The use of acupuncture as adjunctive modality to treat symptoms of canine cognitive dysfunction and neck pain in a 17-year-old pug
By Dr Jennifer Robinson, Veterinarian (DE), CVE (IVAS)
Melbourne Veterinary Acupuncture
Introduction
Canine cognitive dysfunction (CCD) is neurobehavioral syndrome similar to Alzheimer’s in humans, leading to a decline in cognitive function as part of an age-related degenerative process in the central nervous system. Common symptoms described by pet owners are disorientation, a change in social relationships, reduced activity levels, increased anxiety and restlessness/pacing, unusual fear of familiar objects and people, changes in sleep-wake cycle as well as house soiling and excessive vocalizations. Characteristic changes on MRI include brain atrophy, ventricle enlargement and meningeal thickening [1, 2].
Accumulation of beta-amyloid plaques around neurons, and the breakdown of neurons resulting in so-called neurofibrillary tangles, are at this stage considered leading causes, interrupting nerve impulse transmission in the brain and leading to the described symptoms.
There are various drugs that are prescribed, with variable efficacy, to slow the progression of CCD and alleviate clinical signs [1, 3]. Selegiline (Eldepryl, Pfizer) is a selective and irreversible inhibitor of monoamine oxidase B, that may enhance dopamine and other catecholamines in the brain; a neuroprotective effect of this drug is still being investigated.
Propentofylline (Vivitonin, Merck Animal Health) is used to improve dullness, lethargy and depressed demeanour in older dogs. It may increase the blood flow to the heart, skeletal muscles and brain and is purported to have neuroprotective properties [2, 3].
More recently, dietary supplementation with medium chain triglycerides, cognitive enrichment and anxiolytics have all be described as aspects of therapy for CCD [1].
Dudley’s Story
I first met Dudley in October 2018, he was almost 17 years old at that time and the owner was concerned about his quality of life. Dudley’s symptoms of CCD started about 2-3 years ago, when the owner noticed that Dudley sometimes didn’t recognize familiar people and started to show signs of disorientation. He was pacing aimlessly on a daily basis and would at times “forget” to eat or drink. These symptoms improved when he was started on medication (Propentofylline 50mg BID and Selegiline 5mg SID) as well as dietary modification to Hill’s Presciption Diet b/d® about 2 years ago. When he first presented to me, he was still showing signs of disorientation, restless pacing and disrupted sleep but the owner reported that overall Dudley was clinically better than when his symptoms of CCD started initially.
Dudley’s second problem was long standing intermittent neck pain, signalled by a reluctance to be touched and move with head held low and extended. This was attributed to muscle spasms in the neck region, without any neurological signs or impairment. He had been having this problem for several years without any seasonal pattern and the frequency had increased over the past 18 months to fortnightly episodes. Diagnostic imaging was never performed so the underlying cause is unknown. Differential diagnoses include mild cervical IVDD, malformation of the cervical spine, caudal cervical spondylomyelopathy, or recurrent soft tissue injury. Dudley had been treated with meloxicam and diazepam on a PRN basis for this, which helped relieve the symptoms but did not prevent recurrence.
Dudley also suffered from age-related multicentric osteoarthritis with a slow and stiff gait and intermittent hind limb weakness.
Initial treatment:
Below is a summary of Dudley’s list of medications and supplements at the time of his first presentation:
K9 Power Joint Strong®, a glucosamine/chondroitin/omeg-3 dietary supplement Vivitonin (Propentofylline) 50mg BID
Eldepryl (Selegiline) 5mg SID
Zylkene (Alpha-casozepine) 75mg BID
Meloxicam 0.1mg/kg PRN
Diazepam 0.5mg/kg PRN Zydax (sodium pentosan polysulfate 100mg/mL) monthly SC injection
Treatment with acupuncture
Dudley was treated on a weekly basis for 6 weeks and then moved to a fortnightly schedule, which we have been following for the past 7 months. After his first treatment with acupuncture, the owner reported Dudley was immediately more alert and much brighter and more energetic at home in the week following treatment.
After the 2nd treatment he started to sleep through the night again and the pacing and anxiety had greatly reduced. His energy levels and eagerness to go for walks returned and despite walking at a very slow pace, according to the owner Dudley started to enjoy his walks again, the ability to explore his environment and meeting other dogs. This remained stable over the subsequent months and remains so today. After the 4th treatment his mobility also started to noticeably improve, and the episodes of neck pain subsided.
How is Dudley doing today?
The owner reports Dudley is currently doing well and despite the fact that his life slowed down a lot, he enjoys his days as a geriatric dog with good quality of life. He is eager to go for his daily four walks; he eats well and is sleeping well. His pain levels appear well controlled, and the episodes of neck pain have not recurred at this point.
We were not able to further reduce the treatment frequency for Dudley without recurrence of the symptoms of CCD, especially the pacing/ aimless wandering and disturbed sleep pattern. He intermittently shows setbacks of hind limb weakness, which always respond well to an extra acupuncture treatment.
Conclusion
This is a great case to demonstrate how acupuncture integrates successfully into standard veterinary practice. Dudley had shown good response to medical treatment of CCD initially but significantly improved again with the introduction of acupuncture treatments and has regained improved quality of life.
The episodes of neck pain subsided and have not recurred with acupuncture treatment, which was previously not achievable with conventional medical treatment, even though this was able to treat his pain temporarily.
1. Dewey, C.W., et al., Canine Cognitive Dysfunction: Pathophysiology, Diagnosis, and Treatment. The Veterinary clinics of North America. Small animal practice, 2019. 49(3): p. 477-499.
2. Carrera‐Justiz, S., Canine Cognitive Dysfunction, in Chronic Disease Management for Small Animals, R.J.M.a.R.L. W. D. Gram, Editor. 2017, John Wiley & Sons, In.: Hoboken, NJ, USA. p. 135-140.
3. Landsberg, G.M., J. Nichol, and J.A. Araujo, Cognitive Dysfunction Syndrome:A Disease of Canine and Feline Brain Aging: A Disease of Canine and Feline Brain Aging. Veterinary Clinics of North America: Small Animal Practice, 2012. 42(4): p. 749-768.