Is Your Dog 7 or Older? You May Want to Read This — Dog Dementia
Canine Cognitive Dysfunction Syndrome (dog dementia) is common but often missed in senior dogs. Learn the DISHAA framework to spot early signs, assess risk, and know when to seek veterinary care.
At a Glance
Canine Cognitive Dysfunction Syndrome (CDS) — what many pet parents and
vets call dog dementia — affects an estimated 14–35% of dogs over age 8. Yet
fewer than 2% are ever diagnosed, because the early signs look so much like
“just getting old” that most pet parents never think to mention them.
If your senior dog has started staring at walls, pacing at night, having
accidents in the house, or just does not seem like himself any more — those
are not quirks of ageing. They may be symptoms of a treatable condition, and
the earlier you catch it, the more you can do about it.
DISHAA is a veterinary framework that gives you a structured way to spot
cognitive decline early. It covers six domains: Disorientation, Interaction
changes, Sleep-wake disruption, House soiling, Activity alterations, and Anxiety. In December 2025, a working group of 12 leading veterinary neurologists formally adopted DISHAA as the diagnostic standard and recommended screening from the age of 7.
This guide walks you through each category with apartment-specific context,
a simplified scoring table, and a link to our interactive DISHAA Check Tool. If your dog scores in the moderate or significant range, it is time for a vet conversation — not next month, now.
The earlier you catch it, the more you can do about it. Read on.
The Full Guide
You have probably already noticed something. Maybe it was the night your
nine-year-old Labrador paced the hallway for an hour at 2 AM, then stood
facing the corner as though he had forgotten why he got up. Maybe it was the
morning your 12-year-old Indie, who has greeted you at the door every single
day for a decade, simply did not — she was in the next room, awake, staring
at nothing in particular. Or maybe it was the afternoon your elderly Pug
stopped mid-walk in the neighbourhood park, looked around as though she
had never been there before, and refused to move.
You told yourself it was nothing. Just age. Just a bad night. Just an off day.
It might not be nothing.
Canine Cognitive Dysfunction Syndrome — the veterinary equivalent of
dementia — affects an estimated 14–35% of dogs over the age of 8. The risk
increases roughly 52% with each additional year of life. And here is the
number that should stop you: only 1.9% of affected dogs ever receive a formal
diagnosis. Not because anyone fails them, but because the early signs of
dementia in dogs — the behaviour changes, the slowing down, the subtle
withdrawal — look so much like “just getting old” that most pet parents —
understandably — never think to mention them to their vet.
In December 2025, a working group of 12 of the world’s leading veterinary
neurologists and behavioural scientists published the first-ever consensus
guidelines for diagnosing canine cognitive dysfunction. The framework they
adopted as the clinical standard is called DISHAA. It was created by Dr Gary
Landsberg, one of the founders of veterinary behavioural medicine, and it
gives you something no amount of worry can: a structured way to observe
your dog, recognise what is changing, and act before the window closes.
This article walks you through each of the six DISHAA categories with the kind
of detail your dog deserves — not a bullet-point checklist, but a guide to
understanding what you are seeing and what it means. At the end, you will
find a simplified scoring system you can use right now. For the full interactive assessment, use our DISHAA Check tool
What Is DISHAA?
DISHAA is an acronym for the six behavioural domains that change when a
dog’s brain begins to decline:
D — Disorientation
I — Interaction changes
S — Sleep-wake cycle disruption
H — House soiling
A — Activity alterations
A — Anxiety
The framework was first presented by Dr Landsberg at the World Small Animal
Veterinary Association Congress in 2017 and refined through subsequent
publications. In December 2025, the CCDS Working Group — a 12-member
panel including Landsberg himself, veterinary neurologists from NC State,
Cornell, and Colorado State, and researchers from Budapest and Hannover —
formally adopted DISHAA’s domains as the foundation of the first
standardised diagnostic guidelines for canine cognitive dysfunction. They
published these guidelines in the Journal of the American Veterinary Medical
Association, recommending that every dog be screened from age 7 and
assessed with a validated questionnaire every six months from age 10. That is the clinical picture. Here is what it looks like in your living room.
D — Disorientation: Staring at Walls, Getting Stuck in Corners
Pet parents often describe this as: “she just stands there staring at nothing,”
“he gets stuck behind the sofa,” or “she seems lost in her own home.” If that
sounds familiar, this is the DISHAA category that explains what you are
seeing.
What it looks like
Your dog gets stuck behind furniture. He walks to the hinge side of a door and
waits. She stares at a wall, or at a familiar corner, as though she cannot place
where she is. He wanders into a room, stops, and looks confused — not distracted, confused. In a two-bedroom apartment, your dog repeatedly
walks to the wrong room at feeding time. On a walk in the neighbourhood
park she has visited a thousand times, she hesitates at turns she used to take
without thinking.
What it means
Spatial disorientation reflects deterioration in the hippocampus and
prefrontal cortex — the same brain regions affected in human Alzheimer’s
disease. Dogs with CDS develop amyloid-beta plaques and tau-related
changes that disrupt the neural circuits responsible for mapping their environment. The familiar becomes unfamiliar. The automatic becomes
effortful.
What to watch for in your home
In compact apartments, where rooms are small and layouts repetitive, spatial
confusion can be subtle. A dog who paces the same L-shaped corridor three
times before finding the kitchen is not exercising — he is lost. A dog who
stands facing the wrong side of the balcony door, waiting for it to open where
there is no handle, is not being stubborn. Pay attention when your dog fails to
navigate obstacles she once stepped around without thinking: a shoe rack, a
dining chair pushed out, a bucket left in the hallway. These are not clumsiness. They are signals.
I — Interaction Changes: The Velcro Dog, or the Dog Who Stopped Greeting You
Pet parents often describe this as: “he has become a shadow dog — follows
me everywhere,” or the opposite: “she does not come to greet me any more”
and “it is like he does not recognise me.” Both extremes can point to the
same condition.
What it looks like
The greeting at the door fades. Your dog used to meet you with a full-body
wiggle; now he lifts his head from the sofa but does not get up. She stops
initiating play. He no longer follows you from room to room. In multi-pet households, the social dynamics shift — a dog who was once the gentle
referee now withdraws entirely, or is pushed aside by younger pets who sense
his hesitation.
But interaction changes are not always withdrawal. Some dogs with cognitive
decline become more attached — a condition veterinary behaviourists call
hyper-attachment. A dog who suddenly cannot let you out of her sight, who
follows you to the bathroom at 3 AM, who becomes distressed the moment
you step onto the balcony — this is not love intensifying. It is anxiety born from
a world that no longer makes sense. You are the one fixed point.
What to watch for in your home
In multigenerational households — and with housing costs rising, these are
more common than a generation ago — interaction changes can be spotted
earlier than in single-person homes, but only if the family is paying attention.
The grandmother who says “he does not come to me any more” or “she used
to sleep at my feet, now she just stands in the doorway” is often the first to
notice. These observations matter. In families where multiple people interact
with the dog throughout the day, a pattern of declining social engagement is
easier to track than in homes where the dog’s primary bond is with one
person.
S — Sleep-Wake Cycle: Up All Night Pacing, Days and Nights Mixed Up
Pet parents often describe this as: “my old dog paces at night and will not
settle,” “he barks at nothing at 2 AM,” or “it is like having a newborn — she
sleeps all day and wanders all night.” Vets and pet parents call this pattern
sundowner syndrome.
What it looks like
Your dog sleeps heavily during the day and paces at night. She vocalises
between midnight and 4 AM — not barking at a sound, but a restless,
repetitive whine or bark aimed at nothing. He reverses his entire schedule:
alert at 2 AM, unconscious at noon. The pattern is not occasional. It builds over
weeks, and it does not self-correct.
What it means
The suprachiasmatic nucleus — the brain’s internal clock — degrades with
age and is further disrupted by amyloid deposition. The result is the
sundowning pattern: a fragmented circadian rhythm where agitation worsens
in the late afternoon and evening, peaking after dark. The same term is used in human Alzheimer’s care, because the biology is strikingly similar. The late-night pacing is not boredom. It is neurological.
What to watch for in your home
In apartment buildings with shared walls, this is the DISHAA category that
most directly affects the family’s quality of life — and the neighbours’. A dog
pacing on marble or tile floors at 2 AM in a quiet building creates noise that carries. Families often feel pressured to act quickly, sometimes with solutions
(locking the dog in a room, sedation) that address the symptom without
understanding the cause. If your dog’s nighttime behaviour has shifted and
persisted for more than two weeks, it warrants a vet conversation, not a
management workaround.
H — House Soiling: Accidents in the House After Years of Being Trained
Pet parents often describe this as: “he has never had an accident his whole
life — and now it is happening every day,” or “she goes outside, comes back
in, and goes on the carpet.” The shock of a reliably house-trained dog
suddenly forgetting is one of the first things that sends people searching for
answers.
What it looks like
A dog who has been reliably house-trained for years begins having accidents
indoors. He urinates in the living room despite the balcony door being open.
She defecates in her sleep. He stands at the front door asking to go out, then
soils inside two minutes later as though he forgot why he was at the door.
What it means
This is the most misunderstood DISHAA category, because house soiling has
many possible causes — and cognitive decline is only one of them. Urinary
tract infections, kidney disease, diabetes, spinal nerve compression, and gastrointestinal conditions can all cause sudden house soiling in senior dogs.
The cognitive component is the forgetting: the dog who walks to the door and
then forgets the purpose, or who no longer associates outdoor spaces with
elimination. Your vet will need to rule out medical causes before attributing
house soiling to CDS. This means a urinalysis, blood panel, and possibly
imaging — not a behavioural assumption.
What to watch for in your home
If your dog is trained to use a designated balcony area or a specific spot near
the door, cognitive-related house soiling may look like “laziness” — the dog
soils in the hallway instead of walking ten more steps to the balcony. It is not
laziness. He has lost the association. If your senior dog is having accidents
and the vet has cleared medical causes, the behaviour is worth logging:
when, where, how often, and whether it happens more at night (suggesting
sleep-wake overlap with house soiling).
A — Activity Alterations: Walking in Circles, Lost Interest in Everything
Pet parents often describe this as: “she just stopped doing things she used to
love,” “he walks in circles like he cannot stop,” or “he wanders aimlessly
around the house.” Some dogs lose all curiosity; others develop repetitive
movement that looks purposeless.
What it looks like
Your dog loses interest in toys she has loved for years. Walks become shorter
— not because of joint pain (though that should always be assessed), but
because the motivation has faded. She eats less, or eats with less
enthusiasm. He stares at his food bowl as though uncertain what it is for.
Conversely, some dogs develop repetitive behaviours: pacing in circles,
licking the same spot on the floor, following the same route around the
apartment over and over. This is not energy. It is perseveration — a
neurological loop where the brain gets stuck on a single motor pattern.
What to watch for in your home
Activity decline in apartment dogs can be masked by limited exercise
opportunity. If your dog’s world is already a 900-square-foot apartment with
two short walks a day, the drop in activity may not be dramatic enough to
notice unless you are looking for it. The signal is not the quantity of movement
but the quality of interest. Does your dog still get excited when you pick up the
leash? Does she still investigate new smells on a walk? Does he still respond
when a family member comes home? The loss of curiosity and anticipation is
the cognitive marker, not the loss of kilometres walked.
A — Anxiety: Scared of Everything, Cannot Settle Down
Pet parents often describe this as: “he is suddenly scared of everything,” “she
will not stop panting and trembling,” or “something is off — he is not himself.” New fearfulness in a dog who was never fearful is one of the clearest signals
that the brain, not the personality, has changed.
What it looks like
New fears in a dog who was never fearful. Separation anxiety that appears for
the first time at age 10. Sound sensitivity that seems to have worsened without
a clear trigger. Generalised restlessness — the dog is unsettled, cannot find a
comfortable position, moves from room to room without purpose. Excessive
panting at rest. A dog who once handled Diwali firecrackers with mild unease
now trembles for hours.
What it means
Anxiety in CDS is not a personality change. It is a consequence of a brain that
can no longer make reliable predictions about its environment. When spatial
memory fails, when familiar sounds become confusing, when the circadian
rhythm fragments, the world becomes unpredictable — and unpredictability
is the neurological definition of threat. The anxiety is real, it is neurochemical,
and it deserves treatment, not dismissal.
What to watch for in your home
Festival and firework seasons — Diwali, New Year’s Eve, Fourth of July, Guy
Fawkes Night, Chinese New Year — create a compounding problem. If your
senior dog already has emerging CDS, the noise and disruption can amplify
every DISHAA domain simultaneously: disorientation worsens with sensory overload, sleep cycles shatter from days of firecrackers, anxiety spikes
beyond baseline, and the dog may begin house soiling from sheer distress. If
your dog’s behaviour deteriorated sharply around a festival and did not fully
return to baseline within two weeks after the noise stopped, that residual
change may be CDS unmasked by stress. Note it. Mention it to your vet.
The Simplified DISHAA Score
The table below is a simplified scoring version of the DISHAA framework. For
each of the six categories, rate what you have observed in your dog over the
past month.
For each category, you can also score 2 — Marked / frequent: the sign is
consistent, happening multiple times per week, and clearly different from your
dog’s normal behaviour a year ago.
This table is a simplified starting point — one score per category. The full
Always Friday DISHAA Check tool available here scores each individual sign on a 5-point frequency
scale (Never to Daily+), giving you a much more detailed picture and results
you can track over time. We recommend starting here, then using the tool for
a comprehensive assessment.
When Should You Start?
The 2025 CCDS Working Group guidelines are clear: begin monitoring from
age 7. This does not mean your 7-year-old Labrador has dementia. It means
that cognitive decline is a progressive condition, and the earlier you establish
a baseline of normal behaviour, the easier it is to detect when something
shifts. From age 10, the guidelines recommend a validated questionnaire
every six months, regardless of whether symptoms are present.
For breeds with shorter lifespans — Great Danes, Rottweilers, German
Shepherds — consider starting at 5–6. For Indies and other long-lived breeds,
age 8–9 is a reasonable start, though there is no harm in beginning earlier.
The Dog Aging Project, tracking over 15,000 companion dogs, found that the
odds of cognitive dysfunction increase 52% with each additional year of life.
Time is not neutral. It compounds.
Before You Read Your Score
If you have just worked through the categories above and your stomach has
tightened, we want to say something before you scroll any further.
You are not late. You are not to blame. Cognitive decline in dogs is not caused
by anything you did or did not do. It is a biological process — as natural and
as unfair as ageing itself. The fact that you are here, reading a guide most pet
parents will never find, means your dog has exactly the kind of person they
need.
Whatever your score says, it is not a verdict. It is a starting point. It tells you
where your dog is today, and it gives you and your vet a shared language to
talk about what comes next. That conversation — not this number — is what
matters.
What to Do With Your Score
Mild (0–3) — Worth Monitoring
Good. You have a baseline. Write it down. Save it. Run the DISHAA Check again
in six months. The value of a low score is not reassurance — it is a point of
comparison for the future.
Moderate (4–6) — Talk to Your Vet
Schedule a vet appointment. Not urgently, but soon. Tell your vet you have
been tracking cognitive signs and share your DISHAA scores. Ask for a senior
wellness panel: a complete blood count, metabolic panel, urinalysis, and thyroid screen. The purpose is twofold: to rule out medical conditions that
mimic CDS (hypothyroidism, kidney disease, pain-related behavioural
changes) and to establish a clinical baseline if CDS is suspected.
Significant (7–12) — See Your Vet Soon
See your vet within the next two weeks. Multiple DISHAA domains scoring 1–2
means the condition is no longer subtle. Ask your vet about:
Diagnostic workup: The CCDS Working Group defines two diagnostic levels.
Level 1, available at any well-equipped clinic, requires a consistent history of
progressive DISHAA signs plus exclusion of other medical causes. Level 2, at a
referral centre, adds brain MRI showing cortical atrophy. Most dogs are
diagnosed at Level 1.
Interventions that have evidence: MCT oil for cognitive support (strong
evidence from a 2018 double-blind trial showing improvement across all six
DISHAA categories). Omega-3 fatty acids for neuroinflammation. A structured
environment: consistent routines, night lights for disoriented dogs, non-slip
surfaces on tile and marble floors. For a full evidence-rated guide, read our
Foundational Supplement Stack article.
Medication: Selegiline (marketed as Anipryl) is the only drug with regulatory
approval specifically for canine CDS, reported effective in up to 70% of dogs.
Your vet may also consider anxiolytics for the anxiety component, particularly
if sleep disruption and restlessness are severe.
The Bigger Picture
The reason 98% of dogs with cognitive dysfunction go undiagnosed is not
negligence. It is the absence of a framework. When you do not have a way to
categorise what you are seeing, every sign looks like “just getting old.” Night
pacing is just restlessness. Withdrawal is just tiredness. Accidents are just age.
The signs are there. The framework to read them was not — until now.
DISHAA gives you that framework. It does not require a blood test, an MRI, or
special equipment. It requires observation, honesty, and a willingness to act
on what you see. The dog who paces your apartment at 2 AM is not being
difficult. The Indie who no longer greets you at the door after 12 years of
unfailing devotion has not stopped loving you. They are telling you something.
The only question is whether you have the structure to hear it.
Now you do.
Sources Cited in This Article
- Olby NJ et al. (2025). “The Canine Cognitive Dysfunction Syndrome Working
Group guidelines for diagnosis and monitoring of canine cognitive dysfunction syndrome.” Journal of the American Veterinary Medical Association. Dec 24, 2025. DOI: 10.2460/javma.25.10.0668. - Landsberg G, Maďari A, Žilka N. Canine and Feline Dementia. Springer, 2017.
(DISHAA framework development.) - Salvin HE et al. (2010). “Under diagnosis of canine cognitive dysfunction: a
cross-sectional survey of older companion dogs.” The Veterinary Journal.
(1.9% diagnosis rate finding.) - Yarborough S et al. (2022). “Evaluation of cognitive function in the Dog
Aging Project: associations with baseline canine characteristics.” Scientific
Reports. (15,019 dogs; 52% increased risk per year of age.) - Bray EE et al. (2023). “Associations between physical activity and cognitive
dysfunction in older companion dogs: results from the Dog Aging Project.”
GeroScience. (11,574 dogs; physical activity association.) - Pan Y, Landsberg G et al. (2018). “Efficacy of a therapeutic diet on dogs with
signs of CDS: a prospective double blinded placebo controlled clinical study.”
Frontiers in Nutrition. (MCT diet; improvement across all 6 DISHAA categories.) - Dhaliwal R et al. (2023). “2023 AAHA Senior Care Guidelines for Dogs and
Cats.” Journal of the American Animal Hospital Association. (DISHAA
referenced; cognitive screening recommended.) - Bharani KK et al. (2024). “Effects of ashwagandha root extract on aging-
related changes in healthy geriatric dogs.” Veterinary Medicine and Science (Antioxidant defence, cortisol reduction.) - 9. Haake A et al. (2024). “Comparing standard screening questionnaires of
canine behavior for assessment of cognitive dysfunction.” Frontiers in
Veterinary Science. (CADES, CCAS, CCDR comparison across 597 dogs.)