Is normosmic Parkinson disease a unique clinical phenotype?

Lee, Dong Hoon; Oh, Jungsu S.; Ham, Jee Hyun; Lee, Jae J.; Lee, Injoo; Lee, Phil H.; Kim, Jae Seung; Sohn, Young H.

doi:10.1212/wnl.0000000000001999

Cited by 54 publications

(51 citation statements)

References 29 publications

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“…A recent study by Lee et al however, found a prevalence of only 46.1% of abnormal smell in PD despite PET imaging confirmation of nigrostriatal denervation in the patients (Lee et al 2015). A plausible explanation for this significant discrepancy in prevalence is that Lee et al used an abbreviated odor identification test of only 12 odors.…”

Section: Discussionmentioning

confidence: 98%

“…However, there is inconsistency in the literature regarding the prevalence of hyposmia, with estimates ranging from slightly below 50% to roughly 97% (Haehner et al 2009; Lee et al 2015). Factors affecting hyposmia frequency estimates in PD may include the type of olfactory test, normative data to which patients were compared, age distribution and duration of disease (Haehner et al 2009).…”

Section: Introductionmentioning

confidence: 99%

“…Factors affecting hyposmia frequency estimates in PD may include the type of olfactory test, normative data to which patients were compared, age distribution and duration of disease (Haehner et al 2009). For example, the recent study by Lee et al showing a low hyposmia rate included PD patients with disease duration of 3 years or less (Lee et al 2015) Another factor that may explain the significantly lower hyposmia rate in the Lee et al study is the use of normative cut-off values that are in part derived from unscreened elderly subjects. An additional factor is the uncertainty of a PD diagnosis in patients with clinical symptoms without confirmed nigrostriatal denervation.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Prevalence of impaired odor identification in Parkinson disease with imaging evidence of nigrostriatal denervation

et al. 2016

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There is wide variability in reported prevalence rates of abnormal smell in Parkinson disease (PD). This study assessed the prevalence of abnormal smell, using the University of Pennsylvania Smell Identification Test (UPSIT), in 183 patients with PD with confirmed PET imaging evidence of nigrostriatal denervation. Impaired olfaction in this sample was nearly universal (97.8%). Wide-ranging prior olfactory impairment estimates may reflect not only uncertainty regarding diagnostic classification, but also the use of inaccurate normative data and differences in olfactory tests used.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prevalence of impaired odor identification in Parkinson disease with imaging evidence of nigrostriatal denervation

et al. 2016

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“…In a large cohort of de novo patients, it was reported that PD patients with hyposmia exhibit more severe motor symptoms and required greater levodopa-equivalent at a 2.5-year followup compared to those patients with normal olfactory function [12]. The growing importance of olfaction as a diagnostic and predictive tool in individual with PD highlights the need for further examination.…”

Section: Introductionmentioning

confidence: 99%

Aerobic Exercise Preserves Olfaction Function in Individuals with Parkinson’s Disease

Rosenfeldt

Dey

Alberts

2016

Parkinson's Disease

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Introduction. Based on anecdotal reports of improved olfaction following aerobic exercise, the aim of this study was to evaluate the effects of an 8-week aerobic exercise program on olfaction function in individuals with Parkinson's disease (PD). Methods. Thirty-eight participants with idiopathic PD were randomized to either an aerobic exercise group (n = 23) or a nonexercise control group (n = 15). The aerobic exercise group completed a 60-minute cycling session three times per week for eight weeks while the nonexercise control group received no intervention. All participants completed the University of Pennsylvania Smell Identification Test (UPSIT) at baseline, end of treatment, and a four-week follow up. Results. Change in UPSIT scores between the exercise and nonexercise groups from baseline to EOT (p = 0.01) and from baseline to EOT+4 (p = 0.02) favored the aerobic exercise group. Individuals in the nonexercise group had worsening olfaction function over time, while the exercise group was spared from decline. Discussion. The difference in UPSIT scores suggested that aerobic exercise may be altering central nervous system pathways that regulate the physiologic or cognitive processes controlling olfaction in individuals with PD. While these results provide promising preliminary evidence that exercise may modify the disease process, further systematic evaluation is necessary.

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“…Although he was negative for the G2019S LRKK2 gene mutation, the likely monogenic cause of his PD may be an explanation for the atypical study findings with evidence of reduced SN hyperechogenicity in some monogenic, compared to idiopathic PD, cases, and a marked reduction of RBD in LRRK2 cohorts compared to idiopathic PD . Normosmic PD has also been associated with a more benign course . The other PD patient with a risk score of <2 was a 59 year old with hyposmia (score, 1) who had “always been constipated” (score, 0) and could not be insonated on TCS (score, 0).…”

Section: Discussionmentioning

confidence: 98%

A Brief Nonmotor Screen Combined with Transcranial Ultrasound may Improve Diagnostic Accuracy of Parkinson's Disease

Hayes

Puhl

Hagenah

et al. 2016

Movement Disord Clin Pract

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Background The addition of a simple nonmotor symptom (NMS) screen and transcranial sonography (TCS) to standard clinical assessment may improve the diagnostic accuracy of Parkinson's disease (PD). Methods Sixty‐nine subjects (23 established PD group, 23 healthy controls, and 23 possible PD) were enrolled. All completed 3 “yes‐no” NMS questions (score, 0–3) and had a transcranial ultrasound assessing nigral hyperechogenicity (score, 0–1). A combined PD risk score of 0 to 4 was obtained for each subject. A PD risk score of ≥2 was used as the diagnostic cutoff for PD. Results In the established PD group, there was an average of 2 NMSs per person or a group total of 46 of 69 possible NMSs, but only 4 of 69 NMSs in the healthy control group. Of the technically satisfactory TCS, 16 of 20 (80%) of the established PD group and 2 of 16 (12.5%) of the healthy control group were TCS positive. Using ≥2 NMSs alone as the cutoff identified 17 of 23 (74%) of the established PD and 100% of the healthy controls. The PD risk score of ≥2 identified 21 of 23 (91%) of the established PD as PD and 22 of 23 (96%) of the healthy control group as non‐PD. In the possible PD group, the PD risk score identified 9 of 18 (50%) of those with a final clinical diagnosis of PD and 4 of 5 (80%) of non‐PD. Conclusions The combination of a brief NMS screen and TCS discriminated well between normal healthy controls and established PD. A positive TCS and one NMS, or a negative TCS with two NMSs, indicated a likely diagnosis of PD.

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Is normosmic Parkinson disease a unique clinical phenotype?

Cited by 54 publications

References 29 publications

Prevalence of impaired odor identification in Parkinson disease with imaging evidence of nigrostriatal denervation

Prevalence of impaired odor identification in Parkinson disease with imaging evidence of nigrostriatal denervation

Aerobic Exercise Preserves Olfaction Function in Individuals with Parkinson’s Disease

A Brief Nonmotor Screen Combined with Transcranial Ultrasound may Improve Diagnostic Accuracy of Parkinson's Disease

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