Effect of intensive olfactory training for cognitive function in patients with dementia

Older adults represent the fastest-growing segment of the US population, and prevalences of vision and hearing impairment have been extensively evaluated. However, despite the importance of sense of smell for nutrition and safety, the prevalence of olfactory impairment in older US adults has not been studied. To determine the prevalence of olfactory impairment in older adults. A total of 2491 Beaver Dam, Wis, residents aged 53 to 97 years participating in the 5-year follow-up examination (1998-2000) for the Epidemiology of Hearing Loss Study, a population-based, cross-sectional study. Olfactory impairment, assessed by the San Diego Odor Identification Test and self-report. The mean (SD) prevalence of impaired olfaction was 24.5% (1.7%). The prevalence increased with age; 62.5% (95% confidence interval [CI], 57.4%-67.7%) of 80- to 97-year-olds had olfactory impairment. Olfactory impairment was more prevalent among men (adjusted prevalence ratio, 1.92; 95% CI, 1.65-2.19). Current smoking, stroke, epilepsy, and nasal congestion or upper respiratory tract infection were also associated with increased prevalence of olfactory impairment. Self-reported olfactory impairment was low (9.5%) and this measure became less accurate with age. In the oldest group, aged 80 to 97 years, sensitivity of self-report was 12% for women and 18% for men. This study demonstrates that prevalence of olfactory impairment among older adults is high and increases with age. Self-report significantly underestimated prevalence rates obtained by olfaction testing. Physicians and caregivers should be particularly alert to the potential for olfactory impairment in the elderly population. Show more

The sense of smell is today one of the focuses of interest in aging and neurodegenerative disease research. In several neurodegenerative diseases, such as Parkinson's disease and Alzheimer's disease, the olfactory dysfunction is one of the initial symptoms appearing years before motor symptoms and cognitive decline, being considered a clinical marker of these diseases' early stages and a marker of disease progression and cognitive decline. Overall and under the umbrella of precision medicine, attention to olfactory function may help to improve chances of success for neuroprotective and disease-modifying therapeutic strategies. Show more

The neural plasticity of the olfactory system offers possibilities of treatment in terms of stimulation of the sense of smell, and different studies have suggested effectiveness of smell training, i.e., daily exposition to certain odors. To obtain reliable and precise estimates of overall treatment benefit on the olfactory function, we meta-analyzed the effects of smell training reported in 13 previous studies. We analyzed the smell training effectiveness across three different olfactory abilities, smell identification, discrimination and threshold for odor detection. We found a significant, positive effect of olfactory training for all olfactory abilities, with large effects of training on identification, discrimination and TDI-score and small-to-moderate effect in the case of threshold for odor detection. Interestingly, the pattern of results differed across Sniffin Sticks subtests depending on the origin of participants smell disorder, and the smell training duration influenced its effectiveness in the case of identification and the TDI score. Although the exact mechanism of olfactory recovery following the smell training still requires further investigation, our meta-analysis showed that such training should be considered an addition or alternative to existing smell treatment methods. Show more