Behavior Problems of Dogs

If all of the dog’s needs are adequately met, the first step in a behavioral treatment program is to identify each situation, stimulus, or interaction in which the problem might arise, so that a preventive program can be implemented. Prevention ensures safety (eg, in aggression cases), prevents further damage to the household or injury to the dog, avoids further anxiety-evoking situations for the dog, and ensures no further aggravation of the problem through fear conditioning (ie, unpleasant outcomes) and learning (ie, negative reinforcement if the stimulus retreats).

The most effective prevention is to identify and avoid any situation in which the dog might be exposed to the stimulus. Modifications in the environment (eg, distance, visual barriers, auditory barriers, physical barriers) might be required. Establishing a routine can greatly help anxiety.

When possible, it's best to introduce changes gradually.

Structured interactions can be beneficial in treating problems rooted in fear and anxiety. Structured interaction programs provide the dog with consistent and predictable owner responses, which decrease anxiety and build self-control by improving communication and allowing the dog to control its consequences/outcomes.

Programs based on this idea are sometimes termed "cue-response-reward." Before gaining access to something it desires, the dog can choose to respond to a cued known behavior (eg, sit) and then is granted the desired treat or privilege (eg, toy, play, attention). With consistent implementation of the program, the dog learns that cued behaviors are associated with rewards.

In most cases, treatment of problems related to fear, anxiety, impulsivity, and aggression focuses on changing the dog’s emotional response to the stimulus (counterconditioning) and/or replacing the undesirable response with one that is desirable by using reinforcement-based techniques (response substitution). Teaching the basics of reinforcement-based training enables owners to focus on rewarding desirable behaviors (eg, sit, look at me, relaxed down).

Clicker training can be particularly useful. Because it enables owners to mark the precise moment a desirable behavior occurs with a click, it facilitates their ability to gradually shape outcomes that more closely approximate the final goal.

Positive punishment should be avoided, because it can cause fear and anxiety toward the owner or fear of the situation and surrounding triggers.

Arousal might have to be decreased before treatment can proceed in some cases. Dogs that are highly aroused respond with autonomic fight-or-flight responses and tend to respond reflexively, interfering with their ability to learn. Arousal can be decreased by training the dog to settle on cue and by minimizing the intensity of the stimulus during exposure (desensitization).

Management devices, such as head halters, that can change the dog’s focus and help the dog settle can be helpful. Early intervention with behavioral pharmacotherapy might be necessary to achieve success and can be in the best interest of a fearful, anxious, or phobic dog.

Psychotropic drugs and adjunctive therapies (eg, supplements, nutraceuticals, pheromones, nutritional therapies) can be used to reestablish a more stable emotional state and improve trainability in dogs that are anxious, fearful, or overly reactive. Although drugs can improve the dog's emotional state and facilitate new learning, only with concurrent behavior modification can new neuronal pathways be established, new behaviors learned, and fearful responses to stimuli changed to positive ones.

Depending on whether they are administered regularly or only situationally, medications can be classified as either maintenance medications or as-needed (rapid-onset) medications.

Baseline or maintenance anxiolytic medications should be considered when triggers of fear, anxiety, or aggression occur frequently and unpredictably. They might also be indicated alongside situational medications for dogs that display chronic anticipatory anxiety or that struggle to recover from exposure to stimuli that elicit fear, anxiety, or aggression.

Classes of drugs used for behavioral pharmacotherapy in dogs and cats include selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs).

Among SSRIs, fluoxetine is typically the first choice. In the US, a veterinary formulation of fluoxetine is approved for treatment of canine separation anxiety in conjunction with a behavior modification plan. Fluoxetine is commonly used in an extralabel fashion to treat various other behavior problems (aggression, anxiety, inappropriate urination, and compulsive behavior) in dogs. Fluvoxamine, sertraline, and paroxetine can be alternatives when fluoxetine proves insufficiently effective or when adverse effects, such as anorexia, are a concern.

Among the TCAs, clomipramine has the highest level of serotonergic activity. In the US, a veterinary formulation of clomipramine is approved for use as part of a comprehensive behavioral management program to treat separation anxiety in dogs > 6 months old. Clomipramine is also used as an alternative to fluoxetine for treating anxiety disorders and phobias in dogs.

Buspirone, an azapirone, can be used to enhance the anxiolytic effects of SSRIs or TCAs.

Selegiline, a monoamine oxidase inhibitor that is approved in North America for treating cognitive dysfunction syndrome in dogs, is also approved in Europe for the treatment of emotional disorders or chronic anxiety (2).

Certain medications (rapid-onset medications with a short duration of action) can be used as needed when a fear stimulus can be anticipated:

• Dexmedetomidine oral gel is an alpha-2-adrenergic agonist approved by the FDA for treating canine noise aversion. Because of its rapid onset and short duration of action, it can be particularly useful during thunderstorms.

• Clonidine, another alpha-2 adrenergic receptor agonist, has a slower onset and longer duration, making it helpful for prolonged exposure to frightening stimuli (3).

• Trazodone, a serotonin antagonist and reuptake inhibitor, is another option (4). Its onset is slower (90–120 minutes), and it has a duration of action lasting 4–6 hours.

• Gabapentin, which is an anticonvulsant, analgesic, and anxiolytic, is also an option for situational treatment of fear and anxiety (5). Combining gabapentin and trazodone can help further decrease anxiety and fear.

• Benzodiazepine medications such as diazepam, alprazolam, clonazepam, and lorazepam are powerful anxiolytics that can greatly decrease fear and anxiety. However, drugs in this class have been associated with paradoxical excitement and increased aggression in some instances, so they should be prescribed with caution.

Because as-needed drugs have a range of individual variability in behavioral effects and adverse effects, trials with different as-needed medications should be conducted in advance to determine which drug and dose achieve the desired effect and for how long.

Natural products can be used alone or in conjunction with drugs or other natural products to help alleviate or lessen anxiety; however, evidence of their effectiveness in dogs is somewhat limited. Several studies support the use of pheromone therapy.

A commercially available synthetic dog-appeasing pheromone (apasine) analogue mimics the calming pheromones produced by lactating dogs and is available as a spray, diffuser, or collar. Pheromones have been used to treat anxiety related to car rides, veterinary visits, separation anxiety, and aversion to storms and fireworks, as well as to lessen adoption stress and facilitate socialization.

A calming or anxiety-decreasing effect has been observed with alpha-casozepine (a milk protein hydrolysate), with a botanical product containing Magnolia officinalis and Phellodendron amurense, with L-theanine, and with aromatherapy (using lavender).

The essential amino acidL-tryptophan is a precursor to serotonin. Dietary supplementation of L-tryptophan has been investigated as a means of treating problem behaviors in dogs (6, 7, 8).

Commercial diets have been developed that incorporate L-tryptophan and alpha-casozepine or that include omega-3 fatty acids and probiotics. These diets might help to decrease stress and anxiety.

Treatment of specific fears and phobias relies on managing the environment to decrease exposure to frightening stimuli, changing the dog’s emotional response to the stimulus (classical conditioning), and helping the dog manage its arousal by teaching skills such as settling on cue (operant conditioning). Early intervention with medication might be necessary to achieve success and can be in the best interest of a fearful, anxious, or phobic dog.

The first step in a treatment program for fears and phobias is to identify each situation, stimulus, and interaction in which the problem might arise so that an avoidance strategy can be implemented. Avoidance has an immediate effect of decreasing stress and important therapeutic value, because each exposure solidifies fear learning, making it more difficult to overcome.

Dogs with noise phobias might benefit from soundproofing (eg, sound-absorbing curtains or panels), white noise, ear covers, or noise-canceling headphones. Developing a safe haven protected from frightening noise (eg, in a finished basement or sound-insulated crate) can be very helpful for predictable noise triggers such as thunderstorms or public fireworks displays.

For a safe haven to be effective, dog owners must build positive associations with it long before using it during actual events. When the safe haven is used for a storm or other noise event, the dog should be taken there before the frightening noises start.

Some dogs benefit from dog clothing that applies gentle compression or special metallic fabric that discharges static buildup.

The ultimate goal of behavior modification to treat phobias of discrete stimuli is to successfully expose the dog to controlled levels of the stimuli while it remains calm and free of anxiety. The dog gradually learns to tolerate a fear-triggering or arousing stimulus (eg, a frightening noise) that is introduced at a low enough intensity not to elicit a reaction, and then gradually increased to the intensity at which it typically occurs.

Counterconditioning can also be used, to form an association between the stimulus and something pleasurable, such as food. By having the stimulus paired with an enjoyable activity or object, the dog’s emotional response to the stimulus can shift from fear or anger to contentment and calm.

To ensure an effective outcome, a dog owner should work with a trainer or veterinarian to design a method of counterconditoning that minimizes and controls the intensity of the stimulus.

For noise phobias, controlled exposure is best accomplished through the use of recordings. Recordings can be played at a volume low enough that a fear response is not evoked and paired with a positive stimulus for counterconditioning. Provided that the dog remains relaxed, sessions can be gradually, systematically increased in intensity (volume and duration of exposure). However, linear increases in stimulus intensity should be avoided. That is, instead of turning up the volume of the recorded noise each session, the owner should vary the volume, with an overall trend toward increasing it.

With phobias that involve multisensory experiences (eg, thunderstorm or fireworks phobia), controlled exposure to the sound (eg, of thunder or fireworks) seldom leads to full resolution of the phobia.

Flooding is a method in which an animal is made to stay in the presence of a fear-evoking but harmless stimulus until the fear is extinguished. Flooding is not recommended. Because the exposure must be continued until all physiological and emotional signs of fear are gone, it is difficult to do, and if done improperly, flooding can increase problem behaviors (sensitization). Furthermore, flooding has negative welfare implications for dogs. Because the dog is exposed to the full intensity of the frightening stimulus for a prolonged time, flooding risks subjecting the dog to severe emotional or even traumatizing distress.

Although controlled exposure behavior modification relies on classical conditioning, operant conditioning has an important role in promoting a successful outcome. This can involve teaching cues that enable avoidance of uncontrolled exposures to stimuli (ie, teaching the dog to move away or back up), which can decrease the risk of setbacks that occur from accidental flooding. Learning to relax on cue on a designated mat or bed helps the dog manage its arousal and fear during controlled exposure sessions, enabling more rapid progress. See the table General Guidelines for Effective Controlled Exposure Behavior Modification in Dogs.

Anxiolytic drugs and supplements can be beneficial components of treatment for fear- and anxiety-based problems:

• For discrete stimuli that can be anticipated, such as fireworks, a rapid-onset medication with a relatively short duration of action, such as dexmedetomidine oromucosal gel, trazodone, clonidine, or a benzodiazepine such as alprazolam, should be considered.

• When exposure to frightening stimuli is chronic or unpredictable, a maintenance medication (TCA, SSRI, azapirone) might be needed.

• For dogs with anticipatory anxiety as well as acute fear, a maintenance medication and situational medication can be beneficial.

• Dogs with thunderstorm phobia might benefit from seasonal use of an SSRI or TCA and situational medication during storm events..

Dogs with separation anxiety should be left alone as rarely as possible to prevent further sensitization, which makes treatment more difficult. For dog owners who cannot bring their dogs to work, day care or dog sitters can be beneficial.

Owners should be instructed meet the dog’s age- and breed-specific environmental needs with a consistent routine for play and exercise.

Regular positive reinforcement training, which increases communication and the predictability of a dog’s environment, is also an important part of treatment.

Dogs with mild separation anxiety might respond to relaxation training and counterconditioning with food. The dog is taught to relax in a designated place where it can enjoy independent activities (chews, puzzle feeders, etc). When the owner prepares to leave, the dog is taken to the designated place and given a selection of high-value food, chews, and special toys. When the owner returns home, the special items should be removed. The aim of this simple behavior modification protocol is to build positive associations with being alone.

For dogs with moderate to severe separation anxiety, a graduated departure training protocol using safety signals is recommended. This approach increases the predictability of departures and the dog’s tolerance of being alone. It differs from previous behavior recommendations geared toward decoupling predictors of departure such as picking up keys or putting on shoes.

A safety signal is a novel object or sound not associated with previous departures, which indicates that the departure will be “safe” (ie, that the owner will return before the dog becomes anxious). In daily training sessions, simulated departures of gradually increasing length are used to build the dog’s capacity to remain calm and comfortable alone. In each training session, the owner places the safety signal immediately before starting the departure routine.

Simulated absences must be short enough not to trigger anxiety. In the beginning, therefore, departures should be very brief. Monitoring the dog’s response to treatment with video enables the owner to make sure the dog remains under its threshold of anxiety during simulations.

Clients should be informed that the graduated departure behavior modification protocol can take months to complete (11).

Two medications—the SSRI fluoxetine and the TCA clomipramine—are approved in the US by the FDA for treatment of canine separation anxiety in conjunction with a behavior modification plan. Both have been shown to be effective at decreasing clinical signs, especially when combined with behavior modification. For dogs that do not tolerate either fluoxetine or clomipramine, other SSRIs might be good alternatives.

A rapid-onset medication should also be considered to provide situational relief for dogs that must be left alone before the daily medication takes effect and behavior modification has been completed. Options include trazodone, gabapentin, clonidine, and alprazolam, all of which take effect in 90 minutes and have a 4- to 6-hour duration of action.

Avoiding stimuli that trigger aggression is critical for safety and for preventing further reinforcement of fear and aggressive behaviors. For example, dogs that display aggression toward strangers should be confined behind a gate or on leash when unfamiliar people visit the owner's home. Dogs that exhibit aggression on leash should be walked in areas where they are less likely to encounter dogs or people that frighten them. A basket muzzle can be useful in situations where triggers of aggression cannot be entirely avoided.

Behavior modification should include desensitization and counterconditioning to stimuli that elicit aggression.

SSRIs and TCAs can increase the success of behavior modification in dogs by decreasing fear and impulsivity. Trazodone or clonidine can also be used situationally for stressors such as the arrival of guests, either in lieu of or in addition to daily medication.

To prevent territorial aggression, owners should be counseled to prevent their dog from having access to people and dogs entering their property. The dog should be confined when visitors come to the home. Doors and gates should be kept locked to avoid unexpected encounters with visitors. The yard should be surrounded by a physical fence.

Tie-outs and electric fences should not be used, because they do not hinder people from entering the dog’s territory. One study found that dogs within an electronic pet containment system might be at increased risk of aggression toward people on or near the property because of avoidance-motivated aggression (13).

Behavior modification should focus on minimizing the dog’s arousal in the presence of visitors and on teaching a behavior such as remaining quiet on a mat when visitors come to the house.

SSRIs or TCAs can be helpful for dogs with comorbid fear, anxiety, hypervigilance, or excessive arousal. Trazodone or clonidine might also be useful on an as-needed basis for fear, anxiety, and arousal associated with time-limited events such as the arrival of a visitor.

Environmental management to support avoidance of stimuli that cause conflict aggression should be instituted immediately for safety and to avoid reinforcing aggressive behaviors:

• Items that could be stolen should be kept out of reach.

• Food, high-value chews, long-lasting treats, and toys that trigger aggression should be provided in an out-of-the-way location where the dog will not be disturbed (eg, in a crate or pen).

• Beds and crates should be placed in areas where the dog can rest undisturbed.

• All unwanted handling should be avoided.

• Owners should avoid confrontation, because it can contribute to a loss of trust, increase in anxiety, and escalation of aggression.

Positive reinforcement training enhances communication and increases the predictability of interactions between owner and dog, which decreases anxiety and conflict. Behavior modification can be used to increase the dog’s comfort with people approaching while it has an object of value. Owners can toss the dog high-value treats whenever they approach or pass by the food bowl and offer high-value treats or toys whenever the dog voluntarily gives up a toy or chew. In addition, the dog can be trained to give and drop items on cue (beginning with items of low value for high-value rewards).

For dogs that are sensitive to touch, a consent petting protocol should be used. Handling for care is best addressed with cooperative care training, which is a positive reinforcement–based approach in which dogs learn to cooperate with nail trimming, grooming, ear cleaning, and other required care in exchange for food rewards.

SSRIs can decrease the anxiety and impulsivity that contribute to conflict-related aggressive behavior and facilitate behavior modification.

The treatment for possessive aggression is the same as for conflict aggression.

Environmental management aimed at avoidance is essential for safety and for the successful treatment of aggression between familiar dogs.

Resources that trigger aggressive interactions should be made unavailable when the dogs are together. Dogs should be separated during meals and when given high-value chews, toys, etc. The dogs might also need to be separated when arousal is likely to be high (eg, when visitors arrive or when the owner comes home).

Interactions such as rough play that can trigger fear or anxiety might also have to be avoided.

Owners should be taught to recognize canine social signals so that they can intervene and separate the dogs before aggression escalates. In severe cases, the dogs might need to be leashed or wear basket muzzles when together, or they might need to be separated entirely.

Owners should be instructed to implement reward-based training to improve communication, as well as predictability and consistency of interactions. Implementing a cue-response-reward protocol in which dogs are asked to perform a simple behavior (such as to sit on cue) before desirable activities and treats is also helpful, because it encourages the dog to check in with the owner (16, 18).

Dogs in the same household should be taught to go to separate designated places on cue. A place cue facilitates avoidance and enables owners to quickly separate the dogs, if they observe social signals that indicate an increased risk of aggression (18).

Treatment with an SSRI can be a useful adjunct to behavior modification. In one study, fluoxetine was associated with positive outcomes (16). Other SSRIs (eg, sertraline, paroxetine, citalopram) and clomipramine can also be effective at treating aggression motived by fear and anxiety (19, 20, 21).

To prevent the development or persistence of undesirable play behaviors with people, clear and consistent rules should be communicated about acceptable play behavior. Teaching puppies to sit before receiving anything of value (eg, toys, treats, play) encourages them to look to the owner for direction. Puppies should be engaged in regular acceptable forms of play, including fetch, tug games, and playing with manipulation and chew toys.

When undesirable play behaviors (eg, oral behaviors, or "mouthiness") occur, interaction should be immediately stopped (ie, negative punishment). A verbal cue can be used to interrupt overly rough or mouthy play. If needed, a leash and head halter can help to interrupt undesirable play. To avoid causing frustration, negative punishment should be immediately followed by redirection to an alternative, more desirable activity (eg, redirecting the puppy to a more acceptable form of play).

Positive punishment (eg, scolding or pushing away) should not be used to stop play, because it can lead to fear of the owner, defensive aggression, or conflict-induced aggression. For some puppies, positive punishment inadvertently reinforces undesirable play behavior.

Dogs that exhibit excessive predatory behavior or predatory behavior directed toward inappropriate targets must be managed carefully to avoid all exposure to triggers of the predatory behavior. Sometimes, when a dog's predatory behavior is directed toward cats, the dog cannot safely live together with cats.

Safety is a serious concern. Before treating a dog for aggression, the veterinarian must assess the potential risk of injury that the dog poses to humans and other animals.

The prognosis is generally guarded to poor for dogs showing predatory aggression, which, by its nature, is uninhibited and likely to result in substantial injury and is often directed toward individuals (eg, children) that cannot reliably avoid the dog. In cases of predatory aggression toward people, especially children, referral to a board-certified veterinary behaviorist is recommended; euthanasia might need to be considered.

Ovariohysterectomy can prevent further incidents of maternal aggression.

Successful resolution of pain-induced/irritable or medically caused aggression requires diagnosis and treatment of the underlying physical health problem. Although necessary, the resolution of physical health problems might not be sufficient for full resolution of aggression. Fear learning that occurred while the dog was experiencing pain might result in subsequent defensive aggression when the dog is handled or approached after a painful physical health problem is resolved.

Clinicians should not delay treatment of fear, anxiety, and distress until investigation of the physical health problem has been completed (22). Environmental changes at home—avoiding handling or rough play, moving the pet’s bed away from a children’s play area, etc—might provide the dog some immediate relief from fear, anxiety, and stress associated with illness and pain.

Behavior modification (desensitization and counterconditioning) should be recommended to treat persistent aggression caused by fear learning.

House soiling in dogs can be due to inadequate or insufficient training. It can also be a result of fear, anxiety, or arousal. 

House soiling can also be caused by pain, impaired mobility, sensory decline, cerebrocortical disease (including cognitive dysfunction), or any medical condition that leads to increased volume of urine, more frequent elimination, pain on elimination, or lack of control. Therefore, physical health problems must be excluded as potential causes or contributing factors.

Barriers to outdoor elimination (frightening outdoor stimuli such as rain, fireworks, neighbor animals, etc) should also be considered as causes of or contributors to house soiling.

A detailed behavior history is necessary to determine whether the dog has been fully housetrained. Dogs obtained from locations where they were extensively caged (eg, pet stores) and dogs that have lived exclusively outside might be more difficult to housetrain, because they have never had to inhibit elimination.

Treatment of House Soiling in Dogs Due to Inadequate or Insufficient Training

If housetraining was absent or insufficient in a case of house soiling by a dog, a housetraining regimen should be discussed. The owner must accompany the dog to a designated outdoor elimination area, reinforce elimination immediately with a food reward, and supervise the dog indoors to prevent opportunities for elimination (eg, by keeping the dog on leash).

The dog should be taken outside at regular intervals. Elimination is most likely to occur after meals, upon waking from sleep, and after finishing an activity such as playing. The dog should also be monitored for signs that it is ready to eliminate, such as sniffing around, standing near the door, or attempting to sneak out of view of the owner, and should be taken out immediately if these signs are observed.

When the owner is not able to supervise, a combination of scheduling (ensuring that the dog eliminates before the owner's departure, having someone come in to take the dog outside, etc) and confinement is required. Dogs can either be confined away from areas where they might eliminate or kept in an area where they will not eliminate, such as a pen, room, or crate where they eat, play, or sleep. Alternatively, the dog can be provided with an indoor elimination area (eg, paper, indoor puppy potty) within a confinement area where it can relieve itself when the owner is gone.

Behavior modification should focus solely on reinforcement of elimination in desirable locations. Punishing a dog after finding evidence of house soiling is ineffective because the dog will not associate the punishment with having eliminated in the house previously, and the punishment might thus cause anxiety.

Punishing a dog caught in the act of eliminating in the house is also counterproductive. It can trigger a fear of eliminating in the presence of the owner, which will impede housetraining. If the dog is observed while eliminating inappropriately, the owner should use a neutral interrupter (eg, clapping hands or whistling) and then take the dog outside. When the dog resumes urinating or defecating outside, it should be rewarded.

Although marking occurs most often in intact males, as a form of social and olfactory communication, it also occurs in females (especially when in heat) and in neutered males and females, often to overmark other odors.

Common targets of urine marking are places that other pets have urinated, as well as items (such as blankets) that have the residual odor of other dogs, people, or cats. Some dogs will mark when they visit unfamiliar households, especially when another dog’s odor is present.

A typical posture of a raised or partially raised leg is common when the surface to be marked is vertical. Fecal marking is uncommon.

Although marking is unacceptable when it occurs indoors, it is likely a component of normal communication.

Treatment of Marking Behavior in Dogs

Neutering intact males decreases marking behavior, and good supervision can prevent or inhibit most marking. As with inadequate training, dogs should be confined away from areas that might be marked when owners are not able to supervise.

Marking related to anxiety might be decreased by identification and treatment of the cause, perhaps with the aid of drugs or nutraceuticals that decrease anxiety.

SSRIs and TCAs might be effective at decreasing the frequency of marking (31).

In one study, 28% of dogs 11–12 years old and 68% of dogs 15–16 years old showed signs consistent with CDS (39). An internet survey estimated CDS in 14.2% of dogs > 10 years old, with prevalence increasing with age; however, > 85% of these CDS cases had not been diagnosed (40).

Owners should be informed of the importance of reporting any signs they observe. Veterinarians should take a proactive approach in asking owners about behavior at each visit. Early detection of CDS signs provides the best opportunity to bring about improvement and slow the decline of cognitive function.

CDS in dogs is analogous to the early stages of Alzheimer disease in humans, both in clinical signs and in brain pathological changes. Some changes to brain tissue include accumulation of beta-amyloid plaques and vulnerability to oxidative damage.

As with humans, some dogs show minimal to no clinical impairment with age, whereas others develop varying degrees of deficits.

ENVIRONMENTAL MANAGEMENT OF COGNITIVE DYSFUNCTION SYNDROME

Treatment of CDS in dogs should focus first on environmental enrichment (both physical and mental stimulation), which has been shown to slow cognitive decline and improve the signs of CDS.

Modifying the dog’s home environment helps to accommodate the limitations of old age and cognitive decline. Providing a consistent and predictable routine decreases the stress caused by change and provides needed social contact. Removing clutter and using barriers (eg, gates, leashes, fences) help to restrict access to particular areas of the home (eg, stairs) or yard to prevent injuries or escape.

Mobility can be improved by providing ramps or nonskid flooring on slippery steps. Dogs with difficulty going through a pet door can be taken outside though an ordinary door. Tactile, sound, and odor cues can help with orientation.

Dogs that can no longer be relied upon to signal when they need to go out to eliminate might need to be taken out more frequently and restricted to easily cleaned areas when the owner is not available.

The dog's day-night cycle can be reestablished by interacting with the dog during the day, providing a consistent place and time for sleeping, increasing the dog’s exposure to light during the day, and darkening the room at night.

Environmental enrichment can help delay cognitive decline by protecting against hippocampal neuron loss, increasing neuronal plasticity, and building up a cognitive reserve.

Regular exercise should be provided in accordance with the dog’s comfort and mobility.

BEHAVIOR MODIFICATION FOR COGNITIVE DYSFUNCTION SYNDROME

Although more patience might be needed with dogs that have CDS, reinforcement-based training enables owners to focus on rewarding desirable behaviors and provides mental stimulation and social connection.

Response substitution (training an alternative desirable behavior) can be a useful approach to decreasing problem behaviors like pacing or barking. Reinforcement of alternative behaviors can include rewarding lying still instead of pacing, rewarding staying quiet instead of barking, and rewarding eliminating outside instead of inside.

Positive punishment should be avoided because it causes anxiety, which exacerbates the dog’s decreased ability to learn.

BEHAVIORAL PHARMACOTHERAPY FOR COGNITIVE DYSFUNCTION SYNDROME

Medications, diets, and supplements might improve signs of CDS or slow its progression in dogs.

The monoamine oxidase B inhibitor selegiline can improve CDS signs by enhancing dopamine and other catecholamines in the cortex and hippocampus and by decreasing free radical load.

Propentofylline, which is licensed in Europe and Australia for the treatment of dullness, lethargy, and depressed demeanor in old dogs, can increase blood flow and inhibit platelet aggregation and thrombus formation.

A number of diets, nutraceuticals, and supplements have also been shown to improve CDS signs and potentially slow cognitive decline.

Commercially available diets include one supplemented with fatty acids, antioxidants, and DL-alpha-lipoic acid and l-carnitine to enhance mitochondrial function, and a specialized diet that uses botanical oils containing medium-chain triglycerides to provide ketone bodies as an alternative source of energy for aging neurons.

Other supplements and nutraceuticals that have demonstrated efficacy in improving cognitive function include a product containing a combination of phosphatidylserine, resveratrol, and vitamins E and B₆; a product containing phosphatidylserine in combination with alpha-lipoic acid, carnitine, fatty acids, glutathione, and other antioxidants; S-adenosylmethionine; and apoaequorin, a calcium-buffering protein found in jellyfish.