive dysfunction?

There is no cure for canine CCD. The disease will progress. However, if CCD is caught early and treated effectively, the dog could live a full life with a normal life span for their breed. Unfortunately, dogs with severe cases of CCD generally have a worse outcome, often being euthanized about two years after signs of CCD appear. If you notice signs of CCD in your dog, it’s best not just to attribute them to old age; consult with your veterinarian. The best way to monitor your dog’s health and cognitive functioning is to work with your veterinarian and track your dog’s quality of life.

Your veterinarian will evaluate your dog to monitor their response to therapy and the progression of symptoms. However, if you notice any new behavioural changes in your dog, notify your vet immediately. In older dogs, any changes need to be attended to quickly, so it’s important to talk to your veterinarian. In senior dogs, it is recommended that the dog gets a physical exam twice a year.

Some dogs with mild forms of CCD can live a full life with good management. Unfortunately, this won’t be the case for all dogs. Since CCD is progressive, this may mean that even with the best possible care, the symptoms may worsen. Some dogs with severe CCD have symptoms that significantly impact their quality of life. One study indicated that in severe CCD cases, some dogs were euthanized within 18-24 months of diagnosis. Ultimately the dog’s quality of life will suffer to a point where you will be faced with a difficult decision.

Deciding to euthanize.

CCD is a difficult diagnosis for dogs and their families. Your dog may be physically healthy yet suffer severe mental or behavioural challenges. Unfortunately, many families of dogs with CCD will have to decide when to euthanize their senior dog.

Maintaining the bond with our dogs is paramount, but there will come a time when your dog’s quality of life will begin to suffer. It is an incredibly difficult decision to make but so is watching your dog continue to deteriorate. I have agonized over this decision in the past, and even when I know it is the right thing to do, I am always hoping for a reprieve. My biggest regret is leaving it for too long and my dog suffering needlessly. It is often said that the decision to humanely euthanize is best made a week too early than a day too late. It isn’t a decision that can not be made for you. In the resources section, I have included a few articles that may be helpful.


Your elderly dog should be evaluated for changes in cognitive abilities by using the diagnostic tools available, and treatment should be initiated as early as possible. Treatment options include behaviour medications, dietary therapy, nutritional supplements, and behavioural enrichment. By bringing changes in your dog’s health to your veterinarian early, you are providing the best possible chance for your dog to live for as long as possible.

You are your senior dog’s biggest advocate. Your dog’s veterinarian is the best source of information. They can prescribe medication and/or supplements that allow you to better manage your dog’s condition. Finally, by managing your senior dog’s CCD symptoms, you are improving your dog’s quality of life. Even with a CCD diagnosis, you and your dog can still enjoy your time together and continue to make lasting memories.



Book: Remember Me?: Loving and Caring for a Dog with Canine Cognitive Dysfunction.  Eileen Anderson

Cognitive Dysfunction Syndrome Evaluation Tool (DISHAA) 




  1. How Will You Know When It’s Time to Euthanize Your Dog?
  2. Preparing for Your Dog’s Euthanasia: 10 Thoughts for Peace
  3. In-Home Dog Euthanasia: Heartfelt Answers to 12 FAQs


  1. Dog Dementia: Symptoms, Causes, Treatment and Life Expectancy.
  2. Canine Cognitive Dysfunction in Dogs: Signs, Symptoms, Solutions.
  3. Makiko OZAWA, Mai INOUE, Kazuyuki UCHIDA, James K. CHAMBERS, Yukari TAKEUCH, and Hiroyuki NAKAYAMA. Physical signs of canine cognitive dysfunction. J Vet Med Sci Dec 2019: 81 (12): 1829-1834, Pub Nov 1 2019
  4. Zuzana Vikartovska, Jana Farbakova, Tomas Smolek, Jozef Hanes, Norbert Zilka, Lubica Hornakova, Filip Humenik, Marcela Maloveska, Nikola Hudakova and Dasa Cizkova. Novel Diagnostic Tools for Identifying Cognitive Impairment in Dogs: Behavior, Biomarkers, and Pathology. Front. Vet. Sci., 15 January 2021 Sec. Veterinary Experimental and Diagnostic Pathology
  5. Neilson JC, Hart BL, Cliff KD, Ruehl WW. Prevalence of behavioral changes associated with age-related cognitive impairment in dogs. JAVMA 2001;218(11):1787-1791.
  6. Salvin HE, McGreevy PD, Sachdev PS, Valenzuela MJ. Under diagnosis of canine cognitive dysfunction: a cross-sectional survey of older companion dogs. Vet J 2010;184(3):277-281.
  7. Rosado B, González-Martínez A, Pesini P, et al. Effect of age and severity of cognitive dysfunction on spontaneous activity in pet dogs—part 1: locomotor and exploratory behavior. Vet J 2012;194(2):189-195.
  8. Takeuchi T, Harada E. Age-related changes in sleep-wake rhythm in dog. Behav Brain Res 2002;136(1):193-199.
  9. Madaria A, Farbakova J, Katina S, et al. Assessment of severity and progression of canine cognitive dysfunction syndrome using the Canine Dementia Scale (CADES). Appl Anim Behav Sci 2015;171:138-145.
  10. Cotman CW, Head E, Muggenburg BA, et al. Brain aging in the canine: a diet enriched in antioxidants reduces cognitive dysfunction. Neurobiol Aging 2002;23(5):809-818.
  11. Opii WO, Joshi G, Head E, et al. Proteomic identification of brain proteins in the canine model of human aging following a long-term treatment with antioxidants and a program of behavioral enrichment: relevance to Alzheimer’s disease. Neurobiol Aging 2008;29(1):51-70.
  12. Pan Y. Enhancing brain function in senior dogs: a new nutritional approach. Topics Compan Anim Med 2011;26(1):10-16.
  13. Osella MC, Re G, Odore R, et al. Canine cognitive dysfunction syndrome: prevalence, clinical signs and treatment with a neuroprotective nutraceutical. Appl Anim Behav Sci 2007;105(4):297-310.

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