A change in drinking or activity is easier to discuss when you can describe what changed and how much. The ALIVE Cushing’s Clinical Score offers a shared structure for those observations. It describes signs for discussion with your veterinarian; treatment decisions belong to the veterinarian.
What the Score Is
The 2025 ALIVE consensus, from the Agreeing Language in Veterinary Endocrinology project, includes a clinical scoring system for Cushing’s syndrome. It covers five factors: drinking, urination, appetite, appearance, and attitude/activity. Each receives a score from 0 to 3, giving a total from 0 to 15.
The descriptions move from normal through mild and moderate to severe changes. Drinking, urination and appetite are compared with the dog’s pattern before the onset of Cushing’s; attitude/activity also uses that earlier comparison. Keep the individual observations with any total, so that the number remains connected to what you actually saw.
The Five Areas It Looks At
Drinking
The drinking scale starts at 0 for the same amount or less than before. A mild increase scores 1, a notable increase scores 2, and constantly being seen drinking scores 3. When making notes, describe the pattern behind the category rather than writing only “thirsty.”
Urination
For urination, 0 means the same amount or less than before. A mild increase noticed by the owner scores 1, a notable increase scores 2, and constantly needing to be let out to urinate scores 3. A description of requests to go outside can accompany the category you discuss.
Appetite
The appetite descriptions progress from finishing food eagerly at 1, to finishing eagerly and begging for more at 2, to being obsessed with food at 3. The table places normal or decreased appetite at 0, but specifically flags decreased appetite for assessment of other conditions. Describe a decrease clearly to your veterinarian rather than treating that zero as reassurance.
Appearance
Appearance includes hair, skin, muscle loss and a pot-bellied shape. Normal appearance scores 0. Slightly poor hair and skin quality scores 1. Poor hair and skin quality with hair loss and/or some muscle loss or a pot belly scores 2. Substantial hair loss and/or noticeable muscle loss or a pot belly scores 3. Write down which features you mean.
Attitude and Activity
Normal attitude/activity scores 0. A mild decrease, described as not quite themselves, scores 1. Being quieter and less active and/or panting more than normal scores 2. Being very quiet, dull and weak and/or showing a noticeable increase in panting scores 3. ALIVE also cautions that an ill dog needs consideration of other conditions, so a number should not stand alone.
Keeping Notes at Home
Use the five headings as a simple way to organise your notes. Under each, record a short description and the date of the observation. For drinking, urination and appetite, include what you remember about the pattern before the signs began. If you are unsure about that earlier pattern, say so rather than inventing a comparison.
Keep observations separate from interpretation. “Finishes eagerly and begs for more” describes appetite in the terms used by the score; “the disease must be worse” is a conclusion. If more than one person helps care for your dog, you can keep their descriptions together and bring any differences to the discussion.
What the Score Is Not
The score is a description of clinical signs, not an endocrine test result. ALIVE says treatment should ideally be considered when consistent clinical signs are present and the disease has been confirmed by endocrine testing. A total cannot supply that confirmation or identify the underlying form by itself.
There is no medication instruction in adding the five numbers. A lower total can also conceal an observation that needs explanation, such as decreased appetite. Keep the five descriptions visible and leave decisions about treatment and the meaning of changes to your veterinarian.
Talking It Through With Your Veterinarian
Bring the observations as well as any scores you have discussed or recorded. Useful questions include which category best fits an observation, how uncertain comparisons should be recorded, and how the descriptions relate to the examination and test results. The aim is a clear account of your dog’s signs.
The symptoms guide gives an overview of the signs owners may notice. If the names in a report are confusing, the terminology guide explains the ALIVE definitions. Neither the terminology nor a score replaces your veterinarian’s assessment of an individual dog.