Olfaction and risk of dementia in a biracial cohort of older adults

Yaffe, Kristine; Freimer, Daniel; Chen, Honglei; Asao, Keiko; Rosso, Andrea L.; Rubin, Susan M.; Tranah, Greg; Cummings, Steve; Simonsick, Eleanor M.

doi:10.1212/wnl.0000000000003558

Cited by 87 publications

(106 citation statements)

References 44 publications

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“…Specifically, we demonstrate the predictive power of olfaction in addition to cognition by including baseline cognitive function as a covariate in the analyses and by confirming results after excluding individuals with SPMSQ scores indicating high dementia risk. An additional strength that gives this study its broad implications is that olfaction is predictive of dementia even in cognitively intact older adults, extending prior work with high‐risk populations and smaller, more‐homogenous samples …”

Section: Discussionmentioning

confidence: 66%

Olfactory Dysfunction Predicts Subsequent Dementia in Older U.S. Adults

Adams

Kern

Wroblewski

et al. 2017

J American Geriatrics Society

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Objectives To investigate the relationship between olfactory dysfunction and subsequent diagnosis of dementia. Design Longitudinal study of a population representative of U.S. older adults. Setting Home interviews (National Social Life, Health, and Aging Project). Participants Men and women aged 57 to 85 (N = 2,906). Measurements Objective odor identification ability was measured at baseline using a validated five‐item test. Five years later, the respondent, or a proxy if the respondent was too sick to interview or had died, reported physician diagnosis of dementia. The association between baseline olfactory dysfunction and an interval dementia diagnosis was tested using multivariate logistic regression, controlling for age, sex, race and ethnicity, education, comorbidities (modified Charlson Comorbidity Index), and cognition at baseline (Short Portable Mental Status Questionnaire). Results Older adults with olfactory dysfunction had more than twice the odds of having developed dementia 5 years later (odds ratio = 2.13, 95% confidence interval = 1.32–3.43), controlling for the above covariates. Having more odor identification errors was associated with greater probability of an interval dementia diagnosis (P = .04, 1‐degree of freedom linear‐trend test). Conclusion We show for the first time in a nationally representative sample that home‐dwelling older adults with normal cognition and difficulty identifying odors face higher odds of being diagnosed with dementia 5 years later, independent of other significant risk factors. This validated five‐item odor identification test is an efficient, low‐cost component of the physical examination that can provide useful information while assessing individuals’ risk of dementia. Use of such testing may provide an opportunity for early interventions to reduce the attendant morbidity and public health burden of dementia.

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Section: Discussionmentioning

confidence: 66%

Olfactory Dysfunction Predicts Subsequent Dementia in Older U.S. Adults

Adams

Kern

Wroblewski

et al. 2017

J American Geriatrics Society

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“…Effect modification by race was examined in one study, which stratified its cohort into black and white. The magnitude of association between olfactory impairment and risk of dementia was significant among both groups; however, the association was weaker among black compared with white participants …”

Section: Resultsmentioning

confidence: 82%

“…Interestingly, the presence of apolipoprotein E (APOE)‐e4 allele was found to modify the effect of olfactory impairment and cognitive decline in one study, wherein the association was strongest among those who were anosmic with at least one allele (OR 4.93, 95% CI, 1.63–14.91), especially among women (OR 9.71, 95% CI 1.34–70.44). However, a different study found no interaction between APOE genotype and olfactory impairment on incident dementia.…”

Section: Resultsmentioning

confidence: 90%

“…In another study, decrease in the 13‐item SOIT score was associated with higher risk of developing dementia at 10 years (adjusted OR = 1.12, 95% CI 1.02–1.23) . When BSIT scores were analyzed as tertiles, the unadjusted odds of developing incident dementia among “poor” odor identification group compared to “moderate” or “good” groups was 2.58 (95% CI 2.09–3.19) at the 12‐year follow‐up time …”

Section: Resultsmentioning

confidence: 98%

“…However, this study included only two longitudinal cohort studies, precluding strong conclusions about the predictive utility of olfactory impairment . Several longitudinal studies have been published since 2012 that support the predictive value of olfactory testing in future cognitive decline …”

Section: Introductionmentioning

confidence: 99%

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Predictive value of olfactory impairment for cognitive decline among cognitively normal adults

Windon

Kim

et al. 2019

The Laryngoscope

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Objective Dementia affects over 47 million people worldwide. Olfactory impairment (OI) is a well‐established predictive marker of conversion to dementia among those with mild cognitive impairment. This systematic review aims to describe the predictive value of OI for future cognitive decline among cognitively normal adults. Methods A literature search encompassing PubMed, EMBASE, and Cochrane for longitudinal cohort studies following cognitively normal adults with baseline OI in comparison to those without OI reporting incident cognitive impairment or dementia was included. Study design, participant demographics, olfactory testing method, and incidence of cognitive decline or dementia were abstracted. Two investigators independently reviewed all articles. Results The search yielded 964 nonduplicate abstracts and titles, from which 19 full‐text articles were reviewed and 10 were included. Studies included were all good quality (mean score 8.7 of 9), and all studies (100%) found a statistically significant association between baseline OI and incident cognitive decline compared with normosmic controls. Conclusion The existing literature suggests that OI predicts future cognitive decline among cognitively normal adults, supporting olfactory evaluation as a low‐cost, minimally invasive, and widely available screening tool to be used in combination with other tests to identify adults at early risk of dementia. Level of Evidence NA Laryngoscope, 130:840–847, 2020

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Assessment of Self-reported Sense of Smell, Objective Testing, and Associated Factors in Middle-aged and Older Women

Cao

Yang

D’Aloisio

et al. 2022

JAMA Otolaryngol Head Neck Surg

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IMPORTANCEPoor olfaction is common in older adults and signifies multiple adverse health outcomes, but it often goes unrecognized.OBJECTIVE To characterize the self-awareness of poor olfaction in women, including its prevalence, associated factors, reporting reliability, validity against an objective test, and factors associated with validity. DESIGN, SETTING, AND PARTICIPANTS These cross-sectional survey data and a case-control subsample were taken from the National Institute of Environmental Health Sciences' Sister Study. Of 41 118 participants (aged 41-85 years) who reported olfaction in 2014 through 2016, 3406 (aged 50-79 years) reported olfaction again in 2018 through 2019 and completed the 12-item Brief Smell Identification Test, version A, including 2353 women who self-reported poor olfaction in 2014 through 2016 and 1053 women who reported normal olfaction. Data analyses were performed between May 28, 2021, and December 23, 2021.MAIN OUTCOMES AND MEASURES Self-reported (yes/no) and objectively tested poor olfaction defined as a Brief Smell Identification Test score of 9 or lower. Multivariable logistic regressions were used to assess factors that might be associated with the prevalence and reporting accuracy of self-reported olfaction. In subsample analyses, the sampling strategy was accounted for to extrapolate data to eligible cohort samples. RESULTSOf the 41 118 women (mean [SD] age, 64.3 [8.7] years) included in the analysis, 3322 (8.1%) self-reported poor olfaction. Higher prevalence was associated with older age, not being married, current smoking status, frequent coffee drinking, overweight or obesity, less than optimal health, Parkinson disease, cognitive impairment, depression, anxiety, and seasonal allergy, whereas a lower prevalence was associated with non-Hispanic Black race and physical activity. In the subsample analyses, olfaction status reported 3 years apart showed a modest agreement (κ, 0.56; 95% CI, 0.51-0.61). The prevalence of objectively tested poor olfaction was 13.3% (95% CI, 11.5%-15.0%), and in contrast with self-reports, it was twice as high in non-Hispanic Black women as in non-Hispanic White women (24.5% vs 12.5%). Compared with objective tests, self-reports showed a low sensitivity (22.6%; 95% CI, 19.6%-25.6%), especially in non-Hispanic Black women (12.4%; 95% CI, 7.0%-17.8%). The specificity was uniformly high (>90%). Among participants who reported poor olfaction, higher odds of true vs false positives were associated with age older than 60 years (60-64

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Olfaction and risk of dementia in a biracial cohort of older adults

Cited by 87 publications

References 44 publications

Olfactory Dysfunction Predicts Subsequent Dementia in Older U.S. Adults

Olfactory Dysfunction Predicts Subsequent Dementia in Older U.S. Adults

Predictive value of olfactory impairment for cognitive decline among cognitively normal adults

Assessment of Self-reported Sense of Smell, Objective Testing, and Associated Factors in Middle-aged and Older Women

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