In the DISHAAL acronym for CCDS, what do the two 'A's represent?

• A. Aggression changes and Anxiety
• B. Attention changes and Amnesia
• C. Appetite changes and Anxiety
• D. Activity changes and Anxiety

Answer: (D)

In CCDS, the DISHAAL checklist lists the behavioral signs veterinarians look for in aging dogs with cognitive decline. The two A’s correspond to Activity changes and Anxiety. Activity changes describe shifts in how the dog engages with daily life—things like reduced participation in activities, less exploration, or unusual restlessness and pacing. Anxiety refers to increased nervousness, fearfulness, or new irritability in situations the dog previously handled easily. Together with disorientation, changes in interactions, altered sleep-wake cycles, house soiling, and learning/memory deficits, these Y-sign signs form the overall picture of canine cognitive dysfunction. The other options mix terms not used for the two A components (aggression, attention, or appetite) and memory issues are captured by the learning and memory deficits element, not an A.