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A D Smith

Publications and source records attributed to A D Smith.

At least 55 records · Page 3Linked to original sources

Deafferentation of the hippocampus results in the induction of AT8 positive 'granules' in the rat.

Hyperphosphorylated tau is a pathological hallmark of Alzheimer's disease, but the mechanisms that lead to its formation are poorly understood. To investigate what effect deafferentation of the hippocampus has on the phosphorylation state of tau, we lesioned the entorhinal cortex in rats and looked for hyperphosphorylated tau in the hippocampus at various days post lesioning. After 7 and 21 days, small AT8-positive 'granules' appeared in the molecular layer of the dentate gyrus on the lesioned side. No such staining was seen in the animals injected with saline. This study shows that deafferentation leads to induction of hyperphosphorylated tau. The AT8 positive 'granules' seen resemble the argyrophilic grains that characterize Argyrophilic Grain disease suggesting that lesioning the perforant pathway may serve as a useful model for inducing argyrophilic grains in vivo.

Alzheimer Disease↗

The architecture of Mg(II) centres in MAPO-36 solid acid catalysts.

The local structure around Mg2+ ions of a Magnesium substituted aluminophosphate, with the ATS structure (MgAPO-36, Mg/P=0.08), in the as-prepared and calcined state has been investigated by Mg K-edge XAS spectroscopy. High quality XAS data were collected using the solid-state fluorescence detector. Mg2+ is found to replace tetrahedrally co-ordinated Al3+ in the as-prepared state and remained intact even after calcination, thus yielding a highly active, solid acid catalyst.

Journal Article↗

Control of electrochemical reactions at the capillary electrophoresis outlet/electrospray emitter electrode under CE/ESI-MS through the application of redox buffers.

It was found that combining capillary electrophoresis (CE) and electrospray ionization mass spectrometry (ESI-MS) overlays two controlled current techniques to form a three-electrode system (CE inlet, CE outlet/ES emitter, and MS inlet electrodes) in which the CE outlet electrode and the ES emitter electrode were shared between the CE and the ESI-MS circuits. Depending on the polarities and magnitudes of the voltages at the CE inlet, CE outlet/ES emitter, and MS inlet electrodes, the nature of the two redox reactions at the shared electrode was the same or different (both reduction, both oxidation, or one oxidation and the other reduction). Several redox buffers were introduced for controlling electrochemical reactions at the shared electrode. By reacting at this electrode, redox buffers were able to maintain electrode potentials below the onset of water electrolysis, thereby eliminating gas bubble formation and/or pH drift. The volume of the gas generated due to water electrolysis was used to quantitate water oxidation or reduction at this electrode. Two types of redox buffers were used. A reactive electrode with an oxidation potential below that of water was used as the electrode under anodic conditions. Also, a reactive compound with a redox potential below that of water was added to the CE and/or ESI running buffer. When the shared electrode was the anode of both CE and ESI-MS circuits, the use of iron or etched and sanded stainless steel (ss) wire, instead of platinum wire, suppressed bubble formation at the shared electrode. Under these conditions, corrosion of the Fe wire and formation of Fe2+ replaced oxidation of water, eliminating O2 gas bubble and H+ formation. When mixtures of peptides were analyzed, iron adducts of peptides were observed. For a fresh wire, however, the intensities of adduct ions were less than 3% of the protonated molecules. After a few days of operation, the intensities of the adduct ions increased to approximately 50%, due to rust formation on the Fe wire. On-column rinsing with a 40% solution of citric acid rejuvenated the Fe wire and reduced the adduct peak intensities to less than 3%. Unmodified ss wire did not quench bubble formation, which was attributed to its passivated surface. When Fe, ss, and Pt wires were used as the shared electrode under forward polarity CE and positive ESI mode, where the shared electrode acted as a cathode with respect to CE inlet and as an anode with respect to MS inlet, reduction of water at the cathodic end of the electrode and, in the case of ss and Pt wires, oxidation of water at the anodic end of the shared electrode produced a significant amount of bubbles. Under these conditions, however, a buffer containing 50 mM p-benzoquinone completely suppressed both cathodic reduction and anodic oxidation of water for CE currents up to 4 microA. Reduction of p-benzoquinone at the cathodic end of the shared electrode to hydroquinone, and oxidation of this hydroquinone at the anodic end of the electrode, replaced reduction and oxidation of water, eliminating bubble formation. A 0.1% acetic acid solution saturated with I2 was also found to suppress bubble formation at the cathode for CE currents up to 3 microA; however, strong iodine adduct ions were observed under CE/ESI-MS when a mixture of peptides was analyzed. The application of iron as an in-capillary electrode for the analysis of a peptide mixture and a protein digest demonstrated a high separation efficiency similar to when hydroquinone was used as a redox buffer.

Journal Article↗

Using meta-analysis to explain the diversity of results in genetic studies of late-onset Alzheimer's disease and to identify high-risk subgroups.

In late-onset Alzheimer's disease, there is a puzzling inconsistency between the findings of case-control studies of most proposed risk genes, except apolipoprotein E epsilon4. This inconsistency may stem from the failure to define the genetic and non-genetic interactions that affect the disease association of each particular susceptibility gene. Such interactions will limit the influence of the gene to a 'relevant subset' of vulnerable people. The relevant subsets for many risk genes will be narrow, compared to that of apolipoprotein E epsilon4. Studies may therefore miss the association or even suggest that a risk gene is protective. In these circumstances, the precise composition of a cohort is critical and defining the relevant subset is crucial. We illustrate how such definition may be achieved through meta-analysis. We take as an example the butyrylcholinesterase K variant, whose association with Alzheimer's disease may now be provisionally defined. This analysis leads to the identification of a potentially high-risk group: over 75 year old male carriers of both apolipoprotein E epsilon4 and butyrylcholinesterase K variant.

Age of Onset↗

Rapid determination of glutathione peroxidase and thioredoxin reductase activities using a 96-well microplate format: comparison to standard cuvette-based assays.

Gluthatione peroxidase and thioredoxin reductase are selenocysteine-containing enzymes that are constituents of the cellular antioxidant defense system. Conventional cuvette-based assays for glutathione peroxidase and thioredoxin reductase enzymes are laborious and time consuming. The ability to assay their activities rapidly in multiple samples would aid efforts focused on understanding the impact of these enzymes on the cellular antioxidant defense system. High throughput can be achieved with assays adapted to work in a clinical analyzer but require expensive equipment. Assays designed to work in a 96-well microplate reader provide an alternative methodology for high throughput with reduced instrumentation cost. However, due to differences in the light pathlength when using a 96-well format, the values obtained cannot be compared directly with those obtained using a 1-cm cuvette. Described here are assays for glutathione peroxidase and thioredoxin reductase modified to work in a 96-well format that incorporates light pathlength determinations into the assays. The values obtained using a high throughput 96-well format in conjunction with pathlength determinations are in agreement with those obtained using a standard 1-cm cuvette. While spectrophotometrically derived pathlengths are the most accurate, calculated pathlengths based on assay volume and well size can be used with only a small amount of error introduced. This method can also be applied to many other enzyme assays, thus allowing the rapid analysis of large numbers of samples without the need for expensive equipment.

Animals↗

Congenital constriction band syndrome causing ulnar nerve palsy: early diagnosis and surgical release with long-term follow-up.

Three children with congenital constriction band syndrome affecting their upper extremities demonstrated clinical and electrophysiologic signs of a complete ulnar nerve palsy. Two of the children were diagnosed immediately postpartum with the subtle findings of an intrinsic minus posture of their hand and inability to actively extend their fingers at the proximal interphalangeal joints. One child had at least 5.5 months of intrauterine compression of the ulnar nerve detected by ultrasound examination at 18 weeks. Despite early release of the constriction bands, at 3 months in 2 children and at 6 months in 1 child, the ulnar nerve palsies persisted for a mean follow-up period of 7 years. If clinical examination of an infant with constriction band syndrome is indicative of a complete ulnar nerve palsy, the constriction band should be released as early as possible. If surgical exploration reveals significant compression of the ulnar nerve, consideration should be given to excising the involved segment of nerve with immediate primary nerve repair or nerve grafting because even early release of the constriction band does not seem to result in neurologic improvement in long-term follow-up studies.

Amniotic Band Syndrome↗

Transitional-cell carcinoma of the renal pelvis: ureteroscopic and percutaneous approach.

There are a variety of publications advocating the ureteroscopic or the percutaneous approach for the treatment of transitional cell carcinoma of the renal pelvis. The diagnostic tool of choice for the upper urinary tract and collecting system is the flexible ureteroscope. One of the major concerns about ureteroscopic management of renal disease initially was the lack of flexibility of the instruments and therefore the inability to deal with demanding sites. The advent of new ureteroscopic techniques, as well as the continuous evolution of the technology, have paved the way for safe and effective access to the upper urinary tract. In the hands of an experienced urologist, such procedures can provide reliable treatment options for small upper urinary tract lesions. Coupling minimal morbidity with ever-improving optics and flexibility, the ureteroscope of today leaves no area of the urinary tract unseen. In patients with bulky tumors or in whom easy access and resection is not possible ureteroscopically, the percutaneous approach to the renal pelvis, although more invasive, provides a better working environment. Clearly, the most difficult aspect of ureteroscopic access to the lower pole is not just visibility but the loss of deflection caused by passage of various instruments through the working channel. Direct access via percutaneous approach with a large resectoscope avoids these problems.

Carcinoma, Transitional Cell↗

Management of malignant extrinsic compression of the ureter by simultaneous placement of two ipsilateral ureteral stents.

BACKGROUND AND PURPOSE: Extrinsic ureteral obstruction caused by various malignancies often necessitates urinary diversion. The use of single ureteral stents as a form of urinary diversion results in a high failure rate, while the use of two ipsilateral stents has shown promising results. We report our experience using the latter technique. PATIENTS AND METHODS: Between 1996 and 2001, four male and three female patients with a mean age of 65 years (range 37-95 years) who had extrinsic compression of the ureters underwent single stent management to relieve obstruction. Ureteral obstruction was secondary to prostate cancer (N = 3), cervical cancer (2), non-Hodgkin's lymphoma (1), and transitional-cell cancer of the bladder and ureter (1). After failure of such management, two 7F stents or a combination of 8F/6F double-J ureteral stents were placed. The stents were changed every 4 to 6 months. Follow-up included serial renal ultrasound scans and serum creatinine measurements. RESULTS: Ureteral stricture length ranged from 2 to 4 cm. Insertion of two double-J ureteral stents in a single ureter was successful in all cases. During the mean follow-up of 16 months (range 1-38 months), the ureteral stents were tolerated by all patients, without significant discomfort. Marked improvement of hydronephrosis and alleviation of flank pain was noted in all patients. Three patients have died at 1 to 3 months. Renal function improved, with a mean decline in the serum creatinine concentration from 3.2 mg/dL to 1.48 mg/dL in the five patients tested. CONCLUSION: Simultaneous placement of two double-J ureteral stents for the management of ureteral obstruction secondary to a malignancy is a safe and effective technique.

Adult↗

Escherichia coli-human uroepithelial cell interaction products enhance fibroblast migration and matrix accumulation.

BACKGROUND AND PURPOSE: Urinary tract infection has been associated with renal interstitial scarring and ureteral wall fibrosis. The mechanism of progression of scarring despite attenuation of the primary insult is not clear. We examined the role of the products of the interaction between Escherichia coli and human uroepithelial cells (HUC-EC-S) on the migration of fibroblasts, as well as their matrix synthesis. MATERIALS AND METHODS: We evaluated the effect of HUC-EC-S (concentration of 10%, 15%, and 25%) on the migration of fibroblasts across a filter in a modified Boyden chamber. To determine the role of transforming growth factor-beta and MCP-1, we studied the effect of anti-TGF-beta and anti-MCP-1 antibodies on interaction product-induced fibroblast migration. The effect of HUC-EC-S on fibronectin and collagen I accumulation was studied by the Western blotting. RESULTS: Bacterial-HUC interaction products enhanced (P < 0.001) migration of fibroblasts compared with uroepithelial interaction product (HUC-S). Anti-TGF-beta and anti-MCP-1 antibodies partly inhibited (P < 0.001) the HUC-EC-S-induced fibroblast migration. Also, HUC-EC-S-treated fibroblasts showed enhanced accumulation of fibronectin and collagen 1. CONCLUSION: Escherichia coli-induced activation of HUC not only promotes migration of fibroblasts but also triggers matrix remodeling.

Antibodies↗

Ureteral ischemia model: an explanation of ureteral dysfunction after chronic obstruction.

BACKGROUND AND PURPOSE: Many models of smooth muscle ischemia have been developed to explain organ insufficiency or failure. Ureteral decompensation may also be described in these terms. We anticipate that ureteral ischemia will result from overdistention brought about by obstruction. A preliminary model of an ischemic ureter is described herein. MATERIALS AND METHODS: Six female New Zealand rabbits were used for this study. All had their left ureters surgically ligated at the level of the urinary bladder. The right ureters served as controls. In the acute-phase group, the ureters were reexplored 2 weeks after creation of obstruction. The other three rabbits were explored 3 weeks later. A laser Doppler needle was used to measure tissue perfusion with bilateral measurements of the renal artery and vein; renal parenchyma; renal pelvis; ureteropelvic junction; upper, mid, and lower ureter; and the lateral wall of the bladder. Baseline and postobstructive measurements of tissue perfusion were collected. RESULTS: In both the acute and chronic obstruction groups, there was a demonstrable drop-off in perfusion of the ureteral wall. CONCLUSION: The increased wall tension in the obstructed ureter results in a significant decrease in smooth muscle perfusion. This ischemia may result in the same functional and histologic changes that occur in other smooth muscle organs deprived of normal blood flow. Ultimately, poor outcomes of some restorative/reconstructive operations on the ureter may be explainable in terms of smooth muscle ischemia.

Animals↗

Laparoscopic ureteral reconstruction with small intestinal submucosa.

PURPOSE: To evaluate the feasibility of laparoscopic ureteral reconstruction with small intestinal submucosa (SIS) in the pig ureter. MATERIALS AND METHODS: Eight female pigs weighing between 25 and 30 kg were enrolled. After anesthesia was administered, a double-pigtail stent was inserted, the animals were moved to a lateral decubitus position, pneumoperitoneum was established, and three 10-mm ports were positioned. The ureter was opened longitudinally for 7 cm, and two thirds of the periphery of the upper third of the left ureter was excised. The SIS was anastomosed to the upper and distal ureteral segments with chromic 4-0 sutures. The double-pigtail stent was removed 6 weeks after the initial procedure, and retrograde pyelography was performed a week later to confirm the viability of the pelvicaliceal system. RESULTS: The average duration of the procedures was 210 minutes (range 125-250 minutes). All animals survived the entire follow-up period of 7 weeks. Retrograde pyelography revealed a patent ureteral lumen, and no obstructive phenomena were observed. Histologically, the SIS-regenerated ureteral segments were remarkably similar to normal porcine ureters and were indistinguishable from neighboring tissue. CONCLUSION: Laparoscopic ureteral reconstruction with SIS proved to be effective and technically feasible. The SIS seems to be an effective biodegradable scaffold, facilitating regeneration of host tissue.

Animals↗

Comparison of symptoms related to positioning of double-pigtail stent in upper pole versus renal pelvis.

PURPOSE: This study was a comparison of the symptomatology associated with placement of the upper coil of a double-pigtail stent in the upper pole or the renal pelvis. PATIENTS AND METHODS: A prospective study with 40 patients was performed. In 20 patients, the stent was placed in the upper pole (Group A) and in another 20 patients (Group B) in the renal pelvis. A questionnaire was addressed to all patients before the removal of the stent concerning the presence and severity of flank pain (using a standardized 10-point scale), the presence and severity of urinary urgency (using a standardized 10-point scale), the presence of dysuria, and quality of life with the stent in place. RESULTS: Flank pain was present in 17 (85%) and 15 (75%) patients in Groups A and B, respectively. The average severity of flank pain was 4.3 (range 0-7) and 4.5 (range 0-10) in Group A and B, respectively (p = 0.764). Urinary urgency was present in 13 (65%) and 15 (75%), patients in Group A and B, respectively. The average severity of urgency was 3.1 (range 0-7) and 5.3 (range 0-10) in Group A and B, respectively (p = 0.037). Dysuria was present in 4 (20%) and 13 (65%), and the average quality of life score was 2.5 and 3.05 in Group A and B, respectively (p = 0.04). CONCLUSION: Positioning of the proximal end of the double-pigtail stent in the upper pole of the kidney appears to be better tolerated by patients than is the standard insertion in the renal pelvis.

Adult↗

In vitro bactericidal effect of a modified thermal Nitinol electrode.

PURPOSE: A standard electrode surgical generator connected to a Nitinol coil was used in vitro to evaluate whether the generated electromagnetic energy had any bactericidal effect on Escherichia coli. MATERIALS AND METHODS: The ATCC 259222 E. coli strain was used. We mixed 135 mL of a 1.5% non-nutritive agar with 15 mL of a 10(6) CFU/mL inoculum and transferred it to gas-sterilized plastic containers lined with aluminium foil. A 22F cylindrical shape was cut from the center of the agar, and a Nitinol coil was placed in that space and connected to a standard electrode surgical generator. Electrical energy was then applied from 5 to 25 V at 5-V increments. Temperatures were measured with two thermocouples placed in the middle and periphery of each agar. The treatment was stopped when the temperature at the middle thermometer reached 50 degrees C. The control group was not treated and was embedded in a water bath at 45 degrees C. Three 3 x 7-mm pieces were sliced from the inner to the outer part of the agar and processed, and colony counts were performed. RESULTS: We observed statistically significant deleterious effects on E. coli in all three zones when the treatment voltage was 15 and 20. When the potential was raised to 25 V, we observed a significant result only in the core zone. The treatment duration was 50 minutes for 5 and 10 V, 45 minutes for 15 V, 15 minutes for 20 V, and 10 minutes for 25 V. CONCLUSION: The bactericidal effect was mainly in the central area, decreasing linearly toward the periphery, and was related to the temperature reached during activation of the electrical generator. These results were disappointing with regard to the utility of Nitinol stents to treat bacterial prostatitis.

Alloys↗

Endopyelotomy failure is associated with reduced urinary transforming growth factor-beta1 levels in patients with upper urinary tract obstruction.

BACKGROUND AND PURPOSE: We previously demonstrated that obstructed ureteropelvic junction (UPJ) segments from patients who had secondary pyeloplasty after endopyelotomy failure expressed transforming growth factor-beta1 (TGF-beta1) at levels significantly lower than patients who had primary pyeloplasty. In order to determine whether these differences in secreted TGF-beta1 are detectable preoperatively in the urine, the TGF-beta1 concentration of urine from patients undergoing endopyelotomy was determined and compared with that from subjects without urologic disease. MATERIALS AND METHODS: Bladder and renal pelvic urine from the obstructed side was obtained from patients (N = 34) undergoing primary endopyelotomy for UPJ obstruction. Bladder urine was also obtained from sex- and age-matched patients (N = 26) having no evidence of urinary tract obstruction. The TGF-beta1 concentration was determined by ELISA and normalized to the creatinine concentration. RESULTS: The bladder urine TGF-beta1 concentration was significantly (P < 0.02) higher in patients with UPJ obstruction (86.1+/-20.5 pg/mg of creatinine) than in those without obstruction (29.7+/-8.0 pg/mg creatinine). The TGF-beta1 concentration in the bladder urine of patients who underwent endopyelotomy and later returned because of UPJ obstruction (25.7+/-12.3 pg/mg of creatinine; N = 6) was not significantly different from the value in unobstructed patients but was significantly lower (P < 0.01) than in patients for whom endopyelotomy was successful (100+/-24.29 pg/mg of creatinine; N = 28). The renal pelvic urinary TGF-beta1 concentration was higher in patients for whom endopyelotomy was successful (772+/-490.1 pg/mg of creatinine) than in patients who underwent endopyelotomy and later returned because of UPJ obstruction (126.1+/-41.9 pg/mg of creatinine). CONCLUSIONS: These data suggest that preoperative concentration of TGF-beta1 in the bladder urine of patients with UPJ obstruction who fail endopyelotomy is not significantly different from that in subjects with no urologic disease and significantly lower than in those patients for whom endopyelotomy is successful. Thus, the preoperative bladder urine concentration of TGF-beta1 may assist in selecting patients for this operation, although further investigation is necessary.

Adolescent↗

Management of ureteral stricture disease during laparoscopic ureteroneocystostomy.

BACKGROUND AND PURPOSE: Laparoscopic surgery has many applications in urology. The surgical management of obliterative ureteral stricture disease using laparoscopy has not been widely reported. We recently implemented this technique in an adult patient with an obliterative ureteral stricture. METHODS: A transperitoneal refluxing right ureteral reimplantation was performed using the Endostitch device. Placement of the new ureteral orifice in the bladder was monitored by simultaneous cystoscopy and laparoscopy. The anastomosis was performed without tension, torsion, or angulation and was stented for 4 weeks. RESULTS: The operative time was 233 minutes. The blood loss was minimal. There were no intraoperative complications, and the postoperative hospital course was uneventful. CONCLUSION: Laparoscopic ureteral reimplantation is a safe and feasible technique. Cystoscopic determination of the neoureteral orifice is helpful. The Endostitch device is a useful adjunct in this procedure.

Adult↗

Retroperitoneoscopic radiofrequency ablation of a solid renal mass.

PURPOSE: To report a new technique for radiofrequency (RF) ablation of a solid renal mass. PATIENT AND METHODS: An 83-year-old man with a history of chronic renal insufficiency was found to have solid mass in the right kidney. Retroperitoneoscopic localization of the renal mass was accomplished using intraoperative ultrasonography. The lesion was treated with a 14-gauge RITA Starburst XL probe (Rita Medical Systems, Inc., Mountain View, CA). RESULTS: The total treatment time included two cycles of 5.5 minutes. There were no intraoperative complications. Tissue desiccation was noted during treatment. A CT scan 48 hours after ablation showed a decrease in the density of the lesion suggestive of coagulation necrosis. The postoperative hospital course was uneventful. CONCLUSION: The retroperitoneal laparoscopic technique is a feasible approach to performing RF ablation of a solid renal mass. It facilitates direct insertion of the RF probe, allows viewing and avoidance of adjacent structures such as bowel, and permits better staging by enabling biopsy of perirenal fatty tissue.

Aged↗

Efficiency and efficacy of different intracorporeal ultrasonic lithotripsy units on a synthetic stone model.

PURPOSE: The efficiency and efficacy of the available intracorporeal ultrasonic lithotripters were compared in a stone model experiment. MATERIALS AND METHODS: Plaster of Paris (POP) stone phantoms having ratios of 1:1, 1.5:1, and 2:1 with water were fabricated into cubes of various hardnesses weighing an average of 24.6 g. The stones were immersed in water in a plastic container, and continuous irrigation through a rigid nephroscope was used. Ultrasonic lithotripters from ACMI, Olympus, Storz, and Wolf manufacturers were evaluated for efficacy in breaking up the three POP concentrations. Time to complete stone fragmentation, occurrence of probe or tubing occlusion, and probe overheating were evaluated. RESULTS: Efficiency of fragmentation and time to fragmentation of the Storz lithotripter were significantly different from those of the Wolf (p = 0.01 and p = 0.02, respectively) and ACMI (p = 0.001 and p = 0.02, respectively) lithotripters. Comparison of the efficiency of fragmentation and time to fragmentation of the ACMI and Wolf lithotripters showed significant differences (p = 0.005 and p = 0.03, respectively) in favor of the Wolf device. The Olympus lithotriptor resulted in incomplete fragmentation of phantoms of all POP concentrations. CONCLUSION: The Storz ultrasonic lithotriptor was found to have the lowest fragmentation time and highest efficiency in the fragmentation of phantom stones.

Calcium Sulfate↗

Anosmia in dementia is associated with Lewy bodies rather than Alzheimer's pathology.

OBJECTIVES: To assess olfactory function of patients with dementia. Odour detection ability is impaired in clinical Parkinson's disease. Evidence of impaired detection in patients with clinically diagnosed Alzheimer's disease is inconsistent. No studies of olfaction have been neuropathologically validated. METHODS: The olfactory function of 92 patients with dementia and 94 controls was assessed using a simple bedside test as part of the Oxford Project To Investigate Memory and Ageing (OPTIMA). Neuropathological assessment was made of cortical Lewy bodies and substantia nigra (SN) cell counts and of Alzheimer's disease in all 92 patients, 22 of whom had SN Lewy bodies and 43 of whom had only Alzheimer's disease. RESULTS: Patients with Lewy bodies were more likely to be anosmic than those with Alzheimer's disease or controls. Patients with Alzheimer's disease were not more likely to be anosmic than controls. Nor was anosmia associated with degree of neurofibrillary tangles, as assessed by Braak stage. Among subjects with Lewy bodies, overall cortical Lewy body scores and Lewy body density in the cingulate were higher in those who were anosmic. Consensus clinical criteria for dementia with Lewy bodies had a sensitivity of 64% and specificity of 89%. In the absence of definite Alzheimer's disease, the criteria had sensitivity of 100%. In patients with definite Alzheimer's disease, anosmia was slightly more sensitive (55%) than the consensus criteria (33%). However, the addition of anosmia to the consensus criteria did not improve their overall performance. CONCLUSION: Dementia with Lewy bodies is associated with impaired odour detection. Misdiagnosis may have accounted for some previous reports of impaired odour detection in Alzheimer's disease. Simple but more sensitive tests of anosmia are required if they are to be clinically useful in identifying patients with dementia with Lewy bodies.

Aged↗