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Reply To: Best treatment for feline cognitive disorder

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Thank you so much for this. Really interesting question.

Diet, drugs or supplements all might be effective in improving signs and slowing the progress of CDS. Canine studies have demonstrated that mental stimulation in the form of training, play, exercise, and use of manipulation toys can help to maintain quality of life as well as cognitive function, but are most effective together with an appropriate nutritional base. This is consistent with studies in humans in which education, and brain and physical exercise, have been found to delay the onset of dementia.
Currently there is one pharmaceutical in North America, selegiline (Anipryl, Zoetis Animal Health), that is approved for the treatment of CDS in aged dogs. Selegiline hydrochloride is a selective reversible monoamine oxidase B inhibitor, which was found to significantly improve cognitive signs in aged dogs. In the canine brain, selegiline increases 2-phenylethylamine, a neuromodulator that enhances dopamine and catecholamine function. Its metabolites l-amphetamine and l-methamphetamine could further enhance cognitive function and improve behavior. Selegiline also might contribute to a decrease in free radical load in the brain.

Propentofylline, a xanthine derivative, is licensed in Europe and Australia for the treatment of dullness, lethargy, and depressed demeanor in old dogs. It could increase blood flow and inhibit platelet aggregation and thrombus formation. In a laboratory trial with aged Beagle dogs, it had no effect on behavioral activity.

No drugs are approved for treatment of CDS in cats; however, both selegiline and propentofylline have been reported anecdotally to be useful.

Another therapeutic strategy for cognitive dysfunction in dogs, cats, and humans is diets and natural supplements that might reduce the risk factors that contribute to brain aging and cognitive decline. It is likely that an integrative approach is required to achieve and maintain brain health, such as diets supplemented with polyunsaturated fatty acids, antioxidants, and mitochondrial co-factors. Two veterinary therapeutic diets that have been developed for the management of CDS have been demonstrated in laboratory studies to improve learning and memory in dogs. A diet from Hills Pet Nutrition (Canine b/d) is supplemented with fatty acids, antioxidants (vitamins C and E, beta carotene, selenium, flavonoids, carotenoids), and dl-alpha-lipoic acid and l-carnitine to enhance mitochondrial function. When the diet was combined with environmental enrichment, the greatest level of improvement was achieved. I have a funny feeling this diet is no longer available. In a clinical trial, significant effects were obtained from the diet alone. A diet from Nestle Purina Research (Purina Pro Plan Bright Minds) is supplemented with botanic oils containing medium chain triglycerides to provide ketone bodies as an alternate source of energy for aging neurons. A dietary supplement from Nestle Purina (not yet commercially available) with antioxidants, (vitamins E and C, and selenium), arginine, B vitamins, and fish oil significantly improved learning and memory tasks in cats aged 5.5 to 8.7 years.

A number of nutritional supplements also might be effective in the management of CDS based on laboratory and/or clinical studies. Senilife (CEVA Animal Health), which contains phosphatidylserine (a membrane phospholipid) and Gingko biloba, vitamins Eand B6, and resveratrol, is labeled for both dogs and cats but only has been evaluated in canine studies to date. Activait (Vet Plus Ltd), which contains phosphatidylserine, omega-3 fatty acids, vitamins E and C, l-carnitine, alpha-lipoic acid, coenzyme Q, and selenium, has been evaluated in a canine clinical trial. A feline product also is available with alpha-lipoic acid removed. S-adenosyl-l-methionine (Novifit, Virbac Animal Health) might help to maintain cell membrane fluidity and receptor function, regulate neurotransmitter levels, and increase production of glutathione. Apoaequorin (Neutricks, Neutricks, LLC), is a calcium-buffering protein found in jellyfish that improved learning and attention in dogs in laboratory trials. Immunotherapy has also been evaluated in aged dogs, involving the vaccination of aged animals against the A-beta protein. Although the study was not successful in reversing cognitive deficits, this approach might have future treatment potential.

Hope that helps.

Scott x