Good evening everybody and welcome to tonight's webinar. I'm Libby Sheridan and I'm very, very pleased to welcome you all on behalf of Purina. Improving the welfare of senior pets is something that Purina is very committed to, as you'll you'll have seen with the launch of our diet in Eurocare earlier this year.
And we've been really excited and privileged to have been able to work with Doctor Mantea on the production of some really nice innovative and practical tools that that they'll be able to use in their practises with their senior patients. And Dr. Monteka will be able to introduce one of these tools in his talk this evening.
So we're really looking forward to making that available to you very, very soon. And so just want to say welcome everybody. Enjoy this evening and I'll hand over to Bruce now.
Thank you. Thank you, Libby. Good evening everybody.
My name is Bruce Stevenson and I have the privilege of chairing tonight's session. Just a little bit of housekeeping before we get going. For those of you that are new to webinars, if you have any questions for Doctor Monteka tonight, please, just click on the Q&A box.
If you move your mouse around over your screen, the control panel will pop up. Write your question into the Q&A box and it'll come through to me and we'll hold it all till the end. And then Xavier has kindly agreed to answer any questions at the end.
So tonight we are very happy and pleased to have Purina as a sponsor to thank you to them. And also Xavier, thank you for coming on tonight. Xavier Manteka received his BVSC and PhD degrees from the Autonomous University of Barcelona and an MSC in Applied Animal behaviour and Animal welfare from the University of Edinburgh.
He is a professor of animal behaviour and animal welfare at the School of Veterinary Science in Barcelona. And he has published extensively on the subject and he's also a diplomat of the European College of Animal Welfare and behavioural Medicine. So he is more than amply qualified to talk to us tonight.
Xavier, welcome to the webinar and it's over to you. Well, thank you very much, Bruce and, and Levy for the introduction and good evening to everyone. I would like to thank Brina for giving me the opportunity to present this webinar and also I'd like to thank my two colleagues, Doctor Susana Lebrech and Doctor Martha Matt, who are co-authors of this presentation.
Now, tonight's focus is gonna be cognitive dysfunction syndrome, and what I like to do is to start with a brief introduction and a few data on the epidemiology of cognitive dysfunction syndrome. And then I will discuss the clinical signs and diagnosis, the treatment strategies, and the animal welfare implications of cognitive dysfunction syndrome. And we'll finish with a summary, highlighting the main ideas of the talk.
So let's get started then with the introduction. We all know that dogs live longer now than ever before, and this is a good sign. It shows that for the most part we are able to provide good care to our domestic dogs.
However, Getting old comes with problems sometimes, and some geriatric dogs will develop medical and behavioural problems which may have a negative effect on their welfare and on the quality of the human dog bone. Now when we talk about geriatric dogs, we have to be aware of the fact that there is a huge variability both between and within breeds with respect to the age when a dog can be thought of as being geriatric. However, I think it is fair to say that most people would agree.
That dogs older than 7 or 8 years can be considered as being senior or geriatric. And by the way, in this talk, I will be using the terms geriatric, senior, and old as being equivalent. Now, as it happens with human beings, not all dogs age the same manner.
Some dogs will age in a very healthy manner, whereas some others will develop medical conditions. Now the thing is that even dogs which age in a healthy manner will change their behaviour. They will basically become less active, meaning that they will play less, explore less, interact less with people and other animals, and spend more time resting.
These dogs ageing in a healthy manner will lie at one end of the spectrum. At the other end of the spectrum, we have dogs that age in a not so healthy manner and develop medical conditions which impair their welfare. And among those medical conditions that may impair the welfare of geriatric dogs is cognitive dysfunction syndrome.
Having said this, however, it is important to remember that dogs, when ageing may develop other medical conditions other than cognitive dysfunction syndrome. And among these other medical conditions, I would suggest that painful conditions, for example, arthritis, which is much more prevalent in geriatric dogs than in young or adult dogs, is one of the most important ones. Now, from a practical standpoint, it is very important to remember that some of the clinical signs of cognitive dysfunction syndrome can be caused as well by other medical conditions.
And it is also important to remember that some of the clinical signs caused by cognitive dysfunction syndrome. Are not fundamentally different from the normal behavioural changes that develop dogs which age in a healthy manner. The only difference being that these changes will be more profound, more intense in dogs with cognitive dysfunction syndrome.
So to make a proper diagnosis, it is important to keep in mind this broad spectrum of different ageing processes and qualities. Some dogs that age in a healthy manner and yet modify their behaviour. Dogs that develop cognitive.
Function syndrome and finally dogs that develop other medical conditions and it might be a significant overlap between these three scenarios in terms of the clinical signs, if not in their intensity, at least in their nature. So, what is cognitive dysfunction syndrome? Well, probably all of you are familiar with this term.
The term cognitive dysfunction syndrome refers to a set of symptoms which are caused by a loss in the cognitive capacities of geriatric dogs. So some geriatric dogs, and I emphasise some, some geriatric dogs may lose partially the cognitive abilities. And this results in a change in behaviour and this set of behavioural changes caused by loss in cognitive capacity is what we label as cognitive dysfunction syndrome.
Now what is the prevalence of cognitive dysfunction syndrome? Well, it might be rather high. I mean, the truth is that reports vary and we have in the literature prevalences ranging from 1414 to over 60% in dogs older than 8 years.
Now the main risk factor for cognitive dysfunction syndrome seems to be age itself. Now you can see this slide here that in dogs of 1112 years of age prevalence is roughly 30%. Whereas in dogs are much older, dogs 1516 years old, prevalence goes up to almost 70%.
So within the group of geriatric dogs, so remember dogs older than 8 years, the older the dog, the more prevalent the condition is. Having said this, however, it is very important to keep in mind that even very old dogs may not develop cognitive dysfunction syndrome. So if you look at dogs 1516 years old, you still have 30% roughly of dogs that do not develop cognitive dysfunction syndrome.
So, cognitive dysfunction syndrome is something that may or may not happen when dogs reach an advanced age. Now, an, an interesting question here is, OK, so increasing age is the major risk factor for cognitive dysfunction syndrome, but is there any other risk factor? And, and I think there is one, issue in particular that is rather interesting, at least, to me being interested in, in, in stress and, and welfare, and that is the possible role that the stress may play in cognitive dysfunction syndrome.
And this This, this more than, than a possibility if we think about the studies looking at how stress compounds the effects of ageing and, and for example, I am, I am sure that many of you are familiar with studies done in human beings and in other animals, for example, in grey parrots. Showing how a telomere length is shorter in animals that have lived stressful lives as compared with animals of the same age that have lived not not so stressful lives. So, it is sensible to wonder whether also in dogs stress may be a risk factor for cognitive dysfunction syndrome.
Now we do have some interesting evidence pointing in this direction. We have, for example, a very nice study done in Mexico and showing that air pollution, which may be seen as an environmental stressor, is indeed a risk factor for cognitive dysfunction syndrome index and we have Several studies showing that environmental enrichment, which is known to prevent or at least to reduce stress has a protective effect on the development of cognitive dysfunction syndrome. So, to make a long story short, we have many geriatric dogs but not all of them.
That will develop cognitive dysfunction syndrome. Why some develop CDS and some don't? Well, we don't know the, the whole answer.
Probably there are genetic differences, but it seems that environmental aspects such as stress of diverse nature may play an important role as well as risk factors for cognitive dysfunction syndrome. Now, another issue which is worth looking at is the mechanisms underlying the development of cognitive dysfunction syndrome. So to put it another way, what is going on in the brain of dogs that end up developing cognitive dysfunction syndrome.
So these are rather complex area and Getting into the details is well beyond the scope of this, of this session tonight. But I think there are a few ideas which are important to understand later some of the treatment strategies to ameliorate the signs of cognitive dysfunction syndrome. And in particular, there are 4 mechanisms which are responsible for cognitive dysfunction syndrome, which I think are worth mentioning.
One is neuron loss. Second is oxidative damage in the brain, then changes in neurotransmitter activity and vascular changes. Now, let me say something else about neuron loss, oxidative damage, and neurotransmitters.
One, key characteristic of the brain of dogs that develop cognitive dysfunction syndrome is a profound and significant loss in neurons, and this loss doesn't happen evenly throughout the brain. It seems to happen mainly in two areas, the prefrontal cortex and the hippocampus and the hippocampus is very relevant here. Because, we know that the hippocampus plays a key role in special orientation and memory.
And as we, shall see in, in, in a few minutes, loss of orientation and loss of memory are key signs. In cognitive dysfunction syndrome. So it, it might well be that this loss of neurons, particularly in the hippocampus, is to a significant extent responsible for these major clinical signs of cognitive dysfunction syndrome.
Now another important aspect is that this process of neuron loss is caused mainly by reduced neurogenesis. Now neurogenesis means production of new neurons. For many years, scientists thought that adult mammals were unable to produce.
New neurons. Now we know that that is not the case and that our brain is able to produce new neurons so engage in neurogenesis throughout our life. What happens, however, is that this capacity for neurogenesis decreases with age, and we know for example that in ageing beetles.
This ability to produce new neurons decreases by 95% and interestingly enough, reduction in neurogenesis is correlated with learning and memory deficits. So we have a issue here, the brain in particular, the hippocampus lost this ability to produce new neurons, and this explains to some extent deficits in learning and memory in animals with cognitive dysfunction syndrome. A second problem has to do with mitochondria function.
You know that the mitochondria are like the engines of the cells, and when mitochondria age, they become less efficient. And this actually means two different things. One is that this age damage mitochondria are less.
Able to produce energy in an efficient manner. And they produce more free radicals that have damaging effects on the brain, whereas healthy mitochondria are more able to produce energy efficiently and produce less free radicals that if you wish, are like the contaminants produced by these engines in the cells of the brain and other parts of the body. Now, a third mechanism explaining cognitive dysfunction syndrome, which is important to understand treatment strategies, changes in the activity of several neurotransmitters.
We have known for many years from studies done in rodents and humans that one thing that happens as we age, particularly if we don't age in a healthy manner, is that we are Lose cholinergic tone, so we experience a decrease in the activity of acetylcholine and this may explain deficits in memory and also changes in the sleep cycle. Another issue is that there is an increase in the activity of one given enzyme, monoamine oxidase D and this results in an increase in the catalysis of dopamine. So there is a reduction in dopamine activity and an increase in the production of free radicals.
So neuron loss caused by a reduction in neurogenesis, particularly in the hippocampus. Problems with the ability of mitochondria to produce energy efficiently and an increase in free radical production and changes in a number of neurotransmitters including dopamine in the brain. OK, so, so far, so good.
Let's now move on to the clinical signs and diagnosis of cognitive dysfunction syndrome. Probably many of you will be familiar with this, with this table. For many years we have used this acronym DISHA to describe the main clinical signs of cognitive dysfunction syndrome.
D standing for disorientation, I standing for changes in interaction. S changes in the sleep, age, how straining problems, and a changes in activity. More recently, this description has been expanded and we have added an extra A, so we have now DISHAA, the last A standing for anxiety.
The reason for this is that we now have good data showing that dogs with cognitive dysfunction syndrome have a much higher prevalence of anxiety and anxiety-related disorders than dogs without cognitive dysfunction syndrome. So let me walk you through some of the main symptoms that we can group into these six domains. Remember, disorientation, interaction, sleep, house training, activity, and anxiety.
Now, some of them are rather straightforward and easy to remember. For example, disorientation. The dog is losing its ability to navigate through space and in some cases it's gonna be unable to find its way back home.
In more dramatic cases, the dog is going to be unable to navigate around a chair or a table and we'll try to go through. In some cases, the animal is gonna remain stuck in a corner without moving for a long period of time. So, disorientation pretty straightforward.
The Sleep is also very straightforward. Basically what happens is that dogs with cognitive dysfunction syndrome become more active at night than they used to be. And in some cases, this increase in activity during nighttime goes together with an increase in vocalisations, barking, howling, or whatever.
Now we have some other groups of signs which may present in a more diverse form. For example, interaction and activity. Now, for interaction, perhaps the easiest manifestation is that the dog with cognitive dysfunction syndrome is simply less willing to interact socially either with people or with other animals.
But in some cases we have dogs which go beyond that if you wish and are more fearful or even show some aggressive behaviour which actually is showing an increase in irritability. So it might be simply A reduced willingness to interact. In some cases, the problem goes beyond that and we have dogs which are fearful or show irritability.
As for activity, once again, the easiest, more straightforward example would be a dog that reduces its activity, it explores less, plays less, but in some cases, we have the opposite in the sense that dogs with cognitive dysfunction syndrome may walk aimlessly. Or may show repetitive behaviours such as licking, scratching or fly snapping. So basically those behaviours which in general, in a general context, we would label as compulsive behaviours.
Then we have house training. Now house training is actually a label for a much broader problem and the problem is that dogs with cognitive dysfunction syndrome have learning and memory deficits. Learning deficits meaning that they may be unable to learn new things.
Memory deficits, meaning that they are likely to forget things that they had learned in the past and one of these things may be house training, so they start showing house soiling problems. And finally, we have anxiety and again anxiety may present in a variety of forms. In some cases, dogs with cognitive dysfunction syndrome tend to show increased anxiety when left alone, so when they lose contact with their owners, in some cases, they are generally more reactive and fearful.
One thing which is important is that not all dogs with cognitive dysfunction syndrome will show all these signs. We may have whichever combination we, we may think of. Some dogs will show one, whichever sign on this list, some will show 234, or even all of them.
And there are several studies indicating that as dogs get older, the likelihood of having more than one sign, more than one symptom increases. So having 234 symptoms is more likely in very old dogs as compared with not so old dogs. OK, so how do we go around this to make a diagnosis?
Well, the truth is that there is no biochemical test right now that is useful enough to make a diagnosis of cognitive dysfunction syndrome. As for behavioural tests, we do have some which seem to be useful, but right now they are useful mainly in a lab setting for research purposes, but they are not feasible or practical in, in, in a, in a clinical, in a clinical setting. So considering this, what we have to do to make a diagnosis of cognitive dysfunction syndrome is two things basically.
One is to rule out other causes that may lead to a similar changes in behaviour. And the other thing we have to do is to assess the intensity of the behavioural symptoms. Let's start with the first of these two steps, ruling out other causes.
Now, the idea I like to to, to, to get across is that when we do this, we have to rule out both medical. And behavioural problems that may cause similar problems as cognitive dysfunction syndrome. If we start with medical causes, well, we have an almost endless list of medical conditions in geriatric dogs that may cause clinical signs similar or even identical to the signs of cognitive dysfunction syndrome.
But among all these conditions, I would like to emphasise painful medical conditions. For example, arthritis. Arthritis is highly prevalent in geriatric dogs, and if you think about the clinical manifestations of arthritis, you will easily understand how easily it might be confounded, .
With, with cognitive dysfunction syndrome. A dog with arthritis is going to interact less because of pain. It might show, some irritability.
It may lose a house training habits because of pain and pain is well known as a disruptor of the sleep cycle. So we have at least 45 symptoms of cognitive dysfunction syndrome. That very easily can be caused by painful conditions.
Not only arthritis, I'm just using arthritis as an example, but many painful conditions may, may cause signs which are typical of cognitive dysfunction syndrome. And painful conditions are just on the top of the list. We have then many other problems.
Pathic problems, urinary problems, cardiovascular and respiratory conditions, and so on. But please remember painful conditions, arthritis, and, and others on the, on the top of the list of your differential diagnostics. Now we have to rule out other problems of behavioural nature and, and again we have a long list here, separation anxiety, stress-related repetitive behaviours or compulsive behaviours, and other causes of fear or irritability.
And again, I like to emphasise one of those which is separation anxiety. In our list of differential diagnosis. Why is that?
Well, you all know, separation anxiety. The objective in this session is not to, to, to go into any depth discussion, discussion separation anxiety, that would be another, another webinar, but, but you know that the main sign of separation anxiety is vocalisation and then we have, house training problems and then destructive, behaviour. Now, the key point here is that separation anxiety may appear in dogs which have a cognitive dysfunction syndrome.
That's true, and I said that before. But it is entirely possible that geriatric dogs that develop separation anxiety do not have cognitive dysfunction syndrome. So to put it another way, we may have dogs of any age, even geriatric dogs that have Separation anxiety and yet do not have cognitive dysfunction syndrome.
So remember we have to do a good differential diagnosis. The reason for that is easy to understand if you remember that separation anxiety, a complex, complex phenomenon. That, that has different causes.
Some of them related to attachments, so attachment-related problems, and then problems which are not related to attachment, in particular condition fear. And, and both attachment related problems and condition fear may well appear in dogs that do not have cognitive dysfunction syndrome. So, the take home message here is Even if you have a geriatric dog that develops operation anxiety, do not jump immediately to the conclusion that the dog has cognitive dysfunction syndrome.
It may, but it may not. Now, Rolling out other causes, both medical and behavioural is step number 1. Step number 2 is assessing the severity of the symptoms.
And to make that an an easier process, we at the vet school in Barcelona together with Purina have developed, and a scale which is meant to be easy and, and practical. The scale includes a total of 17 questions organised into 6 groups, the same 6 groups that I have just described when talking about the clinical signs of cognitive dysfunction syndrome. So disorientation, interaction, sleep, learning and memory, activity, and anxiety.
Now, this scale is meant to be Answer, I mean the the questionnaire is meant to be answered by somebody who knows the dog's behaviour very well. So in practical terms it is meant to be used by the owner, not by the vet. But in our experience, the scale works much better if the veterinarian walks the owner through the scale and helps him or her to understand the questions.
Now each question starts with does the dog do this or that? And then the owner has 4 possible answers for each question, never. Once per month, once a week, or almost every day.
Now let me show one example of the scale using a real case this . Cross bred neutral female, a 13 year old, dog, and, as I said before, we have a total of 1717, 17 questions organised into 6 groups, 6 domains of, of clinical signs. The first domain is disorientation and here we have 6 questions that appear on the slide.
Does the dog is intently where there is nothing visible. Does the dog fails to remember its way back home and so on until 6. Does the dog fail to give any signal when it wants to go out?
And for each of these questions, the owner of the animal is asked to answer. Never. And then we would score 0 once a month and we would score 2 once a week and we would score 4 or almost every day and we would score 6.
That would be the first domain and this domain is the one that gets the highest weight on the scale. Why is that? Well, because when we move to the other domains, for example, the second domain interaction.
We have 3 questions here, the same range of responses, never once per month, once per week, almost every day. The difference being that if we or the owner answers once per month, the score now is going to be 1 instead of 2. If he or she answers once per week, the score is going to be 2 instead of 4 as before.
And finally, if the dog does it almost every day, the score is gonna be 3 instead of 6. So I, I go back one slide now to the domain disorientation and remember the scoring was 024, and 6, whereas for the other domains, the scores are 012, and 3. This applies to domain number 3, sleep with two questions, works during the night and vocalises during the night, same possible responses.
Domain number 4, learning and memory to questions again, how straining problems, finds it difficult to respond to previously learned commands. Domain number 5, activity. Is there any reduction in activity or playfulness, shows repetitive behaviours or works without an obvious purpose?
Same sort of responses and finally the last six domain anxiety with just one question. Question number 17, does the dog shows, more signs of anxiety when separated from its owner than before? And then there is a short description of the main signs of anxiety index.
Now, when we have the answer to the 17 questions, the only remaining thing is to add up all the scores and get an overall score. In this particular example, the final score was 47. Now, what does it mean?
Well, if you look at the box on the bottom right, we consider three different bands in terms of quality of ageing. If the overall score is up to 7, we consider the dog is ageing in a healthy manner. If the overall score ranges between 8 and 40, then we would consider there is a mild cognitive impairment.
And finally, if, as it is the case with this example. The overall score is 41 or higher up to 69, which would be the highest possible score on this scale, then we would conclude there is a severe cognitive impairment. So, remember that we may have scores higher than 0.
And yet that doesn't mean that there is any cognitive problems. So it is very frequent that dogs which are perfectly healthy. Score 123, up to 6 or 7, that, that's normal, normal ageing.
So when it is 8 or higher, would be a case of cognitive impairment which could be either mild or severe depending on the overall score. So as I said before, it is meant to be an user friendly scale. It doesn't take long to respond.
It is meant to be answered by the owner. I insist on that, but our experience shows that it, it works better when the veterinarian, walks the owner through the scale and, and, and resolves, possible, doubts and, and, and problems. And this scale is now in the process of being validated, in a project together with Purina.
And we are hopeful that the validated scale will be available for all of you, pretty, pretty soon. OK, so, let's move now to treatment, treatment strategies of cognitive dysfunction syndrome. Basically, we have 3 different types of strategies here.
We have the possibility to use drugs or pharmacological treatment, we have changes in diet, and we have changes in the environment and general husbandry of, of the dog. So, let's say something very briefly about pharmacological treatment. So, probably the best known drug to to treat cognitive dysfunction syndrome is a selegiline.
Actually, in some countries, particularly North America, salegyline is the only approved drug for cognitive dysfunction syndrome, in dogs. Basically, is a, is a MOB inhibitor. Remember, MB is that enzyme that is involved in the metabolism of dopamine and selegyline inhibits this enzyme, the activity of dopamine is increased.
And there are several studies suggesting that selegiline acts not only on dopamine but also on other neurotransmitters as well, particularly norepinephrine, which is also involved in a cognitive dysfunction syndrome. Beyond this, soleline has a neuroprotective effect, which is due in part to the fact that it increases the clearance of a free, free radical. So that's, that's one.
One drug, saleyline that has been shown to, to work, to some extent in dogs with cognitive dysfunction, syndrome. Another option is propanofilin. Propanofiin basically acts by reducing inflammation in the brain and the drug does this via.
Three different, 3 different mechanisms. It, it, it has, an enhancing effect on the blood flow to the brain. Remember when I was explaining mechanisms underlying cognitive dysfunction syndrome, I briefly mentioned vascular problems, so, propentofilin would, would act on, on this, on this.
Aspect, vascular, mechanisms. It reduces the activation of microglial cells and inhibits the production of free radicals and all these, three things together, explain why the drug reduces inflammation in, in the brain. And finally, we have Nircoline.
Merlin basically acts again on, the blood flow of the brain, increases, cerebral, blood flow, but also it has other effects, enhances synaptic transmission, and once again has neuroprotective, effects. So that's, that's. Tracks very, very briefly that was not the main, main topic of this, of this talk, but, but they do exist and they they do work.
They kind of slow down the changes caused by this cognitive decline in dogs with, with CDS. Now, our second, group of strategies have to do with, with diet. So what can we achieve when, when we change the, the, the diet of, of dogs with, cognitive impairment due to old age and, and in extreme cases, cognitive dysfunction syndrome.
Well, we can achieve a variety of things and, and I like to emphasise that these these changes. Are useful not only when we have dogs with clear cognitive dysfunction syndrome, but also when we have dogs with a mild cognitive impairment. So if you remember the scale, we, we have those dogs with mild cognitive impairment and dogs with severe cognitive impairment and, and, and dietary treatment may be, may be useful whenever we have these cognitive changes.
So what can we achieve? Well, we can provide an alternative source of energy for the brain. We may have an antioxidant effect, we may enhance blood flow to the brain, we may reduce inflammation, and we, may enhance energy use and synaptic plasticity.
So let me, say something about, the first of these, mechanisms, an alternative energy source. The fact is that apparently all brains seem to be less efficient at using glucose as the main source of energy, you know, the brains tend to use glucose. It is the main consumer of glucose of, of our body, but what happens is that as we age and as Dogs age, their brain is less able to use glucose and then providing an alternative source of energy, in particular, medium chain triglycerides, seems to work, pretty well to to ameliorate these changes caused by, by ageing.
As for the other effects, we have several dietary, tools, for example, arginine, which, has an enhancing effect on, on, on, blood, blood flow and synaptic plasticity, omega 3 fatty acids that reduce inflammation, . Vitamins in the group B, which, may increase, energy, metabolism and then an array of antioxidants, in particular vitamin C and, and E that will help reduce oxidative stress and provide better protection. From, changes in the brain caused by oxidative changes and production of free radicals.
And all these elements can be included in, in diets which are specifically tailored for geriatric dogs with different degrees of cognitive impairment. Now, the third and last set of treatment strategies refer to environment and husbandry and here what I would like to suggest is that we have to, we may do 3 things if you want to put it this way. One is to provide a dog friendly environment for an animal which may have not only cognitive deficits but also other problems as well.
And, and I will show a couple of examples of that. And remember that our main objective is to safeguard the welfare of the dog, and dogs with cognitive dysfunction syndrome do have cognitive problems, of course, but very often they have other problems as well. So making a small changes in the environment may mean a significant difference for the welfare of the dog.
Retraining the dog is another strategy, another option. And then, environmental enrichment, which has been shown to be extremely useful both at preventing and at ameliorating cognitive dysfunction syndrome. So a dog-friendly environment.
Well, this is one example. Remember, geriatric dogs with or without cognitive dysfunction syndrome, Mobility problems, so making life easier for the dog is gonna make a significant change in the welfare. Geriatric dogs again with or without cognitive dysfunction syndrome, they're gonna spend a long time resting so providing an extra comfortable resting place is gonna be, gonna make a very significant difference.
So none of These things is, is gonna, gonna target cognitive dysfunction syndrome, but we are concerned mainly with the welfare of the dog and dogs with cognitive dysfunction syndrome are geriatric dogs which will have other problems as well. And now we have environmental enrichment. Well, you may remember that I was explaining that one of the mechanisms underlying cognitive dysfunction syndrome.
Is a reduction in neurogenesis in the hippocampus. Well, this diagram shows in a very simple manner 4 factors that have an effect on neurogenesis in the hippocampus in red ageing and stress that reduce neurogenesis. In black, enrichment and physical activity which increase neurogenesis.
Now, the practical application is if you want to prevent, if you want to ameliorate cognitive dysfunction syndrome, reducing stress, providing enrichment, and providing opportunities for physical activity, of course, tailored to the needs of a geriatric dogs is gonna be extremely important. Environmental enrichment, many possibilities, all of you know, toys, opportunities for exploration. Gain physical activity tailored to the needs of a dog which is already senior and do not forget we are talking about a social animal, a very social animal indeed and probably the most effective environmental enrichment technique for dogs is social contact with people in particular.
We know that social contact between dogs and humans leads to a release, an increased release of oxytocin in the brain, and oxytocin has a neuroprotective effect against stress. So it is enrichment for both and it is an issue of welfare, in many cases both animal and human welfare which we have to be aware of, here. OK, I'm talking about animal welfare, just a very very simple couple of thoughts about the animal welfare implications of cognitive dysfunction syndrome.
Well, talking now about animal welfare quality of life if you want, and, and, and all of you know that the concept of animal welfare, the quality of life goes beyond physical health under the stood as, as the absence of, of disease. And that is because emotions are an essential part of welfare quality of life. So the question is, how does cognitive dysfunction syndrome affect the emotional life of dogs?
Well, I like to suggest that cognitive dysfunction syndrome may affect the emotional status of dogs in, in different ways. And one is that many dogs with cognitive dysfunction syndrome. Have a loss of, of memory and it is memory that allows us and dogs to predict what is going to happen.
We know what is going to happen now because we remember that before when we were in a similar situation, this was what happened. Now when dogs Lost their memory, the sense of predictability, their ability to predict what is going to happen is much reduced and we know there is an overwhelming evidence on that, that ability to predict reduces the severity of stress. So simply because cognitive dysfunction syndrome impairs this ability to predict what is going to happen, dogs are left in a much more vulnerable situation in terms of stress sensibility.
That is not only that. It is also that dogs with cognitive dysfunction syndrome are more likely to suffer anxiety, as I said before, including separation anxiety. And we have a fascinating, work done mainly in the United Kingdom, first at, at Bristol and then at Lincoln Universities.
Showing that dogs with separation anxiety tend to have a negative cognitive bias. So, to put it in a more colloquial way if you want, they tend to be more pessimistic. When they face an ambiguous stimulus, they tend to interpret that stimulus as being negative.
So they, they see, the, the glass half empty instead of seeing it half, half full, and negative cognitive bias. So, . Lack of predictability, cognitive bias, and on top of this, you may remember that one of the key features of cognitive dysfunction syndrome is that there is an alteration in the sleep cycle.
Well, we have, evidence now showing that when animals and humans sleep less. This causes an increased sensitivity to pain, which, in turns increases the stress which again feeds back and reduces the sleep, even further. So just think about the dog has arthritis and cognitive dysfunction syndrome.
Because it has cognitive dysfunction syndrome, it may sleep less, which will increase the sensitivity to pain. So arthritis is gonna be more painful and that will end up being a vicious circle, with a very negative effect on the welfare of the dog. OK, so that brings me to my last slide which is meant to be a very, very brief summary indeed with for ideas.
Cognitive dysfunction syndrome has a profound effect on the welfare of the animal. So remember, we are concerned about the welfare of our animals and cognitive dysfunction syndrome has to be seen as a welfare problem, a major welfare problem in geriatric dogs. Early diagnosis is essential and we hope that the scale we are developing may help practising vets to, to, to, to make diagnosis rapidly and, and, and easily.
When doing the diagnosis, we have to rule out other conditions including both medical and behavioural conditions and finally, treatment strategies include pharmacological, dietary, and environmental intervention. So that's all from me. Thank you very much indeed for listening.
Thank you again to Brina and to the technical support from the webinar vet. Thank you. Javier, thank you very much for your time tonight and for all your insights.
It's it's really interesting once you start pulling all these factors together to start thinking about them in this overall pattern which you made incredibly clear tonight. Thank you. So we've got a lot of questions and comments on that coming through.
Probably the most common one that has come through to us is, where can people get hold of this, this scale with these questions and everything else. Well, that, that might not be a question for me actually. I, I know that Purina is going to make this scale available to practising vets, pretty, pretty soon.
We are now in train of validating the, the scale and once the scale has been validated, we aim to publish it in a, in a veterinary journal. But I think that, Purina is, is, is willing to, to make the scale available. So.
Yeah. Libby, can you come in and give us an answer on that? Yes, I can do.
I can do. As Dr. Montega said, we, we hope to make the scale available very, very soon indeed, and perhaps maybe those people who have asked for it, maybe through yourself, we could contact them whenever it's available and let them know.
And it would be a case of going to their, their Purina local representative, which we can help to guide them to. Yeah, so I mean Libby, if you, if you can get a copy of it through to the office of the webinar vet, the very capable office staff there can get it out to all the participants tonight. That would be absolutely fabulous.
OK. Javier, we've got another question that's come through from Sonja. And Sonja wants to know in the later stages of CDS are petite mole seizures and proprioceptive deficits common?
Or would you associate these symptoms to be other comorbidities rather than CDS? Well, it, I think in most cases could be comorbidity, but, there are some, some studies suggesting that they, they may be part of advanced stages of CDS. However, having said that, I think that the, more, we don't have conclusive evidence for that, so I would be inclined to say that in most cases that would be comorbidity.
OK. Kate wants to know if a dog, fails to know its way home, do they end up developing fear and anxiety of going for a walk? Well, that, that may well happen, yes, and this would be an example of how cognitive dysfunction syndrome may lead to other behavioural problems that end up worsening the, the welfare, and the welfare of the animal.
So I think it's, it's very important then that cognitive dysfunction syndrome is approached not only from a neurological point of view, but, but also from, from a behavioural point of view. And, and the veterinarian provides good advice to, to the owner of those with cognitive dysfunction syndrome, not only to slow down the progress of the condition through techniques such as environmental enrichment, but also how to prevent that the condition itself, leads to other, other problems such as, more severe anxiety and fear. OK.
Laurie has raised a question which is why in the normal ageing scale does the senior geriatrics start from 7. It seems to be quite a low figure now that animals are living longer. Yeah, that's, that's true, and, we really thought very, very carefully about it and, and, and to be honest, I don't think we have any, definitive reason to say it is 7 and, and, and couldn't be 8 or 9.
But the, the problem is that we wanted to be on the safe side, mainly because there is quite convincing evidence showing that as dogs start a cognitive decline. This decline tends to, to, to progress. So I think that the fact that we er on, on a conservative side and, and give a warning signal to the owner and to the vet that something may be going on and therefore it is, advisable to do something about it, .
Then, it is, in the long term better for the welfare of the dog. Clearly, as I said, I mean, there is no reason to, to draw the line 7 instead of 8, but we do know that, if, if it goes up. Even a little bit higher than that, something is going on.
If you look at the signs when there is more than a couple of twos or threes, then something is happening which is not completely, completely normal. So, I agree that we have been rather conservative, but this has been deliberate, for the benefit of the, of the dog's welfare to prevent any worsening in the condition. Excellent.
Javier, we've got a load of, of comments coming through saying thank you, very informative, great. Can't wait to see the scale. Looking forward to receiving it.
Looking forward to being able to investigate further. So there's lots of people that are really writing in, but one that I'd like to just read out to you, it comes from Catherine and she says, great. Thank you very much.
Even if it is 7 a.m. Here in New Zealand.
Well, I thank you very much for making the effort to be listening to the webinar at 7 a.m. In New Zealand.
So thank you very much indeed. We've got a couple of questions and folks forgive me if I paraphrase because there's a number of them on the same topic. .
But essentially the, the question is, what would you use as your preferred therapeutic approach to these animals? And the second part of it is, would you use therapeutic approaches as a therapeutic trial if you suspected the condition to see how the animal responded? Well, I think that when we have evidence or suspect that there is a cognitive impairment, I, I would be in favour of using both an, an environmental and dietary, approach.
We know that, in geriatric dogs, these two things, I mean changes in diet and environmental enrichment would be, beneficial and, . And, and the welfare of the dog is, is gonna be, gonna be improved. So my answer is clearly yes with an emphasis in diet and environmental changes.
OK, and which of the drugs, if you had to reach for drugs, would you reach for first as a personal choice or am I putting you on the spot? Well that's fine. No problem at all.
I, I would be inclined to say that the drug for which we have the strongest evidence is egin. OK. A, a great question that's come in here again, a theme running through others.
With, with everything that we're doing with CDS, are we reversing the changes or are we just slowing the progression down? Well, that's a good point really. I think clearly we are slowing down the, the, the process.
Having said this, however, for example, we know that, environmental, enrichment. Has an effect on, on the ability of the brain to produce new, neurons. So I don't think we can rule out the possibility that we may do some reversing of the, of the.
Problem However, I, I think that if we just go through the literature, most people would suggest that what we do mainly is to slow down, but, but I, I, I think again that we, we can, completely rule out that, if we, apply all these changes, we may really do something else than just slowing down. OK. We've got a lot of, of different, questions coming through.
So folks, if I can just point out to you, these webinars are all recorded, and, so they will be up on the website in the next 2 to 3 days. So those of you that are asking to go back slides or to look at other things and that sort of thing, rather go and watch the recording again. And then you can get a, a, a another look and and rewind and stop and and re-look at all these sorts of things.
. Javier, Susan wants to know that or says she's been reading that one of the first problems with cognitive decline is the ability to discriminate between smells. Could this be of any use? Well, yes, that, that's true.
It, it does happen in, in, in some dogs with cognitive dysfunction syndrome. Having said that, however, it is also true that some geriatric dogs seem to retain this, olfactory, discrimination ability longer than others, anyway. Any, any sign of, the dog failing to discriminate between a stimulant of whichever nature that the dog used to be able to discriminate in the past may be a warning signal for cognitive dysfunction syndrome, and the dog being basically olfactory animal, olfaction is clearly important.
But I, I, I put and say white and black, and if this happens, there is a problem, if it doesn't happen, it is not because we have seen dogs with cognitive dysfunction syndrome that yet retain a rather remarkable olfactory ability. But, but yet, when, when it does fail, then it, it, I think it, it says something about a very substantial decline in the animal probably. Excellent.
The last question that I'm going to pose for you tonight, is again a conglomeration of everybody else, along the same topics and it's simply this, what about cats? Well, yes, cats do show, cognitive dysfunction syndrome. In some respects, the, problem is, is similar, but there are, very remarkable differences as well, both, clinically, in terms of, clinical signs and in terms of, some of the mechanisms.
Some of the mechanisms are, are common to both species. But cats, show some peculiarities and, and really that's a fascinating, fascinating, topic. So they do show the problem.
In many respects, it is similar, but we do have the cat touch if you want, that makes things slightly different in all respects and also in cognitive dysfunction syndrome. Excellent. Folks, that's all we have time for.
If I can just remind you all that when you logged into the webinar, there was, on the, the login page, there was a, a questionnaire that popped up on your screen. Please would you go onto that and give us feedback about tonight and any other comments that you want to submit through to us. We at the webinar vet are Very, very interested in your opinions and how you find these.
I know lots of you are sending in great thank yous to Javier for a great webinar. But if you can complete those feedback forms, we really would appreciate it. It helps us to provide you with what you're looking for.
So when we leave the webinar shortly now, just go and fill in that form and, and submit it for us. Xavier, thank you for your time tonight. I really, really appreciate it.
And to Purina. Purina, thank you for your sponsorship of tonight and we all look forward to the results of all your hard work, Xavier, combined with Purina. And from my side and the webinar vet, all the people in the background helping with controlling.
Thank you very much and good night. Thank you, a pleasure. Bye bye now.
