Brief Smell Identification Test Research Articles

Prognostic value of odor identification impairment in multiple sclerosis: 10-Years follow-up

BackgroundOlfactory dysfunction has been linked to clinical severity variables in multiple MS populations. Though, its prognostic value is still unknown. ObjectiveThe aim of this study was to explore the long-term outcome associated with Brief-Smell Identification Test (B-SIT) performance in a cohort of MS patients. MethodsA retrospective review of the clinical records was conducted in 149 patients who participated in a previous study, with a median follow-up of 121 months. Demographic and clinical data regarding the last clinical appointment with EDSS measurement were collected. Multiple Sclerosis Severity Scale (MSSS) and Age-Related Multiple Sclerosis Severity (ARMSS) scores were calculated. Date of the last clinical contact or death was recorded. ResultsAmong MS patients with progressive clinical course (n = 33), those with impaired B-SIT at baseline had greater change per month during follow-up (as measured by increases in MSSS and ARMSS scores) and a higher hazard of death. No significant associations were found among patients with relapsing and remitting MS (n = 116). ConclusionsThe study results demonstrate that odor identification impairment has prognostic value in progressive MS, suggesting that a brief odor identification measure can be a marker of neurodegeneration in progressive MS.

Ethmoid-to-maxillary opacification ratio: a predictor of postoperative olfaction and outcomes in nasal polyposis?

Inflammatory profiles for patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) vary between North American and Asian populations. An elevated ethmoid-to-maxillary (E/M) opacification ratio on preoperative imaging is associated with certain postoperative outcomes in Asian populations and populations that are non-type 2 dominant. In this study we explore this factor in North American/type 2-based populations. Adult patients (n = 165) from a North American population with CRSwNP who underwent endoscopic sinus surgery (ESS) were prospectively enrolled into an observational, multi-institutional study. The 22-item Sino-Nasal Outcome Test (SNOT-22), Brief Smell Identification Test (BSIT), and Lund-Kennedy (LK) endoscopic scores were obtained pre- and postoperatively. Patients were stratified according to increasing E/M ratios based on Lund-Mackay (LM) scores. On average, significant within-subject postoperative improvement was found in all patients for SNOT-22 total and domain scores, and also BSIT results (p ≤ 0.019). Preoperatively, elevated E/M ratio correlated with worse BSIT scores (r = -0.343, p < 0.001). Postoperatively, elevated E/M ratio correlated with BSIT improvement (r = 0.284, p = 0.002), but did not correlate with SNOT-22 improvement or polyp recurrence. An elevated E/M ratio was associated with greater likelihood of reporting a minimal clinically important difference in BSIT scores (χ2 = 9.96, p = 0.041). Elevated E/M ratios were found to associated with worse baseline olfaction and an increased likelihood of achieving a clinically meaningful postoperative improvement in olfaction in this North American population with CRSwNP. Elevated E/M ratios did not predict postoperative changes in SNOT-22 measures or polyp recurrence. This suggests that prognostic factors may vary according to geography and generalized inflammatory profiles (type 2 vs non-type 2) in patients with CRS.

Validation of a new olfactory test for Chinese Parkinson’s disease patients

IntroductionHyposmia is a common non-motor symptom in Parkinson’s disease (PD) and has been used to assist PD diagnosis and early screening of prodromal patients. Although the Brief Smell Identification Test (B-SIT) is the most commonly used olfactory test, its utility was limited by the culture difference in recognition of the smells included in the test. We have developed a new modified B-SIT test for Chinese (B-SITC), and validated and compare it with B-SIT in Chinese PD patients. MethodsFrom 2015 to 2018, PD patients were recruited from the Movement Disorder Clinic of Xuanwu Hospital and healthy controls were recruited from the Beijing Longitudinal Study on Aging Cohort II. The two olfactory tests were used in healthy volunteers and PD patients. ResultsA total of 428 subjects participated in the study: 211 healthy controls and 217 PD patients. The average B-SIT and B-SITC scores were significantly different between control and PD groups (B-SIT, 9.18 ± 1.94 vs. 6.90 ± 2.44, P = 0.0001; B-SITC, 8.60 ± 1.93 vs. 5.91 ± 2.21, P = 0.0001). The B-SITC had good sensitivity (73.1%), specificity (76.8%), positive predictive value (76.8%), and negative predictive value (73.1%) for the diagnosis of Chinese PD, and the area under the curve (AUC) value was greater for the B-SITC than for the B-SIT (0.838 vs. 0.761). ConclusionsThe B-SITC is useful for the clinical assessment of olfactory function in Chinese PD patients.

Intact global cognitive and olfactory ability predicts lack of transition to dementia

IntroductionOdor identification deficits characterize Alzheimer's disease and other dementias. We examined if intact performance on brief cognitive and odor identification tests predicts lack of transition to dementia. MethodsIn an urban community, 1037 older adults without dementia completed the 40-item University of Pennsylvania Smell Identification Test, which includes the 12-item Brief Smell Identification Test (B-SIT). Data from 749 participants followed up for 4 years were analyzed. ResultsIn covariate-adjusted survival analyses, impairment on the Blessed Orientation Memory Concentration Test and B-SIT each predicted dementia (n = 109), primarily Alzheimer's disease (n = 101). Among participants with intact olfactory (B-SIT ≥ 11/12 correct) and cognitive (Blessed Orientation Memory Concentration Test ≤ 5/28 incorrect) ability, 3.4% (4/117) transitioned to dementia during follow-up with no transitions in the 70–75 and 81–83 years age group quartiles. DiscussionOdor identification testing adds value to global cognitive testing, and together can identify individuals who rarely transition to dementia, thereby avoiding unnecessary diagnostic investigation.

Neocortical Lewy bodies are associated with impaired odor identification in community-dwelling elders without clinical PD.

The association of Lewy bodies (LBs) with olfactory dysfunction was investigated in community-dwelling elders without clinical Parkinson's disease (PD) using the 12-item Brief Smell Identification Test (BSIT), a standard measure of odor identification. 280 participants in the Rush Memory and Aging Project completed the BSIT annually. Lewy bodies were detected in 13 brain regions by immunohistochemistry and were assigned to the Braak PD stages 1-6. Of the 280 participants, 101 (36.1%) had LBs which were maximal in the olfactory bulb and tract (85.1%) and least in Heschl's cortex (21.8%). Due to the small number of cases in Braak PD stages 2, 3 and 5, the distribution of LBs in the 6 Braak PD stages was contracted into 3 main LB stages: (1) LBs in olfactory bulbs and dorsal motor nucleus of vagus, (2) further extension of LBs to limbic and other brainstem regions and (3) additional extension of LBs to neocortical areas. MMSE, global cognition and odor test scores were lower and frequency of dementia was higher at the time of the last valid BSIT, in cases with LBs as compared to those without LBs. Linear regression analyses showed that LBs were associated with impaired olfaction. However, on stratification of LBs into 3 stages, only the stage 3 cases were independently associated with impaired olfaction. Although LB pathology was detected in olfactory bulbs in the early stage of LB progression (stage 1), the strongest association of LBs with olfactory dysfunction was observed in the late pathological stage (stage 3) when LBs extended to neocortical areas.

Analysis of Olfaction after Bilateral Nasoseptal Rescue Flap Transsphenoidal Approach with Olfactory Mucosal Preservation

To ascertain the impact of septal olfactory strip preservation and bilateral rescue flap elevation on the incidence of olfactory dysfunction. Case series with chart review of patients undergoing endoscopic endonasal skull base surgery (2012-2014). Providence Saint John's Health Center and John Wayne Cancer Institute. The incidences of postoperative epistaxis, hyposmia, and anosmia were analyzed using the Brief Smell Identification Test (B-SIT), which was completed in 110 of the 165 patients. Seventy-eight patients required extended approaches. Bilateral nasoseptal rescue flaps were elevated in 144 patients (87.3%) and pedicled nasoseptal or middle turbinate flaps in 21 patients (12.7%). The neurovascular pedicles were preserved in all patients, and there were no episodes of postoperative arterial epistaxis. Normal olfaction was noted in 95 patients (86%), with new hyposmia noted in 5 patients (5.5%). Within the rescue flap cohort, new hyposmia occurred in 6.3% (P < .01) of patients, balanced by improvement of olfaction in 43% of patients with preoperative dysfunction (overall pre- and postoperative olfactory function: 85% vs 86%). Patients with pedicled nasoseptal flaps did not have new hyposmia, with a net improvement of olfaction (71% vs 86%, P = .07). No patients experienced new anosmia. There was no difference between flap type within either subgroup. Superior olfactory strip preservation during elevation of reconstructive flaps preserves olfactory function and maintains adequate surgical exposure. In addition, rescue flaps have significantly diminished the rate of arterial postoperative epistaxis while maintaining the ability to harvest nasoseptal flaps for future reconstruction.

Screening performance of abbreviated versions of the UPSIT smell test

BackgroundHyposmia can develop with age and in neurodegenerative conditions, including Parkinson’s disease (PD). The University of Pennsylvania Smell Identification Test (UPSIT) is a 40-item smell test widely used for assessing hyposmia. However, in a number of situations, such as identifying hyposmic individuals in large populations, shorter tests are preferable.MethodsWe assessed the ability of shorter UPSIT subsets to detect hyposmia in 891 healthy participants from the PREDICT-PD study. Shorter subsets included Versions A and B of the 4-item Pocket Smell Test (PST) and 12-item Brief Smell Identification Test (BSIT). Using a data-driven approach, we evaluated screening performances of 23,231,378 combinations of 1–7 smell items from the full UPSIT to derive “winning” subsets, and validated findings separately in another 191 healthy individuals. We then compared discriminatory UPSIT smells between PREDICT-PD participants and 40 PD patients, and assessed the performance of “winning” subsets containing discriminatory smells in PD patients.ResultsPST Versions A and B achieved sensitivity/specificity of 76.8%/64.9% and 86.6%/45.9%, respectively, while BSIT Versions A and B achieved 83.1%/79.5% and 96.5%/51.8%. From the data-driven analysis, 2 “winning” 7-item subsets surpassed the screening performance of 12-item BSITs (validation sensitivity/specificity of 88.2%/85.4% and 100%/53.5%), while a “winning” 4-item subset had higher sensitivity than PST-A, -B, and even BSIT-A (validation sensitivity 91.2%). Interestingly, several discriminatory smells featured within “winning” subsets, and demonstrated high-screening performances for identifying hyposmic PD patients.ConclusionUsing abbreviated smell tests could provide a cost-effective means of large-scale hyposmia screening, allowing more targeted UPSIT administration in general and PD-related settings.

Olfactory identification in HIV positive adults living in Benin city, Nigeria

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Olfactory function has been shown to be impaired in human immunodeficiency virus (HIV) infection. The advent of anti-retroviral therapy has resulted in prolonged survival of these patients requiring increased focus on factors that affect their quality of life including olfaction.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The study was conducted at the University of Benin Teaching Hospital, Benin City. Consenting adult HIV positive patients were assisted to fill a proforma after which they had rigid nasendoscopy done to rule out peripheral causes of anosmia such as nasal infections, nasal polyps and tumours. The brief smell identification test (BSIT) scratch and sniff tests were then administered to those included in the study. The same procedure was repeated with consenting HIV negative subjects serving as control.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; There was a statistically significant difference between olfactory identification ability of HIV positive and HIV negative adults (p=0.001). Cases were 2.92 times likely to have abnormal smell identification abilities than controls.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Olfactory identification ability is reduced in PLWHA relative to the HIV negative population.&lt;/p&gt;

Olfactory Identification in 7-Year-Old Children with Familial High Risk of Schizophrenia or Bipolar Disorder - The Danish High Risk and Resilience Study VIA 7

Background: Olfactory identification deficits are present in individuals with schizophrenia and their unaffected first-degree relatives, while deficits are less pronounced in individuals with bipolar disorder. We hypothesized that children with familial high-risk for schizophrenia (FHR-SZ) show olfactory identification deficits compared to population-based controls (PBC), and that children with familial high-risk for bipolar disorder (FHR-BP) perform intermediate. Furthermore, we investigated potential relationships with psychopathology, cognition, and home environment. Methods: Olfactory identification was assessed at age 7 in 184 children with FHR-SZ, 106 children with FHR-BD, and 186 PBC with the Brief Smell Identification Test (BSIT). BSIT total score and the proportion of children scoring below pre-defined cut-off scores were the outcomes. Potential relationships with psychopathological, cognitive, and home environmental variables were conducted using hierarchical and logistic multiple regression analyses. Outcomes: ANOVA revealed no between-group differences in olfactory identification. Chi-square test of independence showed a significant greater proportion of boys with FHR-SZ than population-based boys with an abnormal olfactory identification (p<0·05). Regression analyses of all children showed significant positive associations of olfactory identification with girls, social responsiveness, and working memory. Less social responsiveness predicted abnormal olfactory identification in boys with FHR-SZ. Interpretation: Abnormal olfactory identification is more frequent in 7-year-old boys with FHR-SZ than in matched low-risk boys and is linked to a deficit of social responsiveness. This supports the idea that olfactory and social dysfunction share a common pathophysiological and perhaps neurobiological pathway in schizophrenia. Funding Statement: Mental Health Services of the Capital Region of Denmark, Aarhus University, and the Lundbeck Foundation Initiative for Integrative Psychiatric Research. Declaration of Interests: All authors confirmed to have no conflicts of interest. Ethics Approval Statement: The project was approved by The Danish Data Protection Agency. The study procedures were aligned with the guidelines of the National Committee for Health Research Ethics, although formal ethical approval was not required due to its observational design.

Impaired olfaction is associated with cognitive decline and neurodegeneration in the brain.

ObjectiveWe aimed to examine whether impaired olfaction is associated with cognitive decline and indicators of neurodegeneration in the brain of dementia-free older adults.MethodsWithin the Rush Memory and Aging Project, 380 dementia-free participants (mean age = 78 years) were followed for up to 15 years, and underwent MRI scans. Olfactory function was assessed using the Brief Smell Identification Test (B-SIT) at baseline, and categorized as anosmia (B-SIT <6), hyposmia (B-SIT 6–10 in men and 6–10.25 in women), and normal (B-SIT 10.25–12 in men and 10.5–12 in women). Cognitive function was annually assessed with a battery of 21 tests, from which composite scores were derived. Structural total and regional brain volumes were estimated. Data were analyzed using linear regression and mixed-effects models.ResultsAt study entry, 138 (36.3%) had normal olfactory function, 213 (56.1%) had hyposmia, and 29 (7.6%) had anosmia. In multiadjusted mixed-effects models, hyposmia (β = −0.03, 95% confidence interval [CI] −0.05 to −0.02) and anosmia (β = −0.13, 95% CI −0.16 to −0.09) were associated with faster rate of cognitive decline compared to normal olfaction. On MRI, impaired olfaction (hyposmia or anosmia) was related to smaller volumes of the hippocampus (β = −0.19, 95% CI −0.33 to −0.05), and in the entorhinal (β = −0.16, 95% CI −0.24 to −0.08), fusiform (β = −0.45, 95% CI −0.78 to −0.14), and middle temporal (β = −0.38, 95% CI −0.72 to −0.01) cortices.ConclusionImpaired olfaction predicts faster cognitive decline and might indicate neurodegeneration in the brain among dementia-free older adults.

Smell status in functional movement disorders: New clues for diagnosis and underlying mechanisms

ObjectiveFunctional movement disorders (FMDs) mimic a range of movements, neuropsychiatric and neurodegenerative disorders known to have smell dysfunction, which has been neglected in terms of its application to FMD. We aim to determine the smell status in FMD patients tested by a non-invasive, reliable and validated olfactory test. Patients and methodsWe quantitatively assessed in thirty-five FMD patients their smell status and compared it to that of healthy age- and sex-matched controls, and of patients with Parkinson’s disease (PD). All participants were administered the Brief Smell Identification Test (B-SIT), a standardized short version of the University of Pennsylvania Smell Identification Test (UPSIT). The Picture Identification Test (PIT), a visual test analogous in content and form to the UPSIT designed to control for non-olfactory cognitive confounds, was also administered. ResultsThe B-SIT scores of the FMD patients were higher than those from PD patients [respective means (standard deviations: SDs) = FMD, 9.54 (1.57); PD, 4.64 (1.05), p < 0.01)] but similar to the smell scores from healthy controls [9.97 (1.77), p = 0.35]. Gender, age, time of disease onset, smoking status, and phenotypic expression did not influence the test scores. Fourteen FMD patients who mentioned having olfactory dysfunction before smell testing have their test results within normal range. PIT scores from patients and healthy controls were within normal range. ConclusionsThese findings indicate that FMD patients have normal olfactory function. Olfactory testing may be helpful in identifying and differentiating FMD from other movement, neurodegenerative and neuropsychiatric diseases for which smell function is altered.

Socioeconomic factors impact quality of life outcomes and olfactory measures in chronic rhinosinusitis.

Healthcare disparities related to socioeconomic factors may adversely impact disease states and treatment outcomes. Among patients with chronic rhinosinusitis (CRS), the impact of socioeconomic factors on outcomes following endoscopic sinus surgery (ESS) remains uncertain. Adult patients with refractory CRS were prospectively enrolled into an observational, multi-institutional cohort study between March 2011 and June 2015. Socioeconomic factors analyzed included household income, insurance status, years of education completed, race, age, and ethnicity. Income was stratified according to the Thompson and Hickey model. The 22-item Sino-Nasal Outcome Test (SNOT-22) and Brief Smell Identification Test (BSIT) were completed preoperatively and postoperatively. A total of 392 patients met inclusion criteria. Higher age and male gender were associated with better mean preoperative SNOT-22 scores (both p < 0.02), whereas Medicare insurance status and male gender were associated with worse preoperative mean BSIT scores (both p < 0.02). Postoperatively, higher household income ($100,001+/year) and lower age were associated with a greater likelihood of improving at least 1 minimal clinically important difference (MCID) on SNOT-22 scores (OR = 2.40 and 1.03, respectively, both p < 0.05), while no factors were associated with increased odds of achieving a MCID on BSIT scores. Preoperative olfactory function and postoperative quality of life (QOL) improvement were associated with metrics of socioeconomic status in patients with CRS electing ESS. The odds of experiencing a clinically meaningful QOL improvement were more than twice as likely for patients with the highest household income level compared to other income tiers. Further investigation is warranted to identify barriers to postoperative improvement.

Validation of the utility of the Brief Smell Identification Test in Chinese patients with Parkinson’s disease

IntroductionHyposmia is a common non-motor symptom occurring in Parkinson’s disease (PD), and has been included in the diagnostic criteria. Although a version of the Brief Smell Identification Test (B-SIT) has been developed specifically for Chinese populations, there have been no reports of the utility of this test in the diagnosis of PD in China. ObjectiveConsidering the influence of cultural factors on olfactory test findings, we sought to investigate the utility and efficiency of the B-SIT in Chinese PD patients. MethodsPD patients were recruited from the Movement Disorder Clinic of Xuanwu Hospital, and healthy controls were recruited from the Beijing Longitudinal Study on Aging Cohort II, between 2015 and 2016. The B-SIT was used for olfactory function testing in all subjects, and the familiarity of 59 odors questionnaire was performed for the investigation of familiarity of odors. ResultsA sample of 275 subjects participated in the study, including 112 healthy controls and 163 PD patients. The sensitivity (64.1%), specificity (83.9%), positive predictive value (83.5%) and negative predictive value (64.8%) for identifying PD were measured with the B-SIT. The consistency values between the results of self-reported smell loss and hyposmia identified by B-SIT in control and PD groups were 74.8% and 64.2%, respectively. Most of the odors in the B-SIT were familiar to people in the Chinese population, based on a survey of 3356 subjects using a familiarity questionnaire. ConclusionsIt is recommended to use the B-SIT olfactory test instead of self-reported smell loss for PD diagnosis for Chinese.

Variability and Coupling of Olfactory Identification and Episodic Memory in Older Adults.

To determine whether assessment-to-assessment fluctuations in episodic memory (EM) reflect fluctuations in olfaction over time. Within-person coupled variation in EM and the Brief Smell Identification Test (BSIT) was examined in 565 participants aged 58-106 with autopsy data from the Rush Memory and Aging Project. A growth model for up to 15 years of EM data, with BSIT as time-varying covariate, was estimated accounting for main effects of sex, education, ε4 allele, and Alzheimer's disease (AD) pathology, BSIT and time-varying BSIT, as well as the interaction between AD pathology and time-varying BSIT. Individuals with higher BSIT scores (b = .01, standard error [SE] = .004, p = .009) had slower declines in EM. High AD pathology (b = -.06, SE = .02, p = .001) was associated with more rapid declines in EM. The association between time-specific fluctuations in EM and BSIT differed by level of AD pathology (b = .08, SE = .034, p = .028), with a higher EM-BSIT association at higher levels of pathology. BSIT and EM fluctuate together over measurement occasions, particularly for individuals with AD pathology. Repeated intraindividual measurements provide information that could lead to early detection and inexpensive monitoring of accumulating AD pathology.

S199. ENHANCED OLFACTORY IDENTIFICATION IN ADOLESCENTS WITH PSYCHOTIC EXPERIENCES

BackgroundThe olfactory system has a widely distributed anatomical network reaching both cortical and subcortical structures (Milardi et al., 2017). Olfactory dysfunction has been associated with schizophrenia (Moberg & Turetsky, 2003), where deficits in odour identification (Seidman et al., 1997), odor detection threshold sensitivity (Serby et al., 1990) and odour memory (Wu et al., 1993) can be seen early in the course of the disorder and persist with illness duration (Rupp, 2010). This olfactory dysfunction has been correlated with cognitive deficits, including language (Corcoran et al., 2005), verbal and non-verbal memory (Moberg et al., 2006) and tests of emotional recognition (Goudsmit et al., 2003) in schizophrenia. Neuroanatomically, areas of the temporal lobe, including the superior temporal gyrus, hippocampus and amygdala have all been implicated in the dysfunction. It is not known whether olfactory changes can be detected in the broader extended psychosis phenotype.MethodsThe current research focuses on a community-based sample of young adolescents aged 11–13 (N= 140) recruited from schools in the Dublin and Kildare areas of Ireland, These adolescents were assessed for psychotic symptoms using the psychosis section of the Schedule for Affective Disorders and Schizophrenia and also completed the Brief Smell Identification Test (BSIT), derived from the University of Pennsylvania Smell Identification Test (UPSIT),as part of a neuropsychological assessment. The BSIT is a self-administered 12-item test of olfactory functioning, containing common odours (eg lemon, chocolate, and smoke) and participants were required to choose one of four multiple-choice answers.ResultsPerformance on the BSIT was compared between participants who reported any psychotic experiences (PE) (N=71), and those who did not (N=69). We examined total score and scores for individual smell types, using ANOVA, and co-varied for age and gender.ResultsA significant group difference was found when both age and gender were co-varied for, in which the PE group performed significantly better on the BSIT (F=5.56, p= 0.02), and one of the individual twelve odours (‘‘paint- thinner’’) of the BSIT also was significantly better identified by the PE group (F=7.53, p=0.007). When examined in terms of correlations with psychotic symptoms, BSIT scores were found to significantly correlate with Grandiosity, one of the eight categories of the Adolescent Psychotic-Like Symptoms Screener (APSS) (p=0.004).DiscussionMoberg et al. (2013) report that positive symptoms of psychosis may be moderating our results, where it was hypothesized that this early olfactory hypersensitivity is due to increased vigilance of external and internal stimuli. Corcoran et al. (2005) similarly found that the presence of features associated with mania, such as grandiosity, was associated with better outcomes in smell identification tests.We hope to extend our analysis to search for neuroanatomical and neuropsychological correlates of these olfactory performance scores in young people with and without psychotic symptoms, as well as looking more in-depth at positive symptoms reported by the PE group and their possible associations with this increased hypersensitivity in olfactory identification. The current research is hoped to capture some of the earliest olfactory changes associated with psychosis vulnerability as a possible biomarker. The study employs a novel participant cohort whom are considered an extended psychosis phenotype and at this point only exhibit psychotic symptoms, but remain at an increased risk of the development of psychosis in adulthood.

F205. OLFACTORY IDENTIFICATION IN 7-YEAR OLD CHILDREN AT FAMILIAL RISK TO DEVELOP SCHIZOPHRENIA

BackgroundOlfactory dysfunction has repeatedly been observed in individuals diagnosed with schizophrenia. The most stable and consistent finding on the behavioral level is that of smell identification deficits. However, the nature of olfactory identification abnormalities seems to extend to structural abnormalities in the underlying neurobiology of the olfactory system. Furthermore, smell identification deficits are also documented in first-episode patients and non-psychotic first-degree relatives of schizophrenia patients. Family members of schizophrenia patients also show structural abnormalities of the olfactory system, suggesting that these may serve as an endophenotype for the development of schizophrenia.Only a few studies examined the olfactory identification ability in adolescents at-risk for schizophrenia and suggested smell identification deficits as a risk marker for schizophrenia. These studies included adolescents at clinical as well as at genetic risk for schizophrenia. None of these studies focused on children at genetic risk for schizophrenia. Therefore, we investigated the olfactory identification ability in children of parents with schizophrenia in comparison to children of parents without a psychotic disorder. As we are also interested in the specificity of the olfactory impairments to schizophrenia, we included children of parents with bipolar disorder. We hypothesize that children at genetic risk for schizophrenia would have the most severe smell identification deficits and that children of bipolar disorder patients would have less severe deficits than the at-risk for schizophrenia group but more severe than the group of children without a psychotic parent.MethodsParticipants - The olfactory identification ability was assessed in 202 children of schizophrenia patients (‘children at familial risk for schizophrenia’) in relation to that of 200 children of parents without a psychotic disorder (‘controls’). In addition, we also assessed the B-SIT in 120 children of bipolar disorder patients (‘children at familial risk for bipolar disorder’). All children were 7 years of age at the time of assessment and they were part of the Danish High Risk and Resilience Study – VIA7.Brief Smell Identification Test - The Brief Smell Identification Test (B-SIT) contains 12 items that need to be scratched and sniffed. The test has excellent reliability (> 0.80) and demonstrates agreement for abnormal olfaction comparing B-SIT with the San Diego Odor Identification Test (SDOIT). A maximum score of 12 reflects intact olfactory identification functioning. B-SIT has been conducted in patients with neurodegenerative disorders (Parkinson’s disease and Alzheimer’s disease) and can be used for individuals above 5 years of age.Statistics - We will use analysis of covariance (ANCOVA) for analysis of the B-SIT total scores with ‘diagnosis of parent’ as the independent variable and age and sex as covariates for the three groups.ResultsAnalyses will be performed within the next 3 months so can be presented in April 2018.DiscussionConclusion and discussion cannot be drawn at this time.

Relationships Between Lower Olfaction and Brain White Matter Lesions in Elderly Subjects with Mild Cognitive Impairment.

Olfactory impairment is reported in mild cognitive impairment (MCI) and Alzheimer's disease (AD) and is associated with hippocampal atrophy. In elderly people, dementia with AD neuropathology and white matter lesions (WML) is common. In this context, olfactory impairment could also depend on the presence of WML. To assess the cross-sectional relationship between olfaction and WML in elderly subjects with MCI. Consecutive subjects, >65 years old, diagnosed as MCI after a comprehensive neuropsychological assessment in an expert memory center, with a brain MRI performed within a year and without major depressive state, were included. Olfaction was assessed by the Brief Smell Identification Test (BSIT). Two trained neuroradiologists, blind to cognitive and olfaction status, visually assessed hippocampal atrophy according to Scheltens' scale and WML according to Fazekas criteria. Seventy-five MCI subjects (mean age (SD) = 77.1 (6.2) years, 74.7% of women) were included. After adjustment for age and sex, factors associated with low BSIT scores were older age (p = 0.007), lower BMI (p = 0.08), lower MMSE score (p = 0.05), lower FCRST (p = 0.008), hippocampal atrophy (p = 0.04), periventricular WML (p = 0.007), and deep WML burden (p = 0.005). In multivariate analysis, severe deep WML (OR (95% CI) = 6.29 (1.4-35.13), p = 0.02) remained associated with low BSIT score independently from hippocampal atrophy. In elderly MCI subjects, low olfactory performances are associated with WML, whose progression may be slowed by vascular treatments. A longitudinal study to evaluate whether the progression of WML, hippocampal atrophy and low olfactory function, can predict accurately conversion from MCI to dementia is ongoing.

Comparison of surgical outcomes between patients with unilateral and bilateral chronic rhinosinusitis.

Although the majority of patients with chronic rhinosinusitis without nasal polyposis (CRSsNP) suffer from bilateral disease, a subset suffer from unilateral disease. Currently, outcomes following endoscopic sinus surgery (ESS) for medically recalcitrant CRS are inferred from outcomes for patients with bilateral disease. This study compares outcomes of ESS between patients with unilateral and bilateral disease. Patients with CRSsNP who failed appropriate medical therapy and elected ESS were enrolled between 2011 and 2015. Patients were dichotomized according to radiographic evidence of unilateral disease (Lund-Mackay [LM] score = 0 for 1 side) or bilateral disease (LM ≥ 1 for both sides). The primary outcome of interest was the 22-item Sino-Nasal Outcome Test (SNOT-22), with secondary outcomes including the Brief Smell Identification Test (BSIT) and the Lund-Kennedy (LK) endoscopy staging system. A total of 190 patients met inclusion criteria consisting of 19 with unilateral (10%) and 171 with bilateral CRSsNP (90%). Both groups were similar across all preoperative demographic factors, SNOT-22, and BSIT scores. Postoperatively, patients with bilateral disease reported greater improvement in mean SNOT-22 scores compared to unilateral disease, but this difference was not statistically or clinically significant (-24.3 ± 21.1 vs -21.5 ± 24.0, p = 0.582). Mean LK scores improved for patients with bilateral disease but not unilateral disease, without a difference between groups (-2.0 ± 3.5 vs -0.4 ± 2.4, p = 0.090). Patients with unilateral CRSsNP experience improvement after ESS comparable to patients with bilateral disease on patient reported outcome measures.

Olfaction and incident Parkinson disease in US white and black older adults.

To investigate olfaction in relation to incident Parkinson disease (PD) in US white and black older adults. The study included 1,510 white (mean age 75.6 years) and 952 black (75.4 years) participants of the Health, Aging, and Body Composition study. We evaluated the olfaction of study participants with the Brief Smell Identification Test (BSIT) in 1999-2000. We retrospectively adjudicated PD cases identified through August 31, 2012, using multiple data sources. We used multivariable Cox models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). During an average of 9.8 years of follow-up, we identified a total of 42 incident PD cases, including 30 white and 12 black participants. Overall, poor sense of smell, as indicated by a lower BSIT score, was associated with higher risk of PD. Compared with the highest tertile of BSIT (t3), the HR was 1.3 (95% CI 0.5-3.6) for the second tertile (t2) and 4.8 (95% CI 2.0-11.2) for the lowest tertile (t1) (ptrend < 0.00001). Further analyses revealed significant associations for incident PD in both the first 5 years of follow-up (HRt1/[t2+t3] 4.2, 95% CI 1.7-10.8) and thereafter (HRt1/[t2+t3] 4.1, 95% CI 1.7-9.8). This association appeared to be stronger in white (HRt1/[t2+t3] 4.9, 95% CI 2.3-10.5) than in black participants (HRt1/[t2+t3] 2.5, 95% CI 0.8-8.1), and in men (HRt1/[t2+t3] 5.4, 95% CI 2.3-12.9) than in women (HRt1/[t2+t3] 2.9, 95% CI 1.1-7.8). Poor olfaction predicts PD in short and intermediate terms; the possibility of stronger associations among men and white participants warrants further investigation.

Neuroimaging biomarkers and impaired olfaction in cognitively normal individuals.

There is a need for inexpensive noninvasive tests to identify older healthy persons at risk for Alzheimer disease (AD) for enrollment in AD prevention trials. Our objective was to examine whether abnormalities in neuroimaging measures of amyloid and neurodegeneration are correlated with odor identification (OI) in the population-based Mayo Clinic Study of Aging. Cognitively normal (CN) participants had olfactory function assessed using the Brief Smell Identification Test (B-SIT), underwent magnetic resonance imaging (n = 829) to assess a composite AD signature cortical thickness and hippocampal volume (HVa), and underwent 11 C-Pittsburgh compound B (n = 306) and 18 fluorodeoxyglucose (n = 305) positron emission tomography scanning to assess amyloid accumulation and brain hypometabolism, respectively. The association of neuroimaging biomarkers with OI was examined using multinomial logistic regression and simple linear regression models adjusted for potential confounders. Among 829 CN participants (mean age = 79.2 years; 51.5% men), 248 (29.9%) were normosmic and 78 (9.4%) had anosmia (B-SIT score < 6). Abnormal AD signature cortical thickness and reduced HVa were associated with decreased OI as a continuous measure (slope = -0.43, 95% confidence interval [CI] = -0.76 to -0.09, p = 0.01 and slope = -0.72, 95% CI = -1.15 to -0.28, p < 0.01, respectively). Reduced HVa, decreased AD signature cortical thickness, and increased amyloid accumulation were significantly associated with increased odds of anosmia. Our findings suggest that OI may be a noninvasive, inexpensive marker for risk stratification, for identifying participants at the preclinical stage of AD who may be at risk for cognitive impairment and eligible for inclusion in AD prevention clinical trials. These cross-sectional findings remain to be validated prospectively. Ann Neurol 2017;81:871-882.