Canine Cognitive Dysfunction Syndrome Assessment Tool

Fairfax, VA CampusRichmond, VA Campus

Dr. PikeDr. EngDr. NallaDr. Engler

Dr. LearnDr. Nalla

Primary Owner name:*

First NameLast Name

Primary Owner email:*

example@example.com

Primary Owner phone number:*

Please enter a valid phone number.Format: (000) 000-0000.

Patient name:*

Patient age:*

Female, IntactFemale, SpayedMale, IntactMale, Neutered

Patient breed:*

Patient weight:*

What is this Patient's current diet:*

YesNo

Instructions:

Identify behavioral signs that have arisen or progressed since 8 years of age and older. After each behavioral sign, please indicate the intensity of presentation according to the following scale:

(There are no correct or incorrect answers.)

SCALE:

0. NONE

1. MILD

2. MODERATE

3. SEVERE

Gets stuck, difficulty getting around objects, goes to hinge side of door:*

Stares blankly at walls, floor, or into space:*

Does not recognize familiar people/familiar pets:*

Gets lost in home or yard:*

Less reactive to visual (sights) or auditory (sounds) stimuli:*

More irritable/fearful/aggressive with visitors, family or other animals:*

Decreased interest in approaching, greeting or affection/petting:*

Pacing/restless/sleeps less/waking at night:*

Vocalization at night:*

Less able to learn new tasks or respond to previously learned cues (commands)/name/work:*

Indoor soiling of urine or stool/decreased signaling to go out:*

Difficulty getting dog’s attention/increased distraction/decreased focus:*

Decrease in exploration or play with toys, family members, other pets:*

Increased activity including aimless pacing or wandering:*

Repetitive behaviors, e.g., circling ; chewing ; licking ; stargazing:*

Increased anxiety when separated from owners:*

More reactive to/fearful of visual (sights) or auditory (sounds) stimuli:*

Increased fear of places/locations (e.g., new environments/going outdoors):*

Summation of Responses:

A score of 4-15 is consistent with mild CDS.

A score of 16-33 is consistent with moderate CDS.

A score of 33+ is consistent with severe CDS.

This Assessment was created by: Dr. Gary Landsberg, DVM, DACVB, DECAWBM, Vice President, Veterinary Affairs CanCog Technologies; to aid in diagnosing Canine Cognitive Dysfunction Syndrome.

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