Current Practices in Diagnosing and Managing Canine Cognitive Dysfunction Syndrome
A national survey reveals where we stand—and where we need to go—in managing this common condition in senior dogs
If you've ever felt uncertain about diagnosing or treating canine cognitive dysfunction syndrome (CCDS), you're not alone. A comprehensive survey of 318 U.S. veterinarians has revealed that while nearly all of us have diagnosed CCDS at some point in our careers, significant gaps remain in our confidence, knowledge, and consensus about best practices.
The findings, published in Frontiers in Veterinary Science, paint a picture of a profession grappling with an increasingly common condition—one that affects a substantial proportion of our aging canine patients yet lacks the standardized diagnostic criteria and proven treatments we'd like to have at our disposal.
The State of CCDS in Practice
The survey primarily captured responses from general practitioners (88%), with most working in general practice settings. Nearly half of respondents considered themselves to have a special interest in geriatric medicine, and senior dogs comprised 21-60% of most practices' canine caseloads—a reminder that we're all essentially practicing geriatric medicine, whether we consider it a special interest or not.
We're Diagnosing, But Perhaps Not Enough
Here's an interesting paradox: While 97% of veterinarians reported having diagnosed at least one case of CCDS during their career, most diagnose relatively few cases annually. Sixty-one percent diagnose only 1-15 dogs per year. Given that studies suggest CCDS affects a substantial proportion of senior dogs, these numbers hint at widespread underdiagnosis.
This gap between expected prevalence and actual diagnosis rates raises important questions. Are we missing cases? Are some dogs dying before cognitive signs become apparent? Or are we prioritizing other comorbidities over cognitive decline? The survey suggests it may be all of the above, compounded by communication barriers with owners who may not recognize or report cognitive changes.
How We're Making the Diagnosis
When it comes to establishing a CCDS diagnosis, the survey revealed both consistency and concerning variability in our approaches.
The Universal Tools
Nearly every veterinarian relies on patient history and clinical signs or behavioral changes—which makes sense, as CCDS is fundamentally a clinical diagnosis. Most of us (78%) also perform a physical examination. So far, so good.
Where Things Get Inconsistent
Here's where the picture becomes more fragmented:
Only 49% perform a neurological examination
Only 49% conduct laboratory work
Just 32% use a screening questionnaire
A mere 2% obtain advanced imaging
This variability is particularly striking when you consider that CCDS is a diagnosis of exclusion. Without thorough workups to rule out sensory decline, chronic pain, renal disease, or intracranial neoplasia, how confident can we be in our diagnoses?
The underutilization of neurological examinations is especially notable. Unlike advanced imaging, a neurological exam is accessible, relatively quick, and doesn't require specialized equipment. Yet only half of us are performing this fundamental assessment. This may reflect a broader phenomenon documented in both human and veterinary medicine: "neurophobia," or an aversion to clinical neurology among practitioners.
Clinical Signs: What We're Looking For
When asked which behavioral changes inform their diagnosis, veterinarians showed near-consensus on most signs:
Changes in sleep/wake cycles (98%)
Disorientation (93%)
Anxiety (91%)
Changes in social interactions (88%)
Increased house soiling (87%)
Interestingly, aggression was considered by only 39% of veterinarians, suggesting we may view this as a less reliable or specific indicator of cognitive dysfunction.
The Treatment Dilemma
If the diagnostic picture is murky, the treatment landscape is even more uncertain. The survey revealed a profession reaching for multiple interventions while expressing limited confidence in any of them.
What We're Recommending
The most commonly recommended management strategies were:
Supplements (89%)
Pharmaceuticals (84%)
Environmental modification (80%)
Diet change (64%)
Exercise (48%)
When it came to specific products, selegiline led the list at 68%—the only FDA-approved drug for canine cognitive dysfunction in the United States. This was followed by Purina ProPlan NeuroCare diet (61%), melatonin (54%), Senilife supplement (48%), and Hills b/d diet (43%).
The Effectiveness Question
Here's the sobering reality: When asked to rate the overall effectiveness of current treatment strategies, only 1% of veterinarians felt they were "very effective." The majority rated them as slightly (57%) or moderately (35%) effective, with 7% feeling they weren't effective at all.
When forced to identify the single most effective intervention, 43% chose pharmaceuticals, with selegiline being named most effective by about 30% of all respondents. Yet this means 70% of veterinarians either don't use selegiline or don't find it to be the most effective option—a striking lack of consensus for the only FDA-approved treatment.
Troubling Inconsistencies
Perhaps most revealing were the internal contradictions in veterinarians' responses:
86% of those who said no available products are effective still reported recommending two or more of these products
Some veterinarians who selected pharmaceuticals as most effective went on to name supplements or diets as the most effective product
Others who championed supplements identified selegiline as most effective
These inconsistencies don't reflect poor survey design—they reflect the genuine uncertainty and confusion we face in clinical practice when evidence is limited and results are variable.
The Barriers We Face
When asked directly what prevents them from recommending available treatments, veterinarians identified:
Lack of knowledge (47%) – This was the most frequently cited barrier, even among veterinarians who had learned about CCDS in school or through continuing education. There's clearly a gap between awareness and clinical confidence.
Lack of owner interest (40%) – This may reflect the perception gap revealed in the survey: Veterinarians reported being more concerned about CCDS than they perceived their clients to be.
Cost (30%) – Always a factor in veterinary medicine, though notably not the top concern.
Lack of clinical trial evidence (25%) – We want data, and for many interventions, robust evidence simply doesn't exist.
What Would Help?
The survey included a particularly important question: What single thing would make veterinarians more confident in diagnosing CCDS?
The answer was overwhelming: 64% wanted standardized diagnostic criteria or guidance on distinguishing CCDS from other age-related diseases. Only 2.5% of veterinarians felt they needed nothing additional—meaning 97.5% of us would benefit from more support.
This echoes challenges in human medicine, where even with formally established guidelines for Alzheimer's disease, diagnostic inconsistency remains a significant barrier to optimal care. But it also suggests a clear path forward: The veterinary profession needs to come together to establish practical, evidence-based diagnostic guidelines.
The Referral Gap
One unexpected finding: Most veterinarians rarely (44%) or never (44%) refer potential CCDS cases to specialists. This means general practitioners are managing the vast majority of cases independently, even when lacking confidence in their knowledge base.
When referrals do occur, they're most often to neurologists (74%), followed by behaviorists (38%) and internists (19%). But the infrequency of referrals overall highlights the critical need to equip primary care veterinarians with better tools and knowledge—we're on the front lines whether we feel prepared or not.
The Client Communication Challenge
The survey revealed an interesting disconnect between veterinarians and their clients. While most veterinarians reported moderate to very strong concern about CCDS in their senior patients, they perceived their clients as having only moderate to slight concern.
This perception gap matters because it may influence whether and how we initiate conversations about cognitive decline. The survey found that conversations about CCDS were fairly evenly split between veterinarian-initiated (47%) and client-initiated (38%), suggesting we're not consistently taking the lead on this topic.
Perhaps most telling: Only 32% of practices offer specialized senior visits, despite the high proportion of geriatric patients in most practices. Given that age is the single most significant risk factor for CCDS, implementing routine senior care visits with cognitive screening could help address the apparent underdiagnosis problem.
End-of-Life Considerations
When owners of dogs with CCDS elect euthanasia, veterinarians reported that it's typically due to a combination of factors (57%) rather than a single presenting issue. However, when a single factor was identified, house soiling was most common (20%), followed by changes in sleep/wake cycles.
This information has practical implications for client counseling. Understanding which symptoms owners find most distressing can help us set realistic expectations and develop management strategies that address quality of life concerns before they become intolerable.
Where Do We Go From Here?
This survey doesn't just document where we are—it illuminates where we need to focus our collective efforts:
1. Education and Training
Nearly half of veterinarians cite lack of knowledge as a barrier to treatment recommendations. This suggests that despite most of us learning about CCDS in school or continuing education, current educational approaches aren't translating into clinical confidence. We need more practical, case-based training that bridges the gap between theoretical knowledge and clinical application.
Particular attention should be paid to neurological examination skills and the use of validated screening questionnaires—accessible tools that remain underutilized in practice.
2. Standardized Diagnostic Guidelines
The profession needs to develop practical, evidence-based consensus guidelines for diagnosing CCDS. These should include:
Recommended minimum diagnostic workup
Guidance on ruling out other conditions
Clear criteria for when referral is appropriate
Validated screening tools with interpretation guidance
3. Treatment Research and Guidelines
We desperately need more robust clinical trials evaluating treatments for CCDS. Current evidence is limited, making it difficult to recommend interventions with confidence. We also need practical treatment guidelines that acknowledge the limitations of current options while providing evidence-based recommendations.
4. Proactive Screening Programs
Consider implementing routine cognitive screening for all patients above a certain age—perhaps 7-10 years depending on breed and size. Early identification of cognitive changes, before they become severe, may improve both outcomes and client satisfaction.
5. Client Communication Resources
We need better tools for initiating and facilitating conversations about cognitive decline with clients. This includes:
Standardized screening questionnaires that clients can complete
Educational handouts and resources
Guidance on setting realistic expectations
Strategies for discussing quality of life and end-of-life decisions
The Bottom Line
This survey confirms what many of us have felt in practice: CCDS is common, concerning, and challenging to manage. While we're generally aware of the condition and attempting to diagnose and treat it, we're doing so without the standardized guidelines, robust evidence base, and clinical confidence we'd like to have.
The good news? Now we know specifically where the gaps are. The veterinary profession can use these findings to focus educational efforts, research priorities, and guideline development where they're needed most. For general practitioners managing the majority of CCDS cases, this means help is hopefully on the way—in the form of better diagnostic criteria, stronger evidence for treatments, and more practical clinical guidance.
Until then, we continue doing what we do best: combining the limited evidence available with clinical judgment, client communication, and a commitment to improving quality of life for our senior patients, one case at a time.
Read full study here: https://www.frontiersin.org/journals/veterinary-science/articles/10.3389/fvets.2025.1685430/full
