780-250-1700
2531 – 17th Street NW Edmonton, AB
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Canine Cognitive Dysfunction Syndrome Assessment
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Canine Cognitive Dysfunction Syndrome Assessment
Canine Cognitive Dysfuntion Syndrome Evaluation Tool
Cognitive Dysfunction Syndrome (CDS) is an irreversible degeneration of the brain similar to Alzheimer's disease in humans, characterized by progressive cognitive impairment beyond that expected to occur with aging. CDS has a slow onset, can be difficult to manage and affects an estimated 14% of dogs 8 years and older.
Date
*
Date Format: MM slash DD slash YYYY
Owner's Name
*
First
Last
Pet's Name
*
First
Age
*
Sex
*
Male
Neutered Male
Female
Spayed Female
Breed
*
Medications and Dosage Frequency
DISORIENTATION
Identity signs that have arisen or progressed since 8 years of age or older.
Gets stuck, difficulty getting around objects, goes to hinge side of door
0
1
2
3
Score as 0=none, 1=mild, 2=moderate, 3=severe
Stares blankly at walls, floor or into space
0
1
2
3
Score as 0=none, 1=mild, 2=moderate, 3=severe
Does not recognize familiar people/familiar pets
0
1
2
3
Score as 0=none, 1=mild, 2=moderate, 3=severe
Gets lost in home or yard
0
1
2
3
Score as 0=none, 1=mild, 2=moderate, 3=severe
Less reactive to visual (sights) or auditory (sounds) stimuli
0
1
2
3
Score as 0=none, 1=mild, 2=moderate, 3=severe
SOCIAL INTERACTIONS
Identity signs that have arisen or progressed since 8 years of age or older.
More irritable/fearful/aggressive with visitors, family or other animals
0
1
2
3
Score as 0=none, 1=mild, 2=moderate, 3=severe
Decreased interest in approaching, greeting or affection/petting
0
1
2
3
Score as 0=none, 1=mild, 2=moderate, 3=severe
SLEEP/WAKE CYCLES
Identity signs that have arisen or progressed since 8 years of age or older.
Pacing/restless/sleeps less/waking at night
0
1
2
3
Score as 0=none, 1=mild, 2=moderate, 3=severe
Vocalization at night
0
1
2
3
Score as 0=none, 1=mild, 2=moderate, 3=severe
HOUSESOILING, LEARNING AND MEMORY
Identity signs that have arisen or progressed since 8 years of age or older.
Less able to learn new tasks or respond to previously learned commands/name/work
0
1
2
3
Score as 0=none, 1=mild, 2=moderate, 3=severe
Indoor soiling of urine ___ or stool ___ /decreased signaling to go out
0
1
2
3
Score as 0=none, 1=mild, 2=moderate, 3=severe
Difficulty getting dog’s attention/increased distraction/decreased focus
0
1
2
3
Score as 0=none, 1=mild, 2=moderate, 3=severe
ACTIVITY
Identity signs that have arisen or progressed since 8 years of age or older.
Decrease in exploration or play with toys, family members, other pets
0
1
2
3
Score as 0=none, 1=mild, 2=moderate, 3=severe
Increased activity including aimless pacing or wandering
0
1
2
3
Score as 0=none, 1=mild, 2=moderate, 3=severe
Repetitive behaviors, e.g., circling ___ chewing ___ licking ___ stargazing ___
0
1
2
3
Score as 0=none, 1=mild, 2=moderate, 3=severe
ANXIETY
Identity signs that have arisen or progressed since 8 years of age or older.
Increased anxiety when separated from owners
0
1
2
3
Score as 0=none, 1=mild, 2=moderate, 3=severe
More reactive/fearful to visual (sights) or auditory (sounds) stimuli
0
1
2
3
Score as 0=none, 1=mild, 2=moderate, 3=severe
Increased fear of places/locations (e.g., new environments/going outdoors)
0
1
2
3
Score as 0=none, 1=mild, 2=moderate, 3=severe
Total (Be sure to carry over the scores within the whole form)
Once this form is completed, your veterinarian will determine the cause of these signs through a physical examination and recommended diagnostic tests. However, even if your senior pet is experiencing multiple health issues associated with aging, there may be some degree of CDS. A score of 4-15 is consistent with mild, 16-33 is moderate, and >33 is severe CDS.
Home
Contact
New Clients
What to Expect
New Client Registration Form
Prescription/Food Refill Request
About Us
Team and Pet Bios
Location & Hours
Make an Appointment
Fear Free Clinic
Services
Medical Services
Surgical Services
Anesthesia and Patient Monitoring
Nutritional Counseling
Additional Services
Pet Health
Pet Health Library
Pet Health Checker
How-To Videos
News
Forms
Consent Forms
General Anesthesia Consent
Euthanasia Consent Form
Echocardiogram – Drop Off Consent Form
Drop Off Consent Form – with sedation
Drop Off Consent Form
Overnight Hospitalization – Drop Off Consent Form
Blood Glucose Curve – Drop Off Consent Form
Dental Surgery Consent Form
Spay/Neuter Surgery Consent Form
Telemedicine Consent Form
Ultrasound Consent Form
Admission Forms
Canine Patient Admission Form
Feline Patient Admission Form
Recheck Exam Admission Form
Questionnaires
Diarrhea Questionnaire
Vomiting Questionnaire
Itching Questionnaire
Canine Cognitive Dysfunction Syndrome Assessment
Shop Online
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