Cognitive Dysfunction Syndrome Survey Form

Has your senior pet been showing signs of confusion, instability, or physical impairment? It may be due to Cognitive Dysfunction Syndrome (CDS), a condition similar to Alzheimer’s in humans. Complete our convenient survey to help find answers.

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Cognitive Dysfunction Syndrome Survey Form

Please fill out this form as completely and accurately as possible so we can best assess your pet’s cognitive condition.

Purina-Cognitive Dysfunction Syndrome (CDS)

Diagnosis Tool, DISHAA Survey

(1 is severely emaciated/underweight, muscle wasting and bones easily visible through skin layer) (5 is perfect. Visible waist from above and abdominal tuck from side. Ribs palpable but not visible) (9 is morbidly obese, no abdominal tuck or waist visible, ribs not palpable under fat layer)

What is Cognitive Dysfunction Syndrome?

Cognitive Dysfunction Syndrome (CDS) is an irreversible degeneration of the brain similar to Alzheimer’s disease in humans, characterized by progressive cognitive impairment beyond that expected to occur with aging. CDS has a slow onset, can be difficult to manage, and affects an estimated 14% of dogs 8 years and older.

What is DISHAA?

DISHAA is a tool to help you and your veterinarian assess the mental acuity of your dog, and for your veterinarian to potentially diagnose Cognitive Dysfunction Syndrome (CDS). It helps you assess a patient’s mental acuity by identifying and grading certain exhibited behaviors at home.

Please complete this pet cognitive assessment.
Behavioral Signs
Identify signs that have arisen or progressed since 8 years of age or older.
Please click and drag the circular gauge across the bar to the appropriate value.

Score as 0=NONE , 1=MILD, 2=MODERATE, 3=SEVERE.

DISORIENTATION

Selected Value: 0
Selected Value: 0
Selected Value: 0
Selected Value: 0
Selected Value: 0

SOCIAL INTERACTIONS

Selected Value: 0
Selected Value: 0

SLEEP/WAKE CYCLES

Selected Value: 0
Selected Value: 0

HOUSE SOILING, LEARNING AND MEMORY

Selected Value: 0
Selected Value: 0
Selected Value: 0

ACTIVITY

Selected Value: 0
Selected Value: 0
Selected Value: 0

ANXIETY

Selected Value: 0
Selected Value: 0
Selected Value: 0

Please provide the completed form to your veterinary team for evaluation. Once reviewed, your veterinarian will aim to determine the cause of these signs through a physical examination and recommended diagnostic tests.

A Score of 4-15 is consistent with mild, 16-33 is moderate, and >33 is severe Cognitive Dysfunction Syndrome.