Cross-Cultural Smell Identification Test Research Articles

Olfactory outcomes after endoscopic skull base surgery: A systematic review and meta-analysis.

Determine the effect of endoscopic skull base surgery (ESBS) on long-term olfactory outcomes after surgery. An English-language search was conducted using the Cochrane, MEDLINE, Scopus, and Embase databases from January 2000 to October 2017 for adult patients undergoing ESBS with subjective and objective olfaction outcomes. Two authors independently examined articles to identify those meeting inclusion criteria. Studies examining objective olfactory outcomes after ESBS were included in the meta-analysis. A random-effects meta-analysis of patients undergoing sellar and parasellar ESBS was conducted to compare preoperative and postoperative olfactory outcomes using the University of Pennsylvania Smell Identification Test (UPSIT) and Cross-Cultural Smell Identification Test (CCSIT). Among 339 eligible articles, 29 articles met inclusion criteria. Twenty-five of these focused on sellar and parasellar tumors. Individual articles not meeting criteria for meta-analysis were qualitatively reported. Meta-analysis showed there was no difference in preoperative and postoperative olfactory function after sellar and parasellar ESBS based on the UPSIT (five studies, mean difference [MD] = -1.03; 95% CI: -3.98, 1.93; P = .50) and the CCIST (three studies, MD = -0.77; 95% CI: -3.03, 1.49; P = .50). A pooled overall meta-analysis revealed similar results (eight studies, effect size = -0.30; 95% CI: -0.79, 0.18; P = .22). However, heterogeneity for all meta-analyses was high (I2 > 95%, P < .01), suggesting significant variation in the included studies. Based on published objective olfaction outcomes after sellar and parasellar ESBS, there was no significant difference between preoperative and postoperative olfaction. Further prospective studies using validated objective measures of olfaction are required to improve our understanding on this subject. 2a Laryngoscope, 129:1998-2007, 2019.

Multiple Sensory Impairment Is Associated With Increased Risk of Dementia Among Black and White Older Adults.

Few studies have examined impairment in multiple senses (multisensory impairment) and risk of dementia in comparison to having a single or no sensory impairment. We studied 1,810 black and white nondemented participants from Health, Aging, and Body Composition (Health ABC) Study aged 70-79 years at enrollment. Sensory impairment was determined at our study baseline (Year 3-5 of Health ABC) using established cut points for vision (Bailey-Lovie visual acuity and Pelli-Robson contrast sensitivity test), hearing (audiometric testing), smell (12-item Cross-Cultural Smell Identification Test), and touch (peripheral nerve function tests). Incident dementia over 10 years of follow-up was based on hospitalization records, dementia medications, or at least 1.5 SD decline in Modified Mini-Mental State Examination score (race-specific). Cox proportional hazard models with adjustment for demographics, health behaviors, and health conditions evaluated the relationship between risk of dementia and increasing number of sensory impairments. Sensory impairments were common: 28% had visual impairment, 35% had hearing loss, 22% had poor smell, 12% had touch insensitivity; 26% had more than two impairments, and 5.6% had more than three sensory impairments. Number of impairments was associated with risk of dementia in a graded fashion (p < .001). Compared to no sensory impairments, the adjusted hazard ratio was 1.49 (95% CI: 1.12, 1.98) for one sensory impairment, 1.91 (95% CI: 1.39, 2.63) for two sensory impairments, and 2.85 (95% CI: 1.88, 4.30) for more than three sensory impairments. Multisensory impairment was strongly associated with increased risk of dementia. Although, the nature of this relationship needs further investigation, sensory function assessment in multiple domains may help identify patients at high risk of dementia.

Peripheral blood inflammatory markers in early Parkinson’s disease

The aim of this study was to characterize peripheral inflammatory markers in patients with early Parkinson’s disease (PD) and to explore whether these markers contribute to motor and non-motor symptoms. We collected serum from patients with early PD (n = 58) and from healthy control subjects (n = 20). The following inflammatory markers were measured: interleukin (IL)-1β, IL-2, IL-6, IL-10, tumor necrosis factor-α, and high-sensitivity C-reactive protein. The Movement Disorders Society Unified Parkinson’s Disease Rating Scale part 3 and Hoehn and Yahr stage were used to assess motor symptoms, and the Non-motor Symptoms Scale, the Cross-Cultural Smell Identification Test, the Montreal Cognitive Assessment, and the Composite Autonomic Symptom Score 31 (COMPASS-31) were used to assess non-motor symptoms. The levels of IL-1β, IL-2, and IL-6 were higher in the PD group than in the control group. However, only IL-1β among those markers remained significant after Bonferroni correction (P = 0.024). In the PD group, the anti-inflammatory cytokine IL-10 levels correlated positively with the COMPASS-31 score (r = 0.277, P = 0.035), whereas no correlation was found between the other inflammatory marker levels and motor or non-motor symptoms. Among the domains of the COMPASS-31, the IL-10 levels correlated only with the gastrointestinal domain (r = 0.358, P = 0.006). Our results suggest increased peripheral inflammation in the early stage of PD, but the role of inflammation in motor and non-motor symptoms is unclear. Although we found a correlation between IL-10 levels and gastrointestinal symptoms, this finding may simply reflect a protective response against inflammatory processes associated with the disease.

The Effect of Olfactory Training Using Korean Version Odorants: A Preliminary Study

Background and Objectives Several studies have reported the benefits of olfactory training (OT) for patients with olfactory dysfunction. However, training odorants should be customized according to the characteristics of individual patients. The aim of this study was to evaluate the effects of OT using odorants familiar to Korean patients with post-upper respiratory infection (URI) olfactory dysfunction. Subjects and Methods We prospectively evaluated patients with post-URI olfactory loss. We carried out OT over a period of 6 months using four odorants: pine, cinnamon, lemon, and peppermint. Olfaction was tested before and at 1, 3, and 6 months after training initiation using the following olfactory tests; Butanol threshold test (BTT), Cross-Cultural Smell Identification Test (CCSIT) and Visual Analog Scale (VAS), Nasal Obstruction Symptom Evaluation (NOSE) scale, Sino-Nasal Outcome Test (SNOT-20), and Beck Depression Inventory (BDI). Results Of the 88 patients who initially enrolled, 82 completed the BTT, CCSIT, VAS, NOSE, SNOT-20, and BDI. In total, 10 Korean patients were included in our analysis, nine of whom showed an improvement in olfaction after OT. All patients reported changes in olfaction and the perception of smells over the duration of OT. Some patients reported an increased sense of smell after OT, although he could not distinguish different smells. Conclusion OT using odorants specifically selected for Korean patients resulted in improved olfactory function, as indicated by the BTT and CCSIT scores. The findings of the present study suggest that customization of odorants to fit the characteristics of patients, including ethnicity, environment, and race, among others, increases the effectiveness of OT. Key words: Anosmia ㆍ Olfaction ㆍ Olfactory training ㆍ Regeneration ㆍ Smell

Reliability and validity of the Korean version of the Questionnaire of Olfactory Disorders.

The Questionnaire of Olfactory Disorders (QOD) is a self-report questionnaire that provides subjective information about olfactory dysfunction. The QOD is widely used in clinical practice because of its high level of reliability and efficacy in Western countries. In this study we evaluated the reliability and validity of the Korean version of the QOD. A total of 213 patients with subjective olfactory dysfunction completed 2 different surveys (the QOD and the 36-item Short-Form Health Survey [SF-36]). Patients' olfactory function was evaluated by a screening cross-cultural smell identification test or the Korean version of the Sniffin' Sticks (KVSS) II Test. The Korean version of the QOD was evaluated for split-half reliability and internal consistency. Criterion validity of QOD was determined by comparing with the SF-36. The split-half reliability was 0.967. Cronbach α coefficients for internal consistency of the QOD parosmia statements (QOD-P), QOD life quality statements (QOD-LQ), QOD sincerity statements (QOD-S), and QOD visual analog scale statements (QOD-VAS) were 0.705, 0.909, 0.243, and 0.953, respectively. There were statistically significant correlations between the SF-36 and the QOD-P, QOD-LQ, QOD-S, and QOD-VAS scores. There were no significant differences in QOD scores among patients with anosmia, hyposmia, and normosmia on the olfactory function test. Mean scores on the QOD-P, QOD-LQ, and QOD-VAS were significantly higher in 15 patients with normosmia on the olfactory function test when compared with 13 healthy controls. The Korean version of the QOD has proven to be a generally reliable and valid questionnaire to assess the degree of subjective olfactory dysfunction in the evaluation of Korean patients suspected of having olfactory dysfunction.

Olfactory dysfunction in Alzheimer's disease– and Lewy body–related cognitive impairment

IntroductionOlfactory dysfunction is common in Alzheimer's disease– and Lewy body–related disorders, but its neural correlates have not been clearly elucidated. MethodsWe retrospectively recruited 237 patients with Alzheimer's disease–related cognitive impairment (ADCI) and 217 with Lewy body–related cognitive impairment (LBCI). They were identically evaluated using the Cross-Cultural Smell Identification Test, neuropsychological tests, and brain magnetic resonance imaging. ResultsLBCI had more severe olfactory dysfunction than ADCI. Patients with more severe cognitive dysfunction had worse olfactory function in both groups. In ADCI, lower Cross-Cultural Smell Identification Test scores correlated with a lower cortical thickness in brain regions typically affected in Alzheimer's disease, most prominently in the right parahippocampal cortex, whereas in LBCI, the scores correlated with white matter abnormalities in regions vulnerable to Lewy body, including subcortical regions of the orbitofrontal and frontoparietal cortices. DiscussionOur results suggest that cortical atrophy in ADCI and white matter abnormalities in LBCI play important roles in olfactory dysfunction.

Can Tumor Size Be a Predictive Factor of Olfactory Dysfunction After Endoscopic Endonasal Trans-Sphenoidal Approach?

The aim of this study is to investigate the relationships between tumor size, nasal symptoms including olfactory function, and posoperative atrophic mucosal changes after the endoscopic endonasal transsphenoidal approach (EETSA). This was a retrospective review of the medical records of 112 patients who underwent the 2 nostrils/4 hands EETSA with bilateral modified nasoseptal rescue flaps between February 2009 and January 2016. Pre- and postoperative paranasal sinus computed tomography, nasal cavity endoscopic images, the Connecticut Chemosensory Clinical Research Center (CCCRC) test, Cross-Cultural Smell Identification Test (CCSIT), the Nasal Obstruction Symptoms Evaluation, and the Sino-Nasal Outcome Test-20 were conducted. Nasal mucosal changes as determined by endoscopy were divided into 4 groups: normal to normal, Group A; atrophy to atrophy, Group B; normal to atrophy, Group C; and atrophy to more atrophy, Group D. The Mimics program was used to calculate nasal cavity volume changes after surgery. There were significant differences between pre- and postoperative olfactory function as reflected by the CCCRC (P < 0.001) and CCSIT (P < 0.001) scores. There was also a correlation between tumor size and olfactory function scores such as the CCCRC (P = 0.012) or CCSIT (P = 0.015). Moreover, nasal mucosal atrophic changes were related to tumor size and olfactory function tests. The tumor size was related to olfactory function and atrophic mucosal changes. Therefore, patients with large tumors should be informed that, after the EETSA, their olfaction may be altered and that nasal symptoms related to mucosal atrophy could occur.

Early-onset drug-induced parkinsonism after exposure to offenders implies nigrostriatal dopaminergic dysfunction

ObjectivesThe onset of parkinsonism in patients with drug-induced parkinsonism (DIP) exhibits extensive individual variability following exposure to offending drugs. We investigated whether the individual variations in the onset time of...

OLFACTORY DYSFUNCTION IN ALZHEIMER- AND LEWY BODY-RELATED COGNITIVE IMPAIRMENT: DIAGNOSTIC IMPLICATION AND ASSOCIATION WITH COGNITION AND BRAIN ATROPHY

Olfactory dysfunction has been reported in Alzheimer's disease (AD) as well as in Lewy body-related cognitive impairment such as Parkinson's disease dementia (PDD) and dementia with Lewy bodies (DLB). We aimed to evaluate the association of olfactory dysfunction with cognition and cortical atrophy in patients with AD-related cognitive impairment (ADCI) and Lewy body-related cognitive impairment (LBCI). Olfactory function, detailed neuropsychological test, structural brain MRI were performed in 244 ADCI subjects without Parkinsonism (110 normal cognition (NC); 51 mild cognitive impairment (MCI); and 83 Alzheimer's disease dementia) and 341 LBCI subjects (118 NC; 153 MCI; and 70 dementia). There were 80 cases with mixed ADCI and LBCI but these cases were excluded in the current study. Olfactory function was assessed with the Cross-Cultural Smell Identification test (CCSIT). The association of CCSIT with cognitive performance and cortical thickness were evaluated using general linear models controlling for age, gender, education, and mini-mental state examination (MMSE) score separately in ADCI and LBCI groups. Patients with LBCI performed significantly worse on the CCSIT than that patient with ADCI (7.11 ± 2.53 vs. 7.96 ± 2.49, p < 0.001). CCSIT score was positively associated with confrontational naming test, delayed recall and recognition items of visual and verbal memory tests, semantic fluency tests, and Stroop color reading test scores in ADCI patients, while it was positively associated with confrontational naming test, recognition item of verbal-memory test, and delayed recall and recognition items of visual-memory test. Cortical thickness analyses revealed that lower CCSIT score was associated with cortical thinning in the bilateral medial and lateral temporal, prefrontal, and inferior parietal cortices with the most significant changes in the bilateral perirhinal cortices. On the contrary, in LBCI group, CCSIT score had no significant association with regional cortical thinning. Olfactory dysfunction was differentially associated with cognitive dysfunction and cortical thinning in ADCI and LBCI. These data indicate that olfactory dysfunction in ADCI and LBCI have different pathophysiologic correlates. Association of olfactory dysfunction with cortical thinning in LBCI and ADCI groups. Results of general linear models controlling for age, gender, education, intracranial volume, and mini-mental state examination score.

Endoscopic Endonasal Transsphenoidal Approach From the Surgeon Point of View.

In February 2009, the authors' center formed a team of neurosurgeons, otolaryngologists, endocrinologists, and radiologists to perform pituitary surgery using the endoscopic endonasal transsphenoidal approach (EETSA). This paper reviews the authors' experience with the technique, pathological outcomes, hormone profiles, and postoperative complications. Between February 2009 and December 2015, 535 patients underwent the EETSA with 2-nostrils/4-hands surgery. All of the patients had preoperative neurophthalmological and endocrinological assessments and neuroimaging. Patients were followed for at least 6 months with otolaryngological evaluations. The most common pathology treated was pituitary adenomas, with 390 (72.9%) patients. Of these, 287 (73.6%) were nonfunctioning adenomas. As the surgical method, the conventional 2-nostrils/4-hands technique was performed in 77 patients (14.4%), a right conventional nasoseptal flap and left modified nasoseptal rescue flap technique was used in 135 patients (25.2%), and bilateral modified nasoseptal rescue flaps were used in 323 patients (60.4%). Postoperative complications occurred in 46 patients (8.6%). The most common complications were vascular injury or hematoma (10 patients, 1.9%), and the most common postoperative sinonasal complaints were hyposmia or anosmia. Olfactory function was significantly decreased according to the Connecticut Chemosensory Clinical Research Center test (P <0.001) and Cross-Cultural Smell Identification Test scores (P <0.001) evaluated 6 months postoperatively. Skull-base tumor surgery via an EETSA with a team approach was performed for various extended tumors. It is important to consider postoperative sinonasal dysfunction, such as hyposmia or anosmia, and to have this followed by an otolaryngologist.

Correlation between olfactory severity ratings based on olfactory function test scores and self-reported severity rating of olfactory loss

Conclusion: Olfactory test scores are significantly correlated with self-rated severity scales. However, the statistical rating based on olfactory tests did not strongly agree with the self-reported severity rating. This suggests that there is a discrepancy between olfactory test results and the severity described by patients themselves.Objectives: This study aimed to identify the correlation between statistical ratings based on test scores and self-rating of the severity of olfactory loss.Method: A total of 1555 subjects were asked to rate olfactory loss severity by one of five scales. Olfactory tests consist of the butanol threshold test (BTT) and cross-cultural smell identification test (CCSIT).Results: There were significant correlations between BTT scores and self-rated severity scales (r = 0.619, p < 0.001) and between CCSIT scores and self-rated severity scales (r = 0.597, p < 0.001) after adjustment for age, sex, and medical conditions. Using discriminant analysis for both BTT and CCSIT, scores 0–4 could be statistically rated as anosmia, scores 5 and 6 as severe hyposmia, scores 7 and 8 as moderate hyposmia, and scores 9–12 as normosmia (Wilks’s lambda = 0.605, p < 0.001 for BTT and Wilks’s lambda = 0.597, p < 0.001 for CCSIT).

Prognosis of Olfactory Dysfunction according to Etiology and Timing of Treatment.

Objective We evaluated the severity of olfactory impairment according to risk factors, compared responses with risk factors and treatment timing, and investigated prognosis according to treatments. Study design Case series with chart review. Setting Tertiary referral center. Subjects and Methods We retrospectively reviewed medical records of patients complaining of loss of their sense of smell between January 2006 and May 2016. In total, 491 patients were included. We evaluated olfactory function using the Connecticut Chemosensory Clinical Research Center test (threshold test) and Cross-cultural Smell Identification Test. Results Post-upper respiratory infection patients showed better results than those with other risk factors (59.6% recovered). Patients with head trauma (12.5% recovered) and congenital olfactory dysfunction (0% recovered) showed poorer results. Earlier treatment showed better olfactory recovery outcomes for post-upper respiratory infection ( P = .001), head trauma ( P = .022), and nasal/sinus surgery ( P = .009). Xerostomia ( P = .73) and idiopathy ( P = .365) showed no significant difference in terms of treatment timing. The threshold test better reflected subjective recovery than the identification test. The systemic + topical steroid group and the systemic steroid treatment group both showed better smell recovery outcomes than the group with topical treatment alone (both, P < .001). However, there was no significant difference between the systemic treatment group and the systemic + topical treatment group ( P = .978). Conclusions Our findings suggest that the duration of smell loss is important for better olfactory outcomes with most etiologies. Also, the effects of systemic steroids were better than those of topical steroids, regardless of combined treatment.

Olfactory identification and white matter integrity in amnestic mild cognitive impairment: A preliminary study

Increasing evidence suggests that olfactory impairment is associated with an increased risk of conversion from mild cognitive impairment MCI to Alzheimer's disease. This study was to explore how olfactory identification relates to white matter WM integrity, using diffusion tensor imaging DTI in individuals with amnestic MCI. DTI was performed from nineteen individuals with amnestic MCI mean age: 69.95±8.20 years. Olfactory identification was assessed using the Cross-Cultural Smell Identification Test CC-SIT, a widely used test for odor identification involving a scratch and sniff test of 12 micro-encapsulated odorants. Cross-sectional voxel-wise analyses of relationships between CC-SIT scores and DTI indices were performed using Tract-Based Spatial Statistics. Higher CC-SIT scores were associated with lower mean, axial and radial diffusivities in areas such as the body and splenium of corpus callosum, frontal WM lateral orbitofrontal, caudal middle frontal, precentral, left superior frontal, and right pars opercularis, right superior longitudinal fasciculus, anterior and superior corona radiata, and internal and external capsules, while CC-SIT scores were not significantly associated with fractional anisotropy across all MCI participants. In individuals with amnestic MCI, impaired olfactory identification is associated with alterations in WM integrity expressed as a lower diffusivities value. This cross-sectional preliminary study suggests that olfactory impairment contributes to WM microstructural alterations in individuals with amnestic MCI. © 2016 Wiley Periodicals, Inc. Int J Imaging Syst Technol, 26, 270-276, 2016

The combined effect of REM sleep behavior disorder and hyposmia on cognition and motor phenotype in Parkinson's disease

BackgroundOlfactory dysfunction and REM sleep behavior disorder (RBD) are recognized as pre-motor symptoms of Parkinson's disease (PD). Cognitive dysfunction is observed at a high rate even in the early stages of PD as an important non-motor symptom. PD has been classified in different subtypes and it is unknown if olfactory dysfunction and RBD occur more often in one particular subtype. We investigated the relationship between olfactory impairment, RBD, initial cognitive performance and motor phenotype in PD. MethodNighty-eight patients with drug-naïve idiopathic PD who visited the Movement Disorders Unit of Korea University Guro Hospital, Seoul, Korea from March 2012 to February 2014 were retrospectively included. Patients were divided into tremor-dominant-type and akinetic-rigid-type PD subgroups using part III of the Unified Parkinson's Disease Rating Scale. Olfaction was assessed by the Cross Cultural Smell Identification Test. RBD was screened using screening questionnaires. Initial cognitive function was assessed with Mini–Mental State Examination. ResultThe PD-normosmia group had higher MMSE scores (p=0.008). PD patients who have both RBD and olfactory dysfunction had lower MMSE scores (p=0.013). Presence of both RBD and hyposmia in PD patients was more strongly correlated with poor cognitive dysfunction. PD patients with RBD and/or hyposmia primarily exhibited the akinetic-rigidity phenotype. ConclusionOlfactory dysfunction and RBD differed according to the motor phenotypes of PD. This suggests that olfactory dysfunction and RBD might relate to prognosis in patients with PD. Patients who have both hyposmia and RBD were more likely to exhibit cognitive dysfunction.

Intranasal Volume Changes Caused by the Endoscopic Endonasal Transsphenoidal Approach and Their Effects on Nasal Functions.

ObjectiveWe evaluated postoperative changes in nasal cavity volume and their effects on nasal function and symptoms after endoscopic endonasal transsphenoidal approach for antero-central skull base surgery.Study DesignRetrospective chart review at a tertiary referral center.MethodsWe studied 92 patients who underwent binostril, four-hand, endoscopic endonasal transsphenoidal approach surgery using the bilateral modified nasoseptal rescue flap technique. Pre- and postoperative paranasal computed tomography and the Mimics® program were used to assess nasal cavity volume changes at three sections. We also performed several pre- and postoperative tests, including the Connecticut Chemosensory Clinical Research Center test, Cross-Cultural Smell Identification Test, Nasal Obstruction Symptoms Evaluation, and Sino-Nasal Outcome Test-20. In addition, a visual analog scale was used to record subjective symptoms. We compared these data with the pre- and postoperative nasal cavity volumes.ResultsThree-dimensional, objective increases in nasal passage volumes were evident between the inferior and middle turbinates (p<0.001) and between the superior turbinate and choana (p = 0.006) postoperatively. However, these did not correlate with subjectively assessed symptoms (NOSE, SNOT-20 and VAS; all nasal cavity areas; p≥0.05) or olfactory dysfunction (CCCRC and CCSIT test; all nasal cavity areas; p≥0.05).ConclusionSkull base tumor surgery via an endoscopic endonasal transsphenoidal approach altered the patients’ nasal anatomy, but the changes in nasal cavity volumes did not affect nasal function or symptoms. These results will help surgeons to appropriately expose the surgical field during an endoscopic endonasal transsphenoidal approach.

Anatomic Changes Caused by Endoscopic Endonasal Transsphenoidal Surgery and Their Effects on Nasal Functions.

We evaluated postoperative changes in nasal cavity dimensions and their effects on nasal functions and symptoms. Case series with chart review. Tertiary referral center. We studied patients who underwent binostril, 4-hand endoscopic endonasal transsphenoidal approach surgery with the bilateral modified nasoseptal rescue flap technique. Pre- and postoperative paranasal computed tomography scans were used to assess nasal cavity dimensional changes at 4 levels. We also performed several pre- and postoperative tests, including the Connecticut Chemosensory Clinical Research Center test and the Cross-Cultural Smell Identification Test (n = 119) to evaluate olfactory functions. Also, the Nasal Obstruction Symptoms Evaluation, the Sino-Nasal Outcome Test-20, and a visual analog scale were used (n = 157) to record subjective symptoms. We compared these data with the pre- and postoperative nasal cavity dimensions. Two-dimensional objective increases in nasal passage dimensions were evident postoperatively (all cross-sectional areas, P < .001, except choana and left inferior turbinate). However, these did not correlate with subjectively assessed symptoms (Nasal Obstruction Symptoms Evaluation, all cross-sectional areas, P ≥ .05, except right middle turbinate; Sino-Nasal Outcome Test-20, all cross-sectional areas, P ≥ .05) or olfactory dysfunction evaluated with the Connecticut Chemosensory Clinical Research Center test (all cross-sectional areas, P ≥ .05) or the Cross-Cultural Smell Identification Test (all cross-sectional areas, P ≥ .05). Endoscopic endonasal transsphenoidal approach surgery altered the patients' nasal anatomy, but the changes in nasal cavity dimensions did not affect nasal functions and symptoms. These results will help surgeons to appropriately expose the surgical field during endoscopic endonasal transsphenoidal approach surgery.

Effect of olfactory impairment and white matter hyperintensities on cognition in Parkinson's disease

IntroductionAlthough white matter hyperintensities (WMH) and olfactory dysfunction are independently associated with the cognitive impairments in Parkinson's disease (PD), the effects of simultaneous presence of these abnormalities remain unknown. Thus, we investigated the different effects of deep WMH and periventricular WMH on olfactory and cognitive performance and evaluated the additive effects of the concurrent presence of WMH and olfactory dysfunction on cognitive performance in PD. MethodsWe enrolled 171 patients with non-demented PD whose WMH scores were assessed using a semi-quantitative visual rating system. The olfactory and cognitive performance was assessed using the Cross-Cultural Smell Identification (CCSI) test and the Seoul Neuropsychological Screening Battery. Additionally, the additive effects of concurrent WMH and olfactory dysfunction on cognitive performance were investigated using binary logistic regression. ResultsThe deep WMH score exhibited a significant negative correlation with the CCSI score (p = 0.026) but the total WMH and periventricular WMH did not. A multiple regression analysis revealed that the total WMH (β = −0.109, p = 0.011) and deep WMH (β = −0.153, p = 0.020) severities had significant negative correlations with semantic fluency. A logistic regression analysis revealed that the simultaneous presence of severe olfactory dysfunction and deep WMH was associated with a greater risk for the semantic fluency impairments (odds ratio = 15.909, p = 0.0005) compared to patients with mild deep WMH or high CCSI scores. ConclusionsThese data indicate that deep WMH was closely coupled with olfactory impairments and cognitive decline in PD. Moreover, the concurrent presence of severe deep WMH and olfactory impairments has a greater influence on semantic fluency.

Endoscopic Modified Transseptal Transsphenoidal Approach for Maximal Preservation of Sinonasal Quality of Life and Olfaction

Patients experience significant postoperative sinonasal symptoms for the first few months after endoscopic transnasal transsphenoidal approach (ETN-TSA) surgery. We modified this technique by bypassing the nasal mucosa and approaching through the septum bilaterally. In this study, we analyze whether these technical modifications, which we have termed the endoscopic modified transseptal transsphenoidal approach (EMTS-TSA), decrease postoperative sinonasal morbidity after endoscopic TSA. We retrospectively reviewed a prospectively collected database. Patients who underwent endoscopic TSA from December 2012 to June 2014 were included. Thirty patients underwent ETN-TSA, and 51 underwent EMTS-TSA. Sino-Nasal Outcome Test-20, anterior skull base nasal inventory, and visual analog scale (VAS) for subjective olfaction were evaluated before and 1 and 3 months after surgery. Cross Cultural Smell Identification Test also was measured before and 3 months after surgery. There was a significant difference between the preoperative and 3-month VAS for olfaction in the ETN-TSA group (from 92.5 to 81.3; P = 0.002) but not the EMTS-TSA group (from 90.6 to 88.8; P = 0.403). There was no statistical difference in Sino-Nasal Outcome Test-20 or Cross-Cultural Smell Identification Test scores between 2 groups during follow-up. The EMTS-TSA group scored better than the ETN-TSA group in the anterior skull base nasal inventory subdomain ("nasal discharge," "urge to blow," and "trouble breading") 1 month postoperatively. EMTS-TSA could preserve almost all nasal mucosa, including the septum and turbinates. EMTS-TSA may be useful for preserving early postoperative olfactory function and some sinonasal quality of life. We believe that EMTS-TSA is a good endoscopic pituitary surgery option.

Olfactory function and neuropsychological profile to differentiate dementia with Lewy bodies from Alzheimer's disease in patients with mild cognitive impairment: A 5-year follow-up study

BackgroundMild cognitive impairment (MCI) is a well-known precursor of Alzheimer's disease (AD) but often also precedes dementia with Lewy bodies (DLB). The early differentiation of DLB from AD is important to delay disease progression. Olfactory dysfunction is a well-known early sign of both AD and Lewy body disorders, including Parkinson's disease (PD) and DLB. Thus, the aim of the present study was to determine whether olfactory and neuropsychological tests can aid in the differentiation of DLB from AD at the MCI stage. MethodsThe present study included 122 MCI patients who were monitored until they developed dementia or until their condition stabilized; the follow-up period averaged 4.9years (range: 3.9–6.2years). Baseline olfactory function as measured with the Cross-Cultural Smell Identification (CCSI) test and neuropsychological data were compared. ResultsDuring the follow-up period, 32 subjects developed probable AD (MCI-AD), 18 had probable DLB (MCI-DLB), 45 did not convert to dementia (MCI-stable), and eight developed a non-AD/DLB dementia. The mean CCSI score (95% confidence interval [CI]) in patients with MCI-DLB (4.6; 95% CI: 4.0–5.3) was significantly lower than that of MCI-AD patients (6.4; 95% CI: 6.0–6.7, p<0.001) and MCI-stable patients (7.3; 95% CI: 6.9–7.8, p<0.001). The area under the curve of the receiver operating characteristic to discriminate MCI-DLB from MCI-AD using CCSI scores was (0.84; 95% CI: 0.72–0.97). Frontal-executive function and visuospatial ability was worse in patients with MCI-DLB, while verbal recognition memory impairment was greater in those with MCI-AD. ConclusionOlfactory and neuropsychological tests can help predict conversion to DLB or AD in patients with MCI.

Apathy and olfactory dysfunction in early Parkinson's disease.

ObjectiveOlfactory and emotional dysfunctions are very common in patients with Parkinson’s disease (PD). Olfaction and emotions share common neuroanatomical substrates. Therefore, in this study, we evaluated the association between olfactory and emotional dysfunctions in patients with PD.MethodsParkinson’s disease patients who had been assessed for their olfactory function and neuropsychiatric symptoms including emotional dysfunction were included. A logistic regression analysis was performed to evaluate the association between low olfaction and different neuropsychiatric symptoms.ResultsThe patients with low olfaction (cross cultural smell identification test score ≤ 6) showed a higher prevalence of apathy when compared with those with high olfaction, whereas the frequencies of other neuropsychiatric symptoms were comparable between the two groups. A multivariate logistic regression analysis revealed that the presence of apathy/indifference [odds ratio (OR) = 2.859, p = 0.007], age 70 years or more (OR = 2.281, p = 0.009), and the male gender (OR = 1.916, p = 0.030) were significantly associated with low olfaction.ConclusionsOur results demonstrate that apathy/indifference is a unique emotional dysfunction associated with olfactory dysfunction in PD. The findings also suggest that PD patients with low olfaction have a high prevalence of apathy.