Veterinary Medicine - July 2008 - (Page V3)

A roundtable discussion Landsberg: If we can get owners to understand the disease process, the signs to look for, and the fact that therapies exist, they might volunteer the information much earlier. Mischoulon: With people, the fact that we now have treatments for Alzheimer’s disease that can alter the course of the illness is a strong incentive for people to open up. People are more likely to admit a problem exists if they know something can be done. Alzheimer’s disease, based on a few clinical trials, but it is not FDA-approved for dementia at this time. Landsberg: Because selegiline is fairly selective for MAO-B, it doesn’t have any food restrictions with it. But what drugs should be avoided? Florsheim: Don’t use selegiline with selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressant drugs. You need a two-week washout period if you transition a dog from one drug to another. Depending on the dog’s clinical signs, that transition time can be di cult for an owner. Landsberg: Amitraz, a parasiticide, is an MAO inhibitor and tramadol may have some e ect on serotonin, so these are more drugs to use with caution. In general, selegiline is fairly devoid of side e ects. It either helps the animal or it doesn’t. Some natural compounds also exist for the treatment of cognitive dysfunction in North America. Hill’s Prescription Diet b/d Canine is the only diet tested in both laboratory and clinical trials. The diet is a sodium and enrichment and this forti ed diet is the most e ective in improving learning and memory.4 Florsheim: I’ve had relatively good success with b/d. However, so many older dogs have other dietary restrictions. For example, you can run into problems when you have a dog with cognitive dysfunction and food allergies. You have to pick the health problem on which you are going to focus your attention. Landsberg: Some supplements on the North American market for cats and dogs have similar ingredients to what is added to b/d. However, very few of these have been tested or there have been few clinical trials. Treatment options Landsberg: In North America, we have a couple of agents used in animals with cognitive dysfunction. Dr. Florsheim, would you please review these treatment options. Florsheim: The drug that most general practitioners in North America turn to for dogs with cognitive dysfunction is selegiline (Anipryl—P zer). Most practitioners report that about half of owners are satis ed with the results. I think practitioners feel fairly limited in what they have to o er clients. Landsberg: Selegiline is classi ed as a monoamine oxidase-B (MAO-B) inhibitor, but we don’t know its true mode of action in dogs. It enhances catecholamine transmission and perhaps serves as an antioxidant because superoxide dismutase has been shown to increase with selegiline therapy. In clinical trials3 about 80% of animals showed improvement in some clinical signs within one to two months of therapy. Is selegiline used in people? Mischoulon: In people, selegiline is used primarily as an antidepressant and for treatment of Parkinson’s disease. Most MAO inhibitors on the market are MAO-A inhibitors, which can cause side e ects and complications if taken with certain foods. People are reluctant to follow a strict diet when taking MAO-A inhibitors, so these antidepressants have mostly fallen by the wayside. However, the MAO-B inhibitors like selegiline don’t have those same issues, particularly at lower doses. So, selegiline has made a comeback in the form of a patch. Selegiline has improved cognition in Behavioral Therapy Landsberg: When a dog is diagnosed with cognitive dysfunction, what speci c things can owners do to help the pet? What behavior modi cation techniques, enrichment programs, and drugs can a veterinarian o er? Florsheim: Behavior modi cation and management are important in cases “Behavior modi cation and management are important in cases involving any older dog, whether it is showing obvious signs of cognitive dysfunction or not.“ - Dr. Amanda Florsheim phosphorus restricted senior diet with added alpha-lipoic acid and L-carnitine, which help mitochondria function more e ciently. It is also supplemented with antioxidants, such as vitamin E, vitamin C, selenium, avonoids, carotenoids, and omega-3 fatty acids. This diet was tested in a laboratory for more than two years. From that study, the researchers learned that a combination of brain involving any older dog, whether it is showing obvious signs of cognitive dysfunction or not. Most owners place a lot of importance on puppy training. As dogs get older, emphasis on training declines and there is less focus on providing environmental stimuli and social structure. These older pets are supposed to know the house rules. But the need for training and structure don’t 3

Table of Contents Feed for the Digital Edition of Veterinary Medicine - July 2008

Veterinary Medicine - July 2008 Contents Leading Off Practical Matters Idea Exchange Clarification Dental Corner The Diagnostic Approach to Hematuria Guidelines for Evaluating Hypercalcemic Cats CE Form Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - July 2008

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