4.6 Article

Olfactory Dysfunction Is Associated with Neuropsychiatric Manifestations in Parkinson's Disease

Journal

MOVEMENT DISORDERS
Volume 26, Issue 11, Pages 2051-2057

Publisher

WILEY
DOI: 10.1002/mds.23792

Keywords

Parkinson's disease; olfaction; nonmotor symptoms; psychiatric symptoms; cognitive symptoms

Funding

  1. NIH [K23 MH067894, NINDS U10 NS044451-023, NINDS P50 NS053488-01, NINDS R43NS0636071, NINDS R01NS065087]
  2. Teva Pharmaceutical Industries Ltd.
  3. Avid Radiopharmaceuticals, Inc.
  4. Boehringer Ingelheim
  5. National Institutes of Health [NIMH K23 MH067894]
  6. NINDS [P50 NS053488-01, R01NS065087]
  7. NIA [RO1AG031348]
  8. Michael J. Fox Foundation for Parkinson's Research
  9. Institute for Neurodegenerative Disorders
  10. U.S. Department of Veterans Affairs
  11. Michael J. Fox Foundation
  12. Samueli Institute
  13. C.R. Bard, Inc.
  14. Celgene
  15. Clarient, Inc.
  16. Johnson Johnson

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Hyposmia, psychiatric disorders, and cognitive problems are common nonmotor manifestations in Parkinson's disease, but how they are related remains unclear. We investigated the relationship between olfactory dysfunction and neuropsychiatric manifestations and performed a cross-sectional study of 248 patients at two movement disorders clinics at academic medical centers. Psychiatric measures were the Geriatric Depression Scale-15, Inventory of Depressive Symptomatology, State Anxiety Inventory, Apathy Scale, and Parkinson's Psychosis Rating Scale. Cognitive measures were the Mini-Mental State Examination, Hopkins Verbal Learning Test-Revised, Digit Span, Tower of London-Drexel, and the Stroop Color Word Test. Olfaction was tested with the University of Pennsylvania Smell Identification Test. There was no significant association between olfaction and mood measures, but psychotic symptoms were more common in patients with olfaction scores below the median (30% vs. 12%; P < 0.001). Worse olfaction was associated with poorer memory (Hopkins Verbal Learning Test-Revised delayed recall items: mean [standard deviation], 6.2 [3.2] vs. 8.4 [2.8]; P < 0.001) and executive performance (Tower of London total moves, 52 [38] vs. 34 [21]; P < 0.001). Odor-identification score was a significant predictor of abnormal performance on these cognitive tests after adjustment for age, sex, and disease characteristics in logistic regression models. The relationship between hyposmia, psychosis, and specific cognitive impairments may reflect the anatomic distribution of Lewy pathology and suggests that olfactory dysfunction could be a biomarker of additional extranigral disease. Future prospective studies are warranted to assess whether hyposmia, a very early feature of Parkinson's disease, might be used to predict the appearance of other common nonmotor symptoms. (C) 2011 Movement Disorder Society

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