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Unirhinal olfactory identification deficits in young male patients with schizophrenia and related disorders: association with impaired memory function.

We have observed discreet subgroups of male patients with psychotic disorders who have unirhinal olfactory identification deficits (microsmia). The purpose of this study was to examine the relationship between left or right nostril microsmia and performance on literalised neuropsychological tests sensitive to lesions in brain areas implicated in the pathogenesis of schizophrenia. Sixty-six male patients diagnosed with schizophrenia or related disorders were assessed with a battery of neuropsychological tests, sensitive to literalised and regional (temporal and frontal lobe) dysfunction. The University of Pennsylvania Smell Identification Test (UPSIT) was administered unirhinally and resultant scores were used to classify patients into olfactory subgroups. Neuropsychological test scores were compared amongst subgroups. A mixed design MANOVA was performed on cognitive domains with olfactory status (right microsmic; RM, n=8, left microsmic; LM, n=20, and normosmic schizophrenic controls; NSzC, n=38) as the between subject factor while hemisphere (left versus right) and domain (executive/fluency versus memory) were within-subject factors. A three-way (olfactory subgroup by hemisphere by region) interaction was observed. Non-verbal memory impairment was observed in the right and left microsmic subgroups. Verbal memory deficits were demonstrated in patients with left nostril microsmia. These results indicate that unirhinal olfactory performance may provide a meaningful manner by which to subtype patients with schizophrenia. Moreover, the data suggest that olfactory deficits in patients with schizophrenia are associated with dysfunction of temporal lobe, rather than frontal lobe abnormalities. The data are consistent with reports linking the right temporal lobe integrity to adequate olfactory processing.

Adolescent↗

Olfactory identification in combat-related posttraumatic stress disorder.

Recent neuropsychological conceptualizations of posttraumatic stress disorder (PTSD) implicate dysfunction of the fronto-limbic system, a brain system thought to be involved in the mediation of emotion. However, few studies have examined fronto-limbic subregions, such as the orbitofrontal cortex, in PTSD. As a measure of orbitofrontal integrity, olfactory identification was assessed in 26 Vietnam War veterans with PTSD, 25 Vietnam War veterans without mental disorders, and 17 Vietnam-era, non-war-zone veterans without mental disorders. Relative to veterans without PTSD, those diagnosed with PTSD were less proficient in odor identification and verbal learning but not on other cognitive tests sensitive to dorsolateral prefrontal and mesial temporal functioning. Results bolster prior research indicating fronto-limbic dysfunction in PTSD, and suggest involvement of the orbitofrontal region.

Analysis of Variance↗

Olfactory function in HIV-positive subjects.

The aim of this study was to reinvestigate previous reports of chemosensory dysfunction in HIV-positive subjects. Odor thresholds, odor discrimination and odor identification were assessed using the Sniffin' Sticks test battery. Seventy-four HIV-positive patients were tested. According to CDC criteria, 38 subjects were classified as stage A, 10 as stage B and 26 as stage C. None of the subjects exhibited severe cognitive impairment. Compared to normative data all subjects had normal odor identification and discrimination. However, odor thresholds were well below the median of a normal population. There were no significant differences between stage A, B or C subjects. This may be interpreted as indicating that olfactory dysfunction is among the primary deficits of HIV infection and occurs independently of disease stage. These results confirm previous work suggesting that odor thresholds are elevated early in HIV infection whereas a decline in identification and discrimination abilities is correlated with reduced cognitive abilities.

AIDS-Related Opportunistic Infections↗

Paradoxical association between smoking and olfactory identification in psychosis versus controls.

OBJECTIVE: Deficits in olfactory identification have been demonstrated in patients with schizophrenia. This study examined the interaction between smoking and olfactory identification in patients with psychotic disorders versus well controls. METHOD: Olfactory identification was assessed in three groups of subjects using the University of Pennsylvania Smell Identification Test (UPSIT). Sixteen patients with affective psychoses, 22 patients with nonaffective psychoses, and 21 well controls were tested. RESULTS: There was a significant interaction between diagnostic classification (patient or control) and smoking. Patients who were smokers scored higher on the UPSIT than non-smokers, while controls who were smokers scored lower than non-smokers. CONCLUSIONS: Smoking may have a 'normalising' effect on olfactory identification in some patients with psychosis. Further studies are needed to examine the relationship between psychosis, olfactory identification and the effects of nicotine.

Adult↗

Dental, visual, auditory and olfactory complications in Paget's disease of bone.

OBJECTIVE: To determine the prevalence of dental problems in Paget's patients and in a control population without Paget's disease. The relationship of localization of bony involvement of Paget's disease with the prevalence of dental, auditory, visual, and smell changes is examined. DESIGN: Cross-sectional national survey. PARTICIPANTS: Four hundred ninety-eight subjects with Paget's disease were generated randomly from the mailing list of the Paget Foundation. INTERVENTION: Each subject was sent a cover letter, two questionnaires, and a stamped, addressed return envelope. One questionnaire contained questions specific for the individual with Paget's disease. Subjects were asked to give the other questionnaire, which contained the same questions except for those asking about the specifics of Paget's disease, to an unaffected spouse or a similar aged friend. MEASUREMENTS: All subjects were asked about their age, gender, race, educational level, income, living situation, chronic medical conditions, self-rating of their general physical and dental health, the number of teeth present, and the presence of dental, auditory, visual, and olfactory problems. Paget's subjects were also asked to indicate which bones were affected. RESULTS: Paget's disease subjects assessed their oral health to be poorer than the controls. Paget's subjects were more likely to report pain when opening the mouth and were more likely to have had dental extractions. A significantly higher percentage of Paget's individuals with facial or maxillomandibular involvement reported having heart trouble. Paget's individuals with skull, facial or maxillo-mandibular involvement were more likely to report a change in their hearing, sight, and smell than Paget's subjects without involvement of the craniofacial complex. Dental problems were reported by 93% of those Paget's subjects with maxillomandibular involvement, compared with only 10% for those with skull involvement only or involvement at sites distant to the craniofacial complex. CONCLUSIONS: Patients with Paget's disease of bone involving facial or maxillo-mandibular parts of the skeleton have a higher prevalence of change in hearing, sight, smell, and dental problems. We also have found an association of heart disease in patients who have involvement of facial or maxillo-mandibular bones.

Adult↗

Johnson-McMillin syndrome: report of another family.

We describe a mother and son with facial nerve palsy, multiple truncal café-au-lait spots, and mild developmental delay. The mother also had hyposmia, increased tendency to caries, and growth retardation, and the son hypotrichosis, hearing loss, and microtia. This apparently autosomal dominant disorder was described first by Johnson et al. [1983: Am J Med Genet 15:497-506] and Johnston et al. [1987: Am J Med Genet 26:925-927].

Adult↗

The olfactory and cognitive deficits of Parkinson's disease: evidence for independence.

In the present study we sought to determine whether the olfactory deficits of parkinsonism are related to the cognitive and perceptual-motor manifestations of the disease. Pearson correlation coefficients were computed among a number of olfactory, neurological, and neuropsychological measures obtained from 58 Parkinson's disease patients, including the University of Pennsylvania Smell Identification Test, a modified Randt memory test, a reaction time test, a finger-tapping test, ratings of motor and neurological function, and selected verbal and performance subtests of the Wechsler Adult Intelligence Scale--Revised. Data from 38 patients with Parkinson's disease who received odor detection threshold testing were also evaluated. The intercorrelation matrix was subjected to a principal components factor analysis which yielded six clear-cut factors: cognitive/memory, gross motor, oral motor, fine motor, olfactory, and tremor. The olfactory factor received strong and nearly exclusive loadings from the olfactory measures (which did not evidence meaningful loadings on any of the other factors). A ten-trial jackknife procedure revealed the factor structure to be stable. Further support of the independence of the olfactory variables from the other measures was provided by multiple regression and canonical correlation analyses. Overall, these findings lend support to the hypothesis that the olfactory disorder of parkinsonism is independent of the cognitive, perceptual-motor, and memory manifestations of the disease.

Aged↗

Idiopathic hypogonadotrophic hypogonadism associated with arachnoid cyst of the middle fossa and forebrain anomalies: presentation of an unusual case.

We report a 22-yr-old male patient with hypogonadotrophic hypogonadism (HH) associated with a giant middle fossa arachnoid cyst (AC) diagnosed by magnetic resonance imaging (MRI). He presented with pubertal and growth delay. He also had learning disabilities and anosmia. Laboratory investigation revealed pre-pubertal levels of testosterone and normal results of the combined test of anterior pituitary function, except for in GnRH acute and prolonged test. Cranial MRI showed an AC in left middle fossa with expansion to suprasellar cisterna and several abnormalities like left temporal lobe hypoplasia, left optic tract and bilateral olfactory bulb hypoplasia and left hypothalamic hypoplasia.

Adult↗

Apolipoprotein epsilon4 is associated with more rapid decline in odor identification than in odor threshold or Dementia Rating Scale scores.

Individuals with the apolipoprotein E epsilon4 genetic risk factor for Alzheimer's disease (AD) show deficits in olfactory function. The purpose of the present study was to examine longitudinally odor identification (odor ID), odor threshold, picture identification, and global cognitive status in allele positive (epsilon4+) and negative (epsilon4-) persons. Participants were initially given the San Diego Odor Identification test, an odor threshold test, and the Dementia Rating Scale (DRS). Participants were re-tested approximately four years later. The results indicate: (1) odor ID declined more rapidly in epsilon4+ than in epsilon4- normal elderly adults; (2) neither group exhibited a significant decline in odor threshold, picture identification or DRS scores. These results suggest that declines in odor identification occur before declines in other measures of dementia in persons at risk for AD because of their APOE allele genetic status.

Aged↗