Cognitive Dysfunction Syndrome, and its hopeful treatment with hyperbaric oxygen.

Cognitive Dysfunction Syndrome, and its hopeful treatment with hyperbaric oxygen.

CDS is a disease that can be considered the canine version of Alzheimer's. The novel treatment with hyperbaric oxygen has shown to improve neurological functions and quality of life

When our dog ages, it tends to change many of its habits, such as tending to sleep more or gradually slowing down its rhythm of life. However, there may be cases of abnormal behavior changes. Until recently these changes were attributed to the aging process, against which much could not be done. But according to the most recent studies, these changes would be linked to a disorder called "Cognitive Dysfunction Syndrome¨.

It is a disease that can be considered as the canine version of Alzheimer's. The canine brain undergoes a series of changes that result in a decrease in the mental faculties associated with thinking, recognition, memory and learned behavior. 50% of dogs over 9 years of age will exhibit one or more symptoms of cognitive dysfunction syndrome. Cognitive dysfunction is a progressive disease with a gradual increase in signs of senile behavior.

The symptomatology of this disease is complex and difficult to diagnose because its symptoms may vary from one animal to another, but they have the following common features:

-Disorientation, the dog seems lost in the house or in the yard, gets stuck in the corners or under the table, has difficulty finding the door (it is placed on the side of the hinges or goes to the wrong door), does not recognize familiar people, and does not respond to verbal cues or their name.

-Sleep disorders, sleeping more during the day, but less during the night.

-Dogs with cognitive dysfunction can also exhibit compulsive behaviors with tremors, stiffness, and weakness.

-Urinating or defecating inside, sometimes even in the sight of their owners, and maybe a less frequent signal to go outside.

-Less interaction with your family. The dog seeks less attention, often walks away when being petted, shows less enthusiasm when he greets or does not even greet his family, while a healthy dog ​​of the same age seems to need human contact 24 hours a day.

Some of these symptoms may be due to physical changes related to age and not to cognitive dysfunction, hence the difficulty of its diagnosis, or also to another medical condition, such as cancer, an infection, an organic insufficiency or side effects of medications. Therefore, medical problems must be examined to be ruled out before being able to confirm the senile symptoms attributed to the Cognitive Dysfunction Syndrome.

Research on canine brain aging reveals a number of pathogenic processes that could explain many of the symptoms of cognitive dysfunction syndrome. A protein called B-amyloid (whose increase is related to the appearance of Alzheimer's) is deposited in the white and gray matter of the brain, which results in progressive cell death and a consequent contraction of the brain, which causes alterations in the neurotransmitters, such as serotonin, norepinephrine, and dopamine, related to a decrease in oxygen levels in the brain, which accelerates the disease.

Timely evaluation and early intervention by a veterinarian can help delay the progression of this pathology.

Diagnosis and treatment

Unfortunately, there is (for the moment) no specific test for Cognitive Dysfunction Syndrome. The veterinarian will make a diagnosis based on a complete physical examination, history and ruling out other similar pathologies.

The treatment consists of a multifaceted approach through drugs, diet, specific dietary supplements and the adaptation of your dog's environment to adapt to your lifestyle.

There is evidence that a structured training and environmental stimulation program can delay the progression of behavioral deterioration. Anipryl (selegiline) is often prescribed as a daily medication and may help relieve signs of Cognitive Dysfunction Syndrome. For severe periodic episodes at night, Xanax (alprazolam) may also be prescribed. A prescription diet that supports an older dog's brain, along with other nutraceutical medications, may also be helpful.

Hyperbaric oxygen therapy as a new treatment:

The novel treatment with hyperbaric oxygen (HBOT) consists of the medical administration of 100% oxygen at an ambient pressure greater than 1 absolute atmosphere (ATA). HBOT has been shown to improve neurological functions and quality of life after neurological incidents such as stroke and traumatic brain injury and improves the performance of healthy subjects in multitasking.

Hypoxia (tissue oxygen deficiency) is a determining factor in the pathogenesis of Cognitive Dysfunction Syndrome. The association between hypoxia and dementia arose from epidemiological studies, which show a higher incidence of dementia in human patients with ischemic stroke. Recent evidence suggests that Alzheimer's patients have reduced cerebral perfusion, which can be detected in the early stages of the disease and decreases further with the progression of the disease (Binnewijzend et al., 2013).

Higher oxygen levels can improve brain function. Studies have shown that in healthy elderly subjects (Kim et al., 2013), oxygen supplementation improves the performance of subjects in cognitive tasks and improves the electroencephalographic pattern (EEG) of brain activity, indicating that oxygen It is a limiting factor of normal frequency, and cognitive function associated with the disease.

At the cellular level, HBOT can:

  • Preserve mitochondrial integrity.
  • Difficult the apoptotic pathways associated with mitochondria.
  • Relieve oxidative stress.
  • Increase levels of neurotrophins and nitric oxide (vasodilator).
  • Neuroprotective effect of HBOT both in experimental ischemic brain injury and in experimental traumatic brain injury, improving cell metabolism.
  • Reduce the amyloid β load. Elevated levels have been associated with an increase in phosphorylation of the tau protein, due to hypoxia (reviewed in Zhang and Le, 2010).

In the context of the disease, oxygen is a speed limiting factor for tissue recovery and cognitive function, similar to other neurological conditions.

When impairment is detected in these measures before a significant functional decrease, HBOT should be applied.

Early diagnosis of Alzheimer's will allow treatment when irreversible damage is still minimal, thus maximizing the effect of HBOT.


A retrospective analysis of patients with CHF (congestive heart failure) caused by cardiac arrest, treated at the Institute of Hyperbaric Medicine, Assaf Harofeh Medical Center, Israel, between January 2008 and December 2014. The study was approved by the review board. Hospital institutional.

Treatment with 60 daily sessions of HBOT. The evaluation included objective computerized cognitive tests (NeuroTrax), daily life activity questionnaires (ADL) and quality of life. The results of these tests were compared with changes in brain activity according to the evaluation of computed tomography by single-photon emission computed tomography (SPECT).

Results: The study included 11 cases of patients with CHF. Patients were treated with HBOT, 0.5–7.5 years (mean 2.6 ± 0.6 years) after cardiac arrest. It was found that HBOT induces an improvement in memory, attention and executive function (average scores) of 12%, 20%, and 24% respectively. It was found that clinical improvements were well correlated with increased brain activity in relevant brain areas as assessed by computerized analysis of the SPECT image.

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The effect of hyperbaric oxygen treatment on the cognitive functions of patients, as assessed by the eight cognitive summary scores. As can be seen, HBOT induced a significant improvement in global cognitive scores with an average relative change of 8% (p = 0.006). The most outstanding improvement was in the indices of executive functions, with an average relative change of 24% (p = 0.011). Attention rates improved with an average relative change of 20% (p = 0.06). Memory rates by mean relative change of 12% (p = 0.08).

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