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The University of Pennsylvania Smell Identification Test: normative adjustment for Australian subjects
Abstract
Clinical assessment of olfactory function is not standardised in Australia. Olfactory function is more often tested qualitatively, with no reference to quantitative norms. This practice leads to misdiagnosis, considering the well established differences in olfactory abilities with sex and age. Published norms for the University of Pennsylvania Smell Identification Test (UPSIT), a standardised test of olfactory function, are based upon North American subjects but their utility has not been shown when used for Australian subjects. We matched the scores of Australians tested with the North American English version of the UPSIT with scores of a group of North Americans matched on the basis of race, gender, age and smoking habits. On average, the Australians performed two points lower than the North Americans, suggesting that a test score correction of two points is appropriate when the North American English version of this test is used in Australia. Yes Yes
... On the other hand, the score in our sample of Egyptian population is lower than the mean score in American and Australian populations when tested using the original version (mean=36 and 34, respectively). [10] This score is lower than the mean score in the Brazilian, Taiwan, and Japanese populations (mean = 35, 33.1 and 34.9, respectively), obtained when tested using the modified versions of UPSIT. [11][12][13] This finding proposes the fact that the used odors to fit the cultural nature of Arab population are not totally appropriate for this purpose. ...
... Participants with high and moderate socio-economic standard reported significantly higher UPSIT than those with low socio-economic standard. This was against the results of Fornazieri et al [10] who assessed the validity of UPSIT in a sample of Brazilian population. They graded their sample according to income levels. ...
Objective:
To assess the validity of the Arabic version of the University of Pennsylvania Smell Identification Test in the Egyptian population.
Patients and Methods:
This was a cross sectional study including 124 normal Egyptian subjects. Socioeconomic standard was assessed, and patients were categorized into three categories; low, moderate and high socioeconomic levels. The total number of correct answers for the 40 odorants presented was used to determine the test score. The difficulty level of the test was checked by a visual analogue scale. The percentage of the study sample detecting every odor was calculated. Internal consistency of the test was checked by cronbach's alpha test.
Results:
The study group included 87 females and 37 males with a mean age of 29.28 ±5.92 years. The average smell identification test score for all participants was 31.49 ± 1.74. The average visual analog scale score for ease of applicability of the test was 7.13 ± 0.58 with no significant difference between males and females. The smell identification test score was higher among males than females with little significance. Participants with high and moderate socio-economic standards reported significantly higher test score. Thirty-one odors were correctly identified by at least 70% of the volunteers, Overall alpha was 0.749.
Conclusion:
The Arabic version of University of Pennsylvania Smell Identification Test is an adequate tool for assessment of olfaction in the Egyptian population. But 9 Odorants of this test needs further revision. Males and higher socioeconomic levels were associated with better test results
... A team of 20 trained research specialists administered a 37-item questionnaire detailing basic health and demographic information and a Brazilian version of the UPSIT to the subjects. The UPSIT, a 40-item odor-microencapsulated odor identification test described in detail elsewhere (Doty 1995;Mackay-Sim and Doty 2001), is widely used throughout the world and has been translated into more than a dozen languages. From the original English version, a total of 8 odorants were changed in the first phase of validation. ...
... It is remarkable that the degree of correction needed across different age groups is relatively small and quite similar, ranging from 0.5 UPSIT points in younger women to 2.5 points for men 60 years of age or older. Similarly small correction factors have been employed in Taiwan and Australia to allow for the use of North American norms (Mackay-Sim and Doty 2001;Jiang et al. 2010). Such correction factors make it possible to compare the results among subjects from different cultures on a common normative metric. ...
It is well established that olfactory dysfunction has significant implications for safety, nutrition, and quality of life. The more reliable standardized tests of olfactory function, such as the University of Pennsylvania Smell Identification Test (UPSIT), assess odor identification ability. Unfortunately, cultural factors can influence such tests, as a number of odors are not universally recognized. In this study, a Portuguese language version of the UPSIT was administered to an age- and sex-stratified prospective sample of 1820 Brazilian subjects. Normative data were developed for a subset of 1578 subjects who reported having no difficulties smelling or tasting. Individuals with a history of head trauma or, in the case of those over the age of 64 years, Mini-Mental State Examination Scores <24, were excluded from analysis. As in other populations, the test scores were significantly influenced by age and sex. The median overall difference between the North American and Brazilian UPSIT scores was 2.2 points for men and 0.8 points for women, although subtle age-related differences were also apparent. This research represents that largest clinical study of olfaction ever performed in South America. Correction factors based upon age and sex are provided to allow for direct comparisons of Brazilian test scores to those based upon North American norms.
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... For example, researchers in a pilot study in Taiwan made changes to several UPSIT odors and response alternatives, which markedly and effectively increased the test scores, although some items still caused the total test score to be lower than that observed in the U.S. population (10). In Australia, Mackay-Sim et al. (11), without changing any odors, substituted some alternatives and evaluated the performance of Australians on the test. Even with this adaptation, patients with normal smelling ability had average scores lower than those of the U.S. population. ...
... We examined whether individuals from different economic strata perform differently on the test. The ultimate goal of our ongoing program, of which this study is a part, is to develop a Brazilian Portuguese UPSIT with scores that can be directly classified on the basis of North American norms (2) and without a correction factor (11). ...
The University of Pennsylvania Smell Identification Test, a test of olfactory function that is widely used by otolaryngologists, geriatricians, and neurologists, has been translated into more than a dozen languages. In some instances, cultural and socioeconomic factors have necessitated changes in the odorant items or the response alternatives to make the test scores congruent with North American norms. The objective of this study was to compare the performance of Brazilian subjects on a new Portuguese language version of the University of Pennsylvania Smell Identification Test with their performance on an earlier Portuguese language version of the test, as well as to assess the influences of gender, age, ethnicity, and economic status on the test scores.
Based on pilot data, several response alternatives of the earlier Portuguese language version of the test were altered in an effort to improve test performance. Forty-nine healthy Brazilian volunteers, who represented several economic classes, were tested. The test scores of the study cohort who received the newer version of the test were compared with those of a group of 25 subjects who received the earlier version of the test.
The mean score for the new version [35 (2.1)] was significantly (p = 0.002) higher than that for the earlier version [32.5 (3.5)]. Although no apparent influence of socioeconomic status was observed, the female participants outperformed the male participants in the current subject cohort.
The changes made in the new cultural adaptation of the Portuguese version of the University of Pennsylvania Smell Identification Test were effective in increasing the average test scores of the participants. Overall, the female subjects outperformed the male subjects on the test.
... because it is not common in the routine diet in Brazil when compared to North America or other countries. 24 The medical team responsible for the test replaced every substance each two or three months, in order to prevent a decrease in the odorant sample because of low humidity or regular use. ...
Introduction
Assessing olfactory perception in olfactory disorders is of utmost importance in therapy management. However, the University of Pennsylvania smell identification test and the sniffin’ sticks are the only tests validated in Brazil.
Objectives
To evaluate the correlation and agreement between the Connecticut chemosensory clinical research center test and the brief-smell identification test – University of Pennsylvania smell identification test - in healthy participants and in participants with olfactory disorders based on the results and technical aspects of both tests.
Methods
Fifty participants without olfactory complaints and 50 participants with olfactory disorders who underwent the Connecticut chemosensory clinical research center test and the brief-smell identification test were included. The following tests were used for statistical analysis: Mann-Whitney U test, Spearman’s correlation, intraclass correlation coefficient and Bland-Altman plot. An alpha error (significance level) of 0.05 was considered in the statistical analysis.
Results
Both tests were effective in distinguishing the groups without the presence of overlapping values for the measured markers. Additionally, there was a strong correlation between Spearman’s correlation and intraclass correlation coefficient between the tests and for both nostrils. However, the correlations were lower when the groups were individually evaluated. The Bland-Altman plot showed no bias when all participants were simultaneously evaluated.
Conclusions
The tests to assess olfactory perception presented a high level of agreement. In our sample, we could infer that the Connecticut chemosensory clinical research center is similar to the brief-smell identification test and can be used in the routine diagnosis of patients with complaints of olfactory disorders, considering the advantage of its low cost.
... The UPSIT was primarily developed to assess olfactory function within the US population and is not applicable without prior adaptation to culturally distinct populations. Since its introduction in the early 80s, a number of culturally adapted versions of UPSIT have been developed (Mackay-Sim and Doty 2001;Ogihara et al. 2011;Altundag et al. 2015;Fornazieri et al. 2015;Hsu et al. 2015). However, no standardized test for olfactory evaluation in Russian population exists at the moment. ...
... Doserelated decrements in olfactory function have been found in cigarette smokers [18,27]. Cultural factors, such as familiarity with certain odorants, can influence scores on some olfactory tests, most notably odor identification tests [14,15,25,31]. There is evidence that environmental and social living factors, including high levels of air pollution in urban areas such as Mexico City, can influence the ability to smell [5,22]. ...
Socioeconomic status can significantly impact health. To what degree education and other socioeconomic factors influence the chemical sense of olfaction is not clear. Most studies that have assessed such influences come from countries lacking large disparities in education and income and generally view such measures as nuisance variables to be controlled for statistically. In this study, we evaluated the influences of education and income on odor identification in a diverse sample of subjects from Brazil, a society where large disparities in both income and education are present. The 40-item University of Pennsylvania Smell Identification Test (UPSIT) was administered to 1572 healthy Brazilian citizens with no self-reported olfactory or gustatory deficits and for whom detailed socioeconomic and educational status data were obtained. Univariate and multivariate models were employed to examine the influence of socioeconomic status on the test scores. After controlling for age, sex, ethnicity, and smoking behavior, income and educational level were positively and independently related to the olfactory test scores (respective ps < 0.001 & 0.01). Both linear and quadratic functions described the relationship between the UPSIT scores and the levels of education and socioeconomic status. Individuals of lower socioeconomic status performed significantly worse than those of higher socioeconomic status on 20 of the 40 odorant items. This study demonstrates socioeconomic status is significantly associated with influence the ability to identify odors. The degree to which this reflects differential exposures to xenobiotic agents, cultural differences, familiarity with odors or their names, cognitive development, or other factors requires further investigation.
... Although due to cultural differences in odor perception, this test is impossible to be mechanically transferred to a different culture. UPSIT has already been successfully adapted in several countries including Brazil, Japan, Australia, and Taiwan (Mackay-Sim and Doty, 2001;Ogihara et al., 2011;Fornazieri et al., 2015;Hsu et al., 2015). Development of a national version of the test is essential for both medical practice and fundamental research. ...
We have tested the original version of the University of Pennsylvania Smell Identification Test (UPSIT) on a population of Central Russia including groups of different ages residing in the city area and in the rural part of the country. Our results demonstrate that the UPSIT is applicable for evaluation of olfactory function within the population of Central Russia and allows us to detect age-related differences in olfactory function. However, several odor samples presented within the original UPSIT proved to be unfamiliar to the subjects due to cultural differences. We have identified and tested odor items that may replace poorly recognizable items of the original UPSIT. Thus, we have developed a culturally adapted version of the UPSIT to be used within the population of Central Russia.
... Nevertheless, some items still caused the total test score to be lower than that observed in the U.S. population [19]. In Australia, researchers suggested adding a correction factor of two points to total scores [20]. In Brazil, a cultural adaptation of the UPSIT Portuguese translation was effective in increasing average scores. ...
Objective
The aim of this study is to determine the usefulness of the University of Pennsylvania Smell Identification Test (UPSIT), Sniffin Sticks (SS-16) and Brief Smell Identification Test (B-SIT) to assess smell identification in the Mexican population and its accuracy in discriminating subjects with Parkinsońs disease (PD).
Methods
We included 199 nondemented PD subjects and 199 control subjects matched by gender. Smell identification was tested using the UPSIT and SS-16. Our group obtained B-SIT data from a previous report.
Results
The mean number of UPSIT items correctly identified by controls was 27.3 ± 6; the PD group had a mean score of 19.4 ± 6. UPSIT had a sensitivity of 82% with a specificity of 66% for a cut-off score of ≤ 25 for detection of PD. The mean number of SS-16 items correctly identified by controls was 10.3 ± 2.2, while the PD group had 7.4 ± 2.8 correct answers. For SS-16, sensitivity was 77.8% and specificity of 71.2% when using a cut-off value of ≤ 9. Lemon, turpentine and rose had an identification rate below the 25th percentile for all three tests. Odors with an identification rate above the 75th percentile include banana for all three tests, and gasoline, onion and chocolate for UPSIT and B-SIT.
Conclusion
The sensitivity and specificity of the smell tests that were evaluated were lower in comparison to other published reports. Cultural biases and smell familiarity may influence the test results. The development of a true cross-culturally adapted smell identification test is warranted may improve test accuracy.
... Countries such as Brazil and Australia have developed their own normative data. [39][40][41] In other parts of the world, olfactory testing is also being performed, sometimes with one of the tests noted previously and sometimes with locally designed tests. 42 In Japan, the standard test is the T&T olfactometer, which is a rack containing 8 concentrations of 5 different odorants. ...
Olfaction and taste promote satisfaction and protection in daily life. The astute facial plastic surgeon recognizes the importance of a baseline smell test to document the patients' olfactory status before surgery. After surgery, the surgeon must be alert to the possible mechanisms of hyposmia and anosmia and the pertinent treatment strategies. The surgeon must also understand the importance of counseling the patient and family regarding the cause of the dysfunction and the proper treatments. This article updates the facial plastic surgeon on the importance of smell and taste and associated disorders with a current review of the literature.
... Second, the effect observed in the MDNT patients in terms of poorer detection accuracy for the olfactory stimuli was unaffected by including the BSIT as a covariate. While BSIT scores here were lower than one might expect in all groups, which may be partially accounted for by cultural differences in experience and naming that are known to differ between US and Australians on the SIT (Mackay-Sim & Doty, 2001), the BSIT should still accurately index relative performance deficits within the sample. If MDNT participants had simply been unable to smell these stimuli, then employing the BSIT as a covariate should have reduced or eliminated the Group difference, yet it did not. ...
Olfactory attention may be important in generating odor-induced tastes - an arguably universal form of synesthesia - by ensuring that the taste concurrent is captured by the nose and olfaction, not by the mouth and gustation (oral-capture). To examine the role of olfactory attention in generating odor-induced tastes and oral capture we tested a small sample (n=4) of participants with likely impairments in olfactory attention - individuals with mediodorsal thalamic nucleus (MDNT) lesions. These participants were compared to two sets of controls on tests of olfactory attention, oral capture, odor and flavor perception, and control tasks. MDNT participants demonstrated impaired olfactory attention and enhanced oral capture. Greater oral capture was associated with greater olfactory attentional impairment. These findings imply that olfactory attention may be important in attributing odor-induced tastes to the olfactory modality. However, unlike for visual binding and for the neurodevelopmental synesthesias, where attention may be necessary to demonstrate both phenomena, olfactory attention deficits did not impair flavor binding or the experience of odor-induced tastes.
... Na maioria dos casos, quando se avalia o sentido do olfato, pede-se somente para o paciente identificar odores como café, amônia, chocolate, laranja, etc. Essa análise constitui apenas parte da avaliação qualitativa, faltando outros critérios, como o limiar de identificação, para a distinção entre os diferentes déficits olfatórios. 1 O teste de identificação de olfato da Universidade da Pensilvânia (SIT), composto de 40 odores diferentes, é um método rápido, autoadministrável e de fácil aplicação para se avaliar quantitativamente a função olfatória humana, além de apresentar uma alta confiabilidade teste-reteste (r=0,94). 2 Outro ponto forte deste teste é que provê um diagnóstico olfatório comparando o escore obtido pelo paciente com o de pessoas de mesmo sexo e faixa etária de sua população 5 . ...
The University of Pennsylvania Smell Identification Test (SIT) is the most cited olfactory test in the literature because it is easy to perform and there is high test-retest reliability. There were no standardized olfaction values in a normal Brazilian population.
To measure the SIT score in a group of Brazilians, and to assess the level of difficulty when implementing the test.
A cross-sectional study.
The SIT was applied in 25 Brazilian volunteers of various income levels who presented no olfactory complaints. Following the test, subjects answered a questionnaire with a visual analog scale (VAS) for the level of difficulty.
The mean in the sample of Brazilians was 32.5 (SD: 3.48) our of 40; this is below what is considered normal for US citizens. The level of difficulty was on average 26 mm (SD: 24.68) in the VAS, but it trended towards easy; 4(16%) participants did not recognize some of the odors under 'alternatives'.
In this pilot study, there was evidence of good test applicability; the score of the sample of Brazilians was just below normosmia. Further studies are needed to confirm the existence of differences between people of different income levels.
... Olfactory identification ability was measured with the University of Pennsylvania Smell Identification Test (15), a standardized, self-administered multiple-choice scratch-and-sniff test consisting of four booklets, each containing 10 items. This test has been normatively adjusted for Australian samples (16). Estimated premorbid IQ was assessed with the Australian-adjusted version of the National Adult Reading Test (17). ...
Previous investigation has revealed stable olfactory identification deficits in neuroleptic-naive patients experiencing a first episode of psychosis, but it is unknown if these deficits predate illness onset.
The olfactory identification ability of 81 patients at ultra-high risk for psychosis was examined in relation to that of 31 healthy comparison subjects. Twenty-two of the ultra-high-risk patients (27.2%) later became psychotic, and 12 of these were diagnosed with a schizophrenia spectrum disorder.
There was a significant impairment in olfactory identification ability in the ultra-high-risk group that later developed a schizophrenia spectrum disorder but not in any other group.
These findings suggest that impairment of olfactory identification is a premorbid marker of transition to schizophrenia, but it is not predictive of psychotic illness more generally.
Dans cette thèse nous avons créé un test olfactif et vérifié son utilité pour dépister des troubles en lien avec la pathologie d'Alzheimer ou celle de l'apathie, ou encore dans la COVID-19.Après avoir recueilli l'avis des cliniciens et les recommandations des experts chimistes, nous avons ensuite sélectionné quatorze odeurs, mis au point un test olfactif informatisé qui permet d'obtenir automatiquement le score de seuil de perception et d'identification. Ce travail a permis le dépôt d'un Brevet d'invention pour le "Test Olfactif de Dépistage de la maladie d'Alzheimer et de l'apathie", ou TODA.Nous avons vérifié l'intérêt du TODA en pratique de soins courants dans l'aide au diagnostic de la maladie d'Alzheimer auprès de malades d'Alzheimer en contrôles sains, en France et au Québec. Les scores olfactifs différenciaient très significativement les sujets et étaient corrélés à la mesure cognitive globale. Le TODA permettait aussi de repérer une identification des odeurs différente en fonction de la culture et de la pathologie.Dans une population de sujets présentant un Trouble Cognitif Mineur avec ou sans apathie, les résultats au TODA permettaient de différencier les sujets très significativement, notamment dans la sous-dimension sociale des critères de l'Apathie.Auprès de sujets présentant une post-infection à la COVID-19, le TODA a été utilisé en parallèle du Sniffin'Sticks Test, gold-standard actuel, pour vérifier la validité des résultats du TODA. Le TODA a aussi permis de mettre en évidence des confusions d'odeurs proches, révélant une atteinte de leurs propriétés olfactives. Son utilisation en cas de suspicion d'atteinte sémantique associée a elle aussi été concluante.La comparaison des scores obtenus au TODA par les sujets MA et par les sujets post-COVID-19 a révélé que les résultats étaient similaires. Seule l'étude des odeurs les plus significatives a permis de faire la différence entre les deux pathologies.
Olfactory identification disorder is regarded as an early marker of Alzheimer’s disease (AD) and of similar diagnostic significance of biological or cognitive markers. Premature damage of the entorhinal olfactory cortex, the hippocampus and the orbitofrontal cortex characterize AD and suggest a specific impairment of olfactory identification. The use of psychophysical olfactory identification tests in clinical diagnostic practice is therefore strongly recommended, but not required. As these widespread tests are rarely used, an innovative test, adapted to this target group has been developed. It has been used and validated in a routine care protocol at different Memory Centers in France and in Quebec, Canada. A total of 157 participants were recruited: including 63 Alzheimer’s patients and 94 healthy controls. The test was composed of 14 odorants diluted into 4 different concentrations. A computer interface generated randomization of 6 odors per participant and the automatic calculation of identification scores, of perceptual thresholds and of composite scores. All participants underwent a Mini Mental Scale Examination within the previous three months or on the same day of the olfactory test. The Alzheimer’s patients had a score between 20 and 30 and healthy controls participants had a score above 28 without any loss of points on recalled items. The results show that our olfactory identification test is able to significantly differentiate Alzheimer’s patients from healthy controls (p < 0.001), and to distinguish the French population tested from the Quebec population (p < 0.001). This study highlights an olfactory identification disorder as a target for early diagnosis of AD. Its cultural qualities make it a potential candidate for differentiated calibration between France and Quebec.
Résumé
Buts
Les « Sniffin’ Sticks test » sont largement utilisés en Europe afin d’évaluer la fonction olfactive. Plusieurs versions culturellement adaptées ont été développées. Néanmoins, il n’existe pas à l’heure actuelle de version adaptée à des populations africaines sub-sahariennes. Les buts de cette étude étaient (1) d’évaluer l’applicabilité du Sniffin’ Sticks test pour évaluer la population du Sud-Kivu, et (2) de développer une version culturellement adaptée, et d’en établir des valeurs normatives.
Matériel et méthodes
Dans une première étude, nous avons évalué 157 volontaires à l’aide de la version originale du Sniffin’ Sticks test. Sur base de ces résultats, nous avons sélectionné les odorants dont le taux d’identification était faible et les avons remplacés par des odeurs culturellement adaptées. Dans une seconde étude, 150 volontaires ont été évalués avec cette version modifiée et nous en avons défini les valeurs normatives.
Résultats
La première étude a montré que le score TDI diminue significativement avec l’âge et est meilleur chez les femmes. De plus, 5 odeurs avaient un faible taux d’identification et ont donc été remplacées par des odeurs culturellement adaptées. La seconde étude a montré que cette version adaptée avait un meilleur taux d’identification. Nous avons pu définir des valeurs normatives pour la population du Sud-Kivu (score TDI : 18–35 ans : 30,4 ± 6,0, 36–55 ans : 26,2 ± 5,3, > 55 ans : 25,6 ± 5,0).
Conclusion
Nous avons développé une version du Sniffin’ Sticks test culturellement adaptée à la population du Sud-Kivu. Les valeurs normatives établies serviront de base pour l’évaluation clinique de populations pathologiques.
Impaired olfactory identification has been reported as a first sign of schizophrenia during the earliest stages of illness, including before illness onset. The aim of this study was to examine the relationship between volumes of these regions (amygdala, hippocampus, gyrus rectus and orbitofrontal cortex) and olfactory ability in three groups of participants: healthy control participants (Ctls), patients with first-episode schizophrenia (FE-Scz) and chronic schizophrenia patients (Scz). Exploratory analyses were performed in a sample of individuals at ultra-high risk (UHR) for psychosis in co-submission paper (Masaoka et al., 2020). The relationship to brain structural measures was not apparent prior to psychosis onset, but was only evident following illness onset, with a different pattern of relationships apparent across illness stages (FE-Scz vs Scz). Path analysis found that lower olfactory ability was related to larger volumes of the left hippocampus and gyrus rectus in the FE-Scz group. We speculate that larger hippocampus and rectus in early schizophrenia are indicative of swelling, potentially caused by an active neurochemical or immunological process, such as inflammation or neurotoxicity, which is associated with impaired olfactory ability. The volumetric decreases in the chronic stage of Scz may be due to degeneration resulting from an active immune process and its resolution.
Aim:
The "Sniffin' Sticks" test is widely used in Europe as a standard test to assess olfaction. Several culturally-adapted versions have been developed. However, no version adapted to Sub-Saharan African populations exists. The aims of the present study were (1) to assess the applicability of the Sniffin' Sticks test in the population of South Kivu (DR Congo), and (2) to develop a culturally adapted version with normative values.
Materials and methods:
In a first study, 157 volunteers were tested with the original Sniffin' Sticks test. Based on these results, we selected odors that were poorly recognized in the identification test and replaced them by culturally adapted odors. In a second study, we assessed the modified version of the Sniffin' Sticks test in 150 volunteers and defined normative values.
Results:
In the first study, we found that olfactory function (threshold-discrimination-identification: TDI score) significantly decreased with age and was better in females. Five odors were poorly recognized and were replaced by culturally adapted odors. In the second study, we found that this adapted version led to a higher rate of correctly identified odors. We defined normative values for the South-Kivu population (TDI score: 18-35 years: 30.4±6.0; 36-55 years: 26.2±5.3; >55 years: 25.6±5.0).
Conclusion:
This culturally adapted version of the Sniffin' Sticks test is culturally adapted to the South Kivu population. The normative values will provide the basis for clinical evaluation of pathologic subjects.
Introduction: Olfactory dysfunction (OD) has been suggested as a possible marker of executive function (EF) deficits after traumatic brain injury (TBI) in adults. Little is known about the relationship between EF and OD in pediatric TBI (pTBI). This study aimed to investigate EF, explore the relationship between OD and EF, and determine the utility of olfactory performance as a marker of later EF in pTBI. It was hypothesized that (i) children with TBI would perform more poorly on EF measures relative to normative expectation; (ii) children with OD would perform more poorly on tests of EF than those with normal olfaction after TBI; and (iii) acute olfactory function would predict later EF for children with TBI.
Method: This was a prospective longitudinal study. Twenty seven children aged 8–16 with TBI completed olfactory assessment using the University of Pennsylvania Smell Identification Test at 0–3, 8 and 18 months post injury. Assessment of EF occurred at 8 and 18 month follow-up.
Results: At 8 month follow-up the pTBI cohort did not demonstrate a consistent pattern of impairment in EF, contrary to our first hypothesis. Children with OD showed significantly poorer performance on a single EF measure of Fluency when compared to those with normal olfaction at 8 months post injury, partially supporting our second hypothesis. Acute olfactory function did not significantly predict EF outcomes at either 8 or 18 months post injury.
Conclusions: Overall our findings provide little support for a significant relationship between EF and OD in pTBI. In particular, there was no strong evidence that acute olfactory function is an accurate predictor of later EF in pTBI. Given the dearth of pediatric research, the limitations of our study and the potential significance of acute olfactory performance as an early marker of later EF deficits in children, further investigation is warranted.
Olfactory disorder takes a special place among non-motor symptoms of Parkinson's disease (PD) as one of earliest signs of the disease. Based on literature data, authors suggest that simple and structured tests for detection of olfactory disorders should be part of diagnostic algorithm for early detection of PD) and occupy a special place in differential diagnosis of diseases of the extrapyramidal system. Literature on the methods of study of olfactory function recommended as an additional instrument for PD diagnosis is presented.
Humans are able to perceive thousands of different smells and to detect odours in very low concentrations. Numerous tests of assessment of olfaction were proposed. The aim of this review was to determine the olfactory threshold using sniffing sticks. The test included identification of odorants, a threshold test with butan-1-ol and distinguishing odours. None of the tested persons showed anosmia but two of them were hyposmic. Sniffing sticks are useful for identification and distinguishing of odours. Their advantages over traditional methods are simple use and transferability.
Objective:
Research into olfactory dysfunction (OD) following paediatric traumatic brain injury (TBI) is limited. The current study investigated the frequency of OD following paediatric TBI and the relationship between OD and injury characteristics including severity, site of impact and cause of injury. It was hypothesized that children with moderate/severe TBI would demonstrate greater OD than those with mild TBI.
Design/method:
Thirty-seven children aged 8-16 with TBI were recruited to a prospective longitudinal study at a metropolitan children's hospital. Olfactory assessment, using the University of Pennsylvania Smell Identification Test, was completed at 0-3 months post-injury.
Results:
Nineteen per cent of participants demonstrated impaired olfaction, while a small number (5%) were anosmic. A significant relationship between OD and severity of injury was found. No other injury variables demonstrated a significant relationship with olfactory outcomes.
Conclusions:
OD was relatively common in this paediatric TBI cohort and the hypothesized relationship with severity of injury was supported. It is recommended that information about OD after TBI be routinely provided to children and families. Further research is needed in larger cohorts to support the implementation of routine clinical assessment, understand the relationship between OD and other injury characteristics, determine the functional implications of OD and document recovery trajectories.
It is well established that people with schizophrenia have impaired olfactory perception. However, another olfactory abnormality that occurs in schizophrenia--olfactory hallucinations (OHs)--has received almost no attention.
This preliminary study compared a small sample of olfactory (OH; n=14) and auditory-verbal (AVH; n=11) hallucinators with schizophrenia, with matched healthy controls (NC; n=21), on tests of odour detection threshold, identification, and hedonics, and bespoke tests relating to possible causes of OHs.
Both OH and AVH participants were equally impaired on tests of odour identification, but neither had any impairment in detection. However, although the AVH group had hedonic impairments, these were not evident in the OH and NC groups. Examination of the possible causes of OHs revealed abnormalities in olfactory habituation. In addition, we observed a far greater rate of past episodes of brief unconsciousness in the OH group.
The presence of habituation deficits and past episodes of brief unconsciousness, and absence of olfactory affective impairment, have not been identified before as correlates of OHs, suggesting these factors may be worthy of further investigation.
Key theories of autism implicate orbitofrontal cortex (OFC) compromise, while olfactory identification (OI) deficits are associated with OFC dysfunction. This study aimed to complete a 5-year follow-up of children with high-functioning autism (HFA) who previously lacked the normal age-OI association; and compare unirhinal-OI in children with HFA, Asperger's disorder (ASP), and controls. While both HFA and controls had improved birhinal-OI at follow-up, reduced OI in some HFA participants suggested OFC deterioration and heterogeneous OFC development. Unirhinal-OI was impaired in HFA but not ASP relative to controls, suggesting orbitofrontal compromise in HFA but integrity in ASP. Differing IQ-OI relationships existed between HFA and ASP. Findings support the hypothesis of separate neurobiological underpinnings in ASP and HFA, specifically differential orbitofrontal functioning.
Disorders of taste and smell can present a challenge to the facial plastic surgeon. Obtaining a detailed history and examination is the key to the diagnosis and work-up of olfactory and gustatory dysfunction. Easy-to-administer tests are available for olfactory evaluation(University of Pennsylvania Smell Identification Test) and gustatory (taste sticks, tasting tablets) evaluation. The prognosis and management of olfactory and gustatory disease depend on its etiology. Despite ongoing research, the treatment of the disorders of smell and taste is limited.
Quantitative olfactory assessment is often neglected in clinical practice, although olfactory loss can assist diagnosis and leads to significant morbidity. The aim of this study was to develop normative data for the Australian population for the 'Sniffin' Sticks', an internationally established olfactory function test. As in other populations, Australian females performed better than males and both lost olfactory function with age. From the normative data, criterion test scores for males and females were established for clinical classifications ('normosmic', 'hyposmic', and 'nosmic'). These clinical classifications were assessed in Parkinson's patients: 81.1% were anosmic or severely hyposmic and only 7.7% were normosmic. A new term ('rebyosmia') is introduced to describe age-related loss of olfactory capacity of unknown aetiology. With these norms, the Sniffin' Sticks can be used in the Australian population to compare an individual's olfactory function against the population of others of similar age and sex and to identify olfactory dysfunction.
There is some evidence for an unusual body odour in schizophrenia that has been linked to a hexenoic acid derivative (trans-3-methyl-2-hexenoic acid; MHA). Poor body odour has been linked to increased negative symptoms and reduced olfactory identification ability. However, the relationship between these findings and MHA, including olfactory sensitivity for MHA, has not been examined. Olfactory sensitivity thresholds were assessed for MHA and n-butyl-alcohol (NBA), in normal controls (CTL; n=24), patients with chronic schizophrenia (CHR; n=32) and a first-episode psychosis cohort (FE; n=31). In addition, forced choice detection of the pheromonal steroids 5-alpha-androst-16-en-3-one, androsterone-sulphate and estrone-3-sulphate was performed along with a measure of olfactory identification. CHR patients had significantly reduced sensitivity to MHA, but not NBA, compared to FE and CTL subjects. While sensitivity to pheromones was not different between the groups, CHR patients who could not detect them also showed poorer sensitivity to MHA. Further, the CHR group showed a significant association between reduced MHA sensitivity and greater levels of disorganised and negative symptoms. No relationships between identification and sensitivity for any substance were found. Our findings are the first to report reduced sensitivity for MHA in chronic schizophrenia patients, in the absence of similar impairment for more traditionally used substances. This may be linked to olfactory habituation effects, abnormal chemical processing or a genetic predisposition.
Due to neuropsychological conceptualizations of orbitoprefrontal cortex (OFC) dysfunction underpinning impulsive aggression and the incidence of such behaviour in post-traumatic stress disorder (PTSD), this study aimed to explore olfactory identification (OI) ability in war veterans with PTSD as a probe of putative OFC dysfunction; and to explore the utility of OI ability in predicting aggressive and impulsive behavior in this clinical population.
Participants comprised 31 out-patient male war veterans with PTSD (mean=58.23 years, s.d.=2.56) recruited from a Melbourne Veterans Psychiatry Unit, and 31 healthy age- and gender-matched controls (mean=56.84 years, s.d.=7.24). All participants were assessed on clinical measures of PTSD, depression, anxiety, and alcohol misuse; olfactory identification; neurocognitive measures of dorsolateral prefrontal, lateral prefrontal and mesial temporal functioning; and self-report measures of aggression and impulsivity.
War veterans with PTSD exhibited significant OI deficits (OIDs) compared to controls, despite uncompromised performance on cognitive measures. OIDs remained after covaring for IQ, anxiety, depression and alcohol misuse, and were significant predictors of aggression and impulsivity.
This research contributes to emerging evidence of orbitoprefrontal dysfunction in the pathophysiology underlying PTSD. This is the first study to report OIDs as a predictor of aggression and impulsivity in this clinical population. It prompts further exploration of the potential diagnostic utility of OIDs in the assessment of PTSD. Such measures may help delineate the clinical complexity of PTSD, and support more targeted interventions for individuals with a greater susceptibility to aggressive and impulsive behaviors.
Determine the suitability of three tests based on the identification of familiar odors and tastes for the clinical assessment of olfaction and gustation in children.
A total of 232 children aged 5 to 7 years from Sydney public schools and 56 adults aged 18 to 51 years participated in a cross-sectional study.
The children demonstrated they can identify the majority of the 16 test odorants and 4 common tastes that describe gustatory function. The response distributions obtained for each test provide the basis for a set of normative data for young children.
Olfactory and gustatory function can be determined in school-age children using the three tests described.
Currently no satisfactory clinical tests of olfaction and gustation for children or normative data are available. The present study resolves these shortcomings and provides normative data that can be used in the diagnosis of olfactory and gustatory impairment in school-age children.
The University of Pennsylvania Smell Identification Test (UPSIT) was administered, on a volunteer basis, to workers frequenting the cafeteria of the corporate offices of a major chemical manufacturing company to (1) establish the level of acceptance of self-administered olfactory testing within such a setting, (2) determine the percentage of the sample that reported or evidenced marked olfactory impairment, and (3) develop guidelines for the use of the UPSIT as a corporate medical surveillance tool. The initial acceptance of the testing program was high. Thus, 640 of the cafeteria visitors agreed to take the test (total work force in building less than 1,000). However, only 52% of the tests handed out were completed by the employees and returned to the test examiners, possibly reflecting the informal atmosphere in which they were distributed. Of the group returning the tests, seven employees reported having smell problems due to allergies or sinus disease. However, all of these employees had normal UPSIT scores. Three subjects (1% of the sample) evidenced marked olfactory dysfunction. Of these three, only one was aware of the problem before testing. On average, the corporate subjects significantly outperformed matched control subjects obtained from previous administrations of the UPSIT at health fairs and other public events, although the difference was less than half a point (37.89 v 37.53; P less than .004). As in previous studies, the test scores of women were slightly, but significantly, higher than those of men (respective means = 37.98 v 37.80, P less than .04).