Marty, the Border Collie
In early November of 2006, a devoted but highly concerned owner of a 15-1/2 year old castrated male Border Collie, Marty, came to see me here at Tufts Cummings School of Veterinary Medicine. Marty, she was told by her vet, was possibly suffering from canine cognitive dysfunction (CCD), a.k.a. canine Alzheimer's disease. There was not much doubt about the diagnosis as Marty was showing all the classical signs of this wretched condition, including disorientation, altered social interactions, sleep disturbances, and house soiling. Marty's disorientation took the form of staring into space or at walls, and standing on the wrong side of the door to go out. He no longer recognized familiar people and showed less interaction with his owner. In addition, he slept a lot during the day but paced back and forth every evening as soon as the sun went down (sundowner's syndrome). Finally, Marty, who was formerly house trained, began to have house soiling accidents around the home and there was no medical explanation for his incontinence. Marty's owner first noticed his mental acuity was slipping when he was around 11-1/2 years old - but things had gotten a lot worse recently.
The vet had started Marty on Anipryl® 2-1/2 months prior. Anipryl® works by slowing the breakdown of the catecholamine dopamine in the brain, thus increasing alertness and activity. And it works pretty well, too. In about 1/3 of cases it is positively rejuvenating while another 1/3 of dogs show useful improvement. Marty fell into the second category and his house soiling and pacing decreased for about six weeks but then he seemed to become resistant to the drug's effects. The vet increased the dose but simultaneously referred Marty to me for further evaluation and treatment.
As you might imagine, because of Marty's age he had other issues as well as CCD. For example, he had hip dysplasia, arthritis, and a thyroid test indicated hormone levels on the low end of normal. In addition to Anipryl®, Marty was treated with an analgesic (Deramaxx), glucosamine/condroitin sulfate and omega-3 fatty acids. In the consulting room, Marty's behavior was subdued and he had a forlorn lost look reminiscent of Eeyore of House of Pooh Corner fame. He was at best only mildly interested in his new surroundings but I was flattered that he made his way across the room to see me and wagged his tail slowly as he lowered his head to be petted. His owner, concerned at his deteriorating condition, asked me whether I thought it was right to keep a dog in his condition alive. She did not want to prolong Marty's life for selfish reasons, especially if he was suffering. I told her that as long as Marty was not in excruciating pain, which I believed he was not, and as long as he was eating well, which he was, and showing interest in some people some of the time, there was no reason to terminate his life prematurely. The owner let out a sigh of relief and almost cried for joy at hearing this news. I did caution, however, that I was not sure that we could make him much better and that we would, at best, only be buying him a bit more quality time. The writing was on the wall.
Primary measures I took to improve Marty's cognitive function were: Treatment of his sluggish thyroid function with hormone replacement therapy; changing his diet to the anti-oxidant rich Hill's BD (specifically designed to help dogs with CCD); and increasing his exposure to novel events and situations. In addition, I had Marty's owner give him melatonin each night to help him sleep. Melatonin has the added benefit of being an anti-oxidant and has been shown to increase life span in some experimental situations. I also recommended giving him coenzyme Q10 as a dietary supplement as this vitamin-like substance has shown some promise for treating neuro degenerative disease. Finally, I recommended treating Marty with acetyl-L-carnitine as this drug has been shown to have beneficial effects in people with Alzheimer's disease.
A month later, Marty's owners got back to me with the encouraging news that he was doing much better on his new treatments. Reports from his daycare were that he was running around much more and showing more interest in his surroundings. His owner noted that he had begun jumping into the car when she picked him up, a thing he had not done for a long while. He continued to eat well and had begun sleeping through the night, rising occasionally to get a drink of water before going back to sleep. He had passed a whole week without urinating indoors and had only one defecation incident in that period. He still panted and paced a bit in the early evening but for less time and with less intensity. Marty's owner reported that perhaps the best thing that happened is that when she looked into his eyes she now found someone looking back at her. Prior to her visit to Tufts, when she looked into Marty's eyes she saw an unfocused anxious looking creature with "no trace of the previously beautiful Marty." But now, she said, he's back again and it's a beautiful thing. "Previously the lights were on but there was no one home - now the lights are on and somebody's home." Overall, things seemed to be moving in a very positive direction.
Marty's improvement will eventually come to an end - as all good things do - but hopefully it will not be for six or twelve months - a decent extension of life for a dog. I'm not completely out of ideas if Marty does have a relapse. His owner had given him L-carnitine instead of the neurologically active version, acetyl-L-carnitine. I can make that adjustment. I also have Namenda, a new drug for treatment of human Alzheimer's disease, waiting in the wings. But for now, all is well - or at least much better - in Marty's life and I trust all will remain well so for quite some time.
PS. Do not try medicating your dog at home without veterinary supervision.
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