Canine cognitive dysfunction syndrome (CCDS) is characterized by behavioral changes that develop with age. It is the canine parallel to Alzheimer's disease in people. Such behavioral changes can have an impact on the quality of life for both the dog and pet owner (Dewey et al., 2019). In this article we will explore some management strategies that can hopefully improve the quality of life for our aging canines.
Background
Depending on the age, anywhere from 18-67% of the senior pet dog population can be affected by CCDS (Dewey et al., 2019). Typical clinical signs associated with CCDS include confusion/memory loss, anxiety, altered interactions with humans, and sleep/wake cycle disturbances (Yarborough et al., 2022). It is considered a progressive disease that can present with varying degrees of severity, though is typically slow in onset.
Diagnosis
The first step in developing an effective therapeutic and management plan is accurate diagnosis. Systemic diseases or other brain diseases may manifest with signs similar to CCDS, so obtaining a full health profile is important to both establish an understanding of general health as well as evaluate for other disease processes that could be contributing to the change in cognition (Kim and Hao, 2025). If you are concerned that your pet may have CCDS, your primary care veterinarian can advise on what diagnostic tests to perform.
Once a general health profile is established, the diagnosis is predominantly made by caregiver questionnaires. Examples of these include the CAnine Dementia ScalE (CADES) and the Canine Cognitive Dysfunction Rating (CCDR) scale (Kim and Hao, 2025). While there is currently research into potential biomarkers, these have yet to be widely validated.
Therapeutic options
Options for therapy include dietary supplements, medications, and physical therapies/environmental enrichment. While none of these therapies can reverse the process of CCD, they have the ability to slow the progression and potentially improve quality of life (Dewey et al., 2019).
Diet and supplements
There is weak evidence supporting a variety of supplements for CCDS. While many seem promising, none have demonstrated consistent clinical results in robust clinical trials. Oxidative stress (free-radical damage) is thought to contribute to the pathogenesis of CCDS and many of the investigated dietary therapies have focused on the reduction of free radical damage through the administration of antioxidants (Dewey et al., 2019).
Evaluated supplements that have early positive indicators include s-adenosyl methionine (SAMe) (Rème et al., 2008), omega-3 DHA (+/- CoQ10), medium chain fatty acids (MCT) (Pan et al., 2010), and a novel brain protective blend that contained antioxidants, fish oil, L-arginine, and B-vitamins (Mood et al., 2025).
Interestingly, disruption of the intestinal microbiome may contribute to some of the neurologic manifestations of CCDS, including anxiety and stress. Prebiotics and probiotics are currently under investigation for their positive effects on modulation of the microbiome, which may confer a beneficial effect in CCDS, though this is purely speculative at this time (Sacoor et al., 2024). (link to pages for each of these)
While the above have focused on treatment of the underlying cause to slow disease progression and improve overall cognition, there are other supplements that may assist with symptomatic care. Since anxiety is a feature in nearly half of all dogs with CCDS, this translates to an impact on quality of life on a large scale. Some supplements that have shown to assist with stress/anxiety in dogs include cannabidiol (CBD) - seemingly more useful for acute anxiety (Hunt et al., 2023; Flint et al., 2024), and potentially L-theanine (Pike et al., 2015). Melatonin, an over-the-counter supplement in the USA has demonstrated a mild reduction in stress and anxiety-related behaviors in dogs associated with upcoming stressful events, and may be useful to assist with some sleep-wake disturbances (i.e. allowing for more regular sleep patterns).
(link to anxiety/calming pages)
Though as always, before starting, stopping, or adjusting a supplement, we recommend consultation with your veterinarian.
There are many prescription diets marketed towards improving brain health and signs of CCDS. Large trials evaluating such diets have yet to be performed, thus, evidence-based recommendations regarding the efficacy of these diets are unable to be established (Sechi et al., 2017). The currently available studies have largely been funded by the manufacturers of the food, thus imparting a high risk of bias on the currently available literature.
Medications
Selegiline is currently the only FDA-approved medication for treatment of CCDS. A previous large open label study showed overall improvement in dogs with CCDS (Campbell et al., 2001) while a more recent study demonstrated a mild reduction in CCDR scores (overall improvement) with selegiline + dietary modification and nutraceutical supplementation compared to dietary modification and nutraceutical supplementation alone (Mood et al., 2025). Importantly, environmental enrichment was also a component of therapy, highlighting the need for a multimodal approach to this disease process. While results of these two studies were consistent, the biologic significance appeared mild and larger clinical trials are recommended for further evaluation.
Many newer medications for the treatment of Alzheimer’s disease in people are being developed and it is possible that crossover therapy to dogs may be possible in the future (Kim and Hao, 2025).
Symptomatic management with medications is also worth discussing with your primary care veterinarian. As dogs may develop anxiety or sleep/wake cycle disturbances, prescription medications may be recommended to alleviate these symptoms.
Environmental enrichment/physical therapies
Regular exercise has a demonstrated protective effect against the development of CCDS (Bray et al., 2023). Furthermore, after the onset of CCDS, physical activity has been shown to slow the progression of the disease, mirroring findings in human trials.
Depending on the age and physical capabilities of the individual, the type of regular exercise will likely be highly variable. For instance, a dog with more advanced CCDS and concurrent severe arthritis will probably be unable to perform the same degree of physical activity as a dog with less advanced CCDS and no arthritis. Therefore, the scope of “physical activity” must be tailored to each dog’s ability and disease state, keeping in mind the balance between healthy exercise and safety.
In addition to exercise, there are other environmental enrichment strategies that can promote maintenance of cognition. These include increased interaction with other dogs (in a controlled environment), increased interaction with caregivers (e.g. playing tug and/or fetch games), and “brain games.”
Examples of brain games include puzzles to find food, treasure hunts to find food, interactive toys, and even trying to teach an old dog a new trick. Something as simple as hiding food in a specialized treat-dispensing toy can provide helpful brain stimulation. When trying out a new toy or environmental enrichment strategy, it is recommended that this be done under direct supervision to ensure the new activity is being performed safely.
Final thoughts
CCDS can become a debilitating disease that affects dogs, pet owners, and the human-animal bond that we all cherish. Early intervention appears to be most rewarding and multimodal management plan may help to improve quality of life. Discussion with your primary care veterinarian to develop such a plan can be very rewarding and hopefully improve the signs associated with CCDS.
We hope you found this article helpful. For further reading, please see the attached references.
References
Vet Clin North Am Small Anim Pract