Olfactory function in atypical parkinsonian syndromes

Wenning, Gregor K.; Shephard, B.C.; Hawkes, Chris; Petruckevitch, Ann; Lees, Andrew J.; Quinn, Niall

doi:10.1111/j.1600-0404.1995.tb06998.x

Cited by 212 publications

(145 citation statements)

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“…Part B of the table: Preferred cutoffs of predictive scores were determined by Youden's index in the discovery cohort and, in a subgroup analysis, did not differ between sexes. SS‐8 = subscore of the eight best‐discriminating odors (licorice, anise, mint, cinnamon, banana, pineapple, rose, and coffee).aResults represent means ± standard deviation; P values calculated using Mann‐Whitney's U test.b P value calculated using chi‐square test.cAdditional lower cutoffs were applied in the distinction versus DDs because a mildly decreased sense of smell had been reported in MSA, PSP, and ET patients2, 5 and our model was established in a comparison of PD patients with HCs (discovery cohort).MMSE, Mini–Mental State Examination; NA, not applicable.…”

Section: Resultsmentioning

confidence: 99%

“…Additional lower cutoffs were applied in the distinction versus DDs because a mildly decreased sense of smell had been reported in MSA, PSP, and ET patients2, 5 and our model was established in a comparison of PD patients with HCs (discovery cohort).…”

Section: Resultsmentioning

confidence: 99%

“…Olfactory deficits affect 75% to 90% of patients with Parkinson's disease (PD), and olfactory testing may also represent a sensitive screening test for individuals at risk of developing PD,1, 2, 3, 4 whereas olfactory function is normal or only mildly impaired in other forms of degenerative parkinsonism or essential tremor (ET) 2, 5. Olfactory testing has recently been incorporated in the newly established International Parkinson and Movement Disorder Society criteria for PD6 and prodromal PD 7…”

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confidence: 99%

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Optimizing odor identification testing as quick and accurate diagnostic tool for Parkinson's disease

Mahlknecht

Pechlaner²,

Boesveldt

et al. 2016

Mov Disord.

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IntroductionThe aim of this study was to evaluate odor identification testing as a quick, cheap, and reliable tool to identify PD.MethodsOdor identification with the 16‐item Sniffin' Sticks test (SS‐16) was assessed in a total of 646 PD patients and 606 controls from three European centers (A, B, and C), as well as 75 patients with atypical parkinsonism or essential tremor and in a prospective cohort of 24 patients with idiopathic rapid eye movement sleep behavior disorder (center A). Reduced odor sets most discriminative for PD were determined in a discovery cohort derived from a random split of PD patients and controls from center A using L1‐regularized logistic regression. Diagnostic accuracy was assessed in the rest of the patients/controls as validation cohorts.ResultsOlfactory performance was lower in PD patients compared with controls and non‐PD patients in all cohorts (each P < 0.001). Both the full SS‐16 and a subscore of the top eight discriminating odors (SS‐8) were associated with an excellent discrimination of PD from controls (areas under the curve ≥0.90; sensitivities ≥83.3%; specificities ≥82.0%) and from non‐PD patients (areas under the curve ≥0.91; sensitivities ≥84.1%; specificities ≥84.0%) in all cohorts. This remained unchanged when patients with >3 years of disease duration were excluded from analysis. All 8 incident PD cases among patients with idiopathic rapid eye movement sleep behavior disorder were predicted with the SS‐16 and the SS‐8 (sensitivity, 100%; positive predictive value, 61.5%).ConclusionsOdor identification testing provides excellent diagnostic accuracy in the distinction of PD patients from controls and diagnostic mimics. A reduced set of eight odors could be used as a quick tool in the workup of patients presenting with parkinsonism and for PD risk indication. © 2016 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

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Optimizing odor identification testing as quick and accurate diagnostic tool for Parkinson's disease

Mahlknecht

Pechlaner²,

Boesveldt

et al. 2016

Mov Disord.

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“…The results of a recent longitudinal study in 2267 elderly men in the Honolulu Heart Study demonstrate that loss of olfaction can precede PD motor symptoms by at least 4 years, thereby suggesting that it could serve as a screening tool to predict the future development of PD (Ross et al, 2008). There is also evidence that olfactory disturbances could be used to differentiate PD from other movement disorders such as progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD), but not from multiple system atrophy (MSA) (Wenning et al, 1995;Hummel et al, 1997;Muller et al, 2002b). In light of these observations, the American Academy of Neurology recommends the use of olfactory testing to differentiate PD from PSP and CBD, but not from MSA (McKinnon et al, 2007).…”

Section: Early Anosmiamentioning

confidence: 99%

Parkinson's Disease Therapeutics: New Developments and Challenges Since the Introduction of Levodopa

Smith

Wichmann

Factor

et al. 2011

Neuropsychopharmacol

194

137

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The demonstration that dopamine loss is the key pathological feature of Parkinson's disease (PD), and the subsequent introduction of levodopa have revolutionalized the field of PD therapeutics. This review will discuss the significant progress that has been made in the development of new pharmacological and surgical tools to treat PD motor symptoms since this major breakthrough in the 1960s. However, we will also highlight some of the challenges the field of PD therapeutics has been struggling with during the past decades. The lack of neuroprotective therapies and the limited treatment strategies for the nonmotor symptoms of the disease (ie, cognitive impairments, autonomic dysfunctions, psychiatric disorders, etc.) are among the most pressing issues to be addressed in the years to come. It appears that the combination of early PD nonmotor symptoms with imaging of the nigrostriatal dopaminergic system offers a promising path toward the identification of PD biomarkers, which, once characterized, will set the stage for efficient use of neuroprotective agents that could slow down and alter the course of the disease.

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“…Olfactory function can vary from normal to strongly impaired in APS [17][18][19]. Olfactory testing is officially recommended by the European Federation of Neurological Societies and the Movement Disorder Society in order to differentiate PD from other parkinsonian disorders [20].…”

Section: Introductionmentioning

confidence: 99%

The diagnostic value of dopamine transporter imaging and olfactory testing in patients with parkinsonian syndromes

et al. 2015

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The aim of the study was to compare the efficacy of olfactory testing and presynaptic dopamine imaging in diagnosing Parkinsons disease (PD) and atypical parkinsonian syndromes (APS); to evaluate if the combination of these two diagnostic tools can improve their diagnostic value. A prospective investigation of 24 PD patients, 16 APS patients and 15 patients with non-parkinsonian syndromes was performed during an 18-month period. Single photon emission computed tomography with the presynaptic radioligand I-123-FP-CIT (DaTSCAN (R)) and olfactory testing with the Brief 12-item Smell Identification Test (B-SIT) were performed in all patients. DaTSCAN was analysed semi-quantitatively, by calculating two different striatal uptake ratios, and visually according to a predefined ranking scale. B-SIT score was significantly lower for PD patients, but not significantly different between APS and non-parkinsonism. The visual assessment of DaTSCAN had higher sensitivity, specificity and diagnostic accuracy compared to olfactory testing. Most PD patients (75 %) had visually predominant dopamine depletion in putamen, while most APS patients (56 %) had visually severe dopamine depletion both in putamen and in caudate nucleus. The combination of DaTSCAN and B-SIT led to a higher rate of correctly classified patients. Olfactory testing can distinguish PD from non-parkinsonism, but not PD from APS or APS from non-parkinsonism. DaTSCAN is more efficient than olfactory testing and can be valuable in differentiating PD from APS. However, combining olfactory testing and DaTSCAN imaging has a higher predictive value than these two methods separately.

Funding Agencies|Ostergotland County Council (ALF); Swedish Parkinsons Foundation

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Olfactory function in atypical parkinsonian syndromes

Cited by 212 publications

References 20 publications

Optimizing odor identification testing as quick and accurate diagnostic tool for Parkinson's disease

Optimizing odor identification testing as quick and accurate diagnostic tool for Parkinson's disease

Parkinson's Disease Therapeutics: New Developments and Challenges Since the Introduction of Levodopa

The diagnostic value of dopamine transporter imaging and olfactory testing in patients with parkinsonian syndromes

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