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Smell identification function as a severity and progression marker in Alzheimer's disease

Published online by Cambridge University Press:  19 April 2013

Latha Velayudhan*
Affiliation:
Department of Health Sciences, University of Leicester, Leicester, LE5 4PW, UK Institute of Psychiatry, King's College London and NIHR Biomedical Research Centre for Mental Health, London SE5 8AF, UK
Megan Pritchard
Affiliation:
Institute of Psychiatry, King's College London and NIHR Biomedical Research Centre for Mental Health, London SE5 8AF, UK
John F. Powell
Affiliation:
Institute of Psychiatry, King's College London and NIHR Biomedical Research Centre for Mental Health, London SE5 8AF, UK
Petroula Proitsi
Affiliation:
Institute of Psychiatry, King's College London and NIHR Biomedical Research Centre for Mental Health, London SE5 8AF, UK
Simon Lovestone
Affiliation:
Institute of Psychiatry, King's College London and NIHR Biomedical Research Centre for Mental Health, London SE5 8AF, UK
*Corresponding
Correspondence should be addressed to: Dr Latha Velayudhan, Senior Clinical Research Fellow, Psychiatry for the Elderly, Academic Department, Leicester General Hospital, Leicester LE5 4PW, UK. Phone: +44-0116-258-4597; Fax: +44-0116-273-1115. Email: lv24@le.ac.uk.

Abstract

Background: Olfactory dysfunction, impaired smell identification in particular, is known as a diagnostic and a marker of conversion in Alzheimer's disease (AD). We aimed to evaluate the associations of olfactory identification impairments with cognition, illness severity, and progression in AD patients.

Methods: Fifty-seven outpatients with late onset mild to moderate AD and 24 elderly non-demented controls (NDC) were assessed, at baseline and after three months, for Mini-Mental State Examination (MMSE), University of Pennsylvania Smell Identification Test (UPSIT), and Bristol Activities of Daily Living and Neuropsychiatry Inventory. AD participants were classified as Rapid Cognitive Decliners (RCD) defined on a priori with a loss of ≥2 points in MMSE within the previous six months.

Results: AD participants had lower olfactory scores than NDC. RCD had lower olfaction scores compared with Non-Rapid Cognitive Decliners (NRCD). Although the baseline UPSIT scores were associated with baseline MMSE scores, it did not interact significantly with change in MMSE over the follow-up period. Using a median split for olfactory scores, the AD participants were classified as Rapid Olfactory Progressors (ROP) (UPSIT ≤ 15) and Slow Olfactory Progressors correlating significantly with RCD/NRCD groups. The ROP group with higher olfactory impairment indicated more symptomatic illness or severity, i.e. lower cognition, higher functional dependence, and presence of behavioral symptoms.

Conclusions: Our study supports association of smell identification function with cognition and its utility as an adjunct clinical measure to assess severity in AD. Further work, including larger longitudinal studies, is needed to explore its value in predicting AD progression.

Type
Research Article
Copyright
Copyright © International Psychogeriatric Association 2013 

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