At the end of December 2025, the Canine Cognitive Dysfunction Syndrome Working Group published guidelines for diagnosis and monitoring canine cognitive dysfunction syndrome (CCDS). Many of the veterinarians on this working group are also on the Dog Aging Project, providing a nice cross over of ideas.
The guidelines were intended to clarify CCDS and provide ways to make a diagnosis of this illusive disease and attempt to develop a standard grading program.
Definition: “Canine cognitive decline syndrome is a chronic progressive age-associated neurodegenerative syndrome characterized by changes in cognitive functions that are severe enough to affect daily life.”
People describe the changes using the following acronym DISHAA
D: disorientation
I: impaired social interactions
S: Sleep disturbances
H: House soiling, learning and memory deficits
A: Activity changes (increased or decreased)
A: Anxiety and fear (increased)
The this is a syndrome, not a singular disease. This allows room to inclusion of other forms of neurodegenerative diseases not yet identified but that present with progressive cognitive decline signs. Currently, canine dementia is the only disease that falls under the umbrella term CCDS, but this could change in the future.
A three tiered grading system is recommended by the working group:
Mild: subtle signs, preserved function
Moderate: functional impairment requiring management changes
Severe: debilitating deficits requiring comprehensive support
There is a nice flow chart (Figure 2) in the article which I recommend printing and keeping at your fingertips. The key points are:
Screening is recommended every 6-12 months starting at age 7 for most dogs (maybe earlier for giant breed dogs).
If progressive changes in DISHAA dementia are noted on the screening, proceed to the typical senior diagnostic testing (PE, NE, CBC, serum biochemistry, UA, BP).
If everything is normal, including the neurologic examination, reassess in 2-8 weeks.
If signs continue to progress, a level 1 antemortem diagnosis of CCDS can be made.
Note that it takes at least 2 evaluations (surveys) to make this diagnosis. I will be instituting a survey, extrapolated from the supplements included in this article, for use in patients with signs of cognitive dysfunction. It will come as a link, just like the seizure questionnaire. If you would like to create something similar for your clinic please look at the supplements section of this article.
Level 2 antemortem diagnosis of CCDS is made when an MRI and CSF tap are added to the diagnostic plan. Currently, these diagnostic procedures are mostly used to exclude other diseases and therefore by elimination, diagnose dementia. We know that brain atrophy occurs with age but distinguishing age related brain atrophy on MRI from neurodegenerative CCDS brain atrophy hasn’t been fully elucidated.
What are the key points?
Canine cognitive dysfunction syndrome (CCDS) is being diagnosed more frequently, and we need to support our senior patients, and their caregivers, through the process.
Diagnosing CCDS requires at least 2 separate completed surveys (preferably by the same caregiver) with evidence of progressive signs. The surveys, combined with normal routine screening, support a tier 1 level diagnosis.
Other diseases can look like CCDS and are therefore important to exclude in older patients. These may include metabolic, orthopedic, neurologic, or behavioral diseases.
Reference: https://doi.org/10.2460/javma.25.10.0668
Thanks for reading! Progressive dementia is a COMMON reason for consultation so don’t feel like you need to go at this alone. Reach out if you have any questions! Have a great week, stay warm, and I look forward to working with you soon.