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Erfanian R, Taherkhani S, Abdullah H, Sohrabpour S, Emami H, Hoorang M, Amirzargar B. New Modification of Smell Identification Test for the Detection of Malingerers: A Pilot Experimental Study. IRANIAN JOURNAL OF MEDICAL SCIENCES 2022; 47:248-255. [PMID: 35634524 PMCID: PMC9126901 DOI: 10.30476/ijms.2021.89049.1977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/30/2021] [Accepted: 03/13/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND A major problem with the University of Pennsylvania Smell Identification Test (UPSIT) is its poor sensitivity for malingering detection in a group of people familiar with the test mechanism. This study aimed to evaluate the modification of UPSIT to detect anosmia malingering. METHODS This was a pilot experimental study conducted in 2019 in Tehran. The participants were 60 healthy subjects classified into two groups of 30 people. The first group was requested to deliberately feign a negative result on the Iranian version of UPSIT, Iran Smell Identification Test (ISIT) (malingering group). The second group consisted of participants, who did not scratch the odorant part of ISIT during the tests (anosmia group). ISIT was modified in two steps. At each step, one incorrect option was deleted from the available choices. The number of each group's answers, altered away from the correct choice, was then calculated and compared. RESULTS The coached malingering group participants were able to feign anosmia in the original ISIT exam. In the modified ISIT, the number of answers changed from correct to wrong during the second stage (from three available choices to two choices) was significantly higher in the anosmia group (P<0.001). In the ROC analysis, the area under the curve was 0.92 (P<0.001). The cut-off of 4.5 for this test showed 93% sensitivity, 82% specificity, and 90% PPV and NPV. CONCLUSION The ISIT is not capable of detecting malingering in the coached participants, yet by deleting the choices step-by-step, the sensitivity and specificity of the test increased.
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Affiliation(s)
- Reza Erfanian
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Safa Taherkhani
- Department of Biomedical Engineering (Center of Excellence), Amirkabir University of Technology, Tehran, Iran
| | - Hakima Abdullah
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Sohrabpour
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Emami
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Hoorang
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Behrooz Amirzargar
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Kim JW, Kim HS, Kim M, Kim SH, Cho SW, Kim JY. Validation of Olfactory Questionnaire in Koreans: an Alternative for Conventional Psychophysical Olfactory Tests. J Korean Med Sci 2021; 36:e34. [PMID: 33559405 PMCID: PMC7870423 DOI: 10.3346/jkms.2021.36.e34] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/30/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The patients with coronavirus disease 2019 (COVID-19), a worldwide pandemic infection, frequently complain of olfactory disorders. However, psychophysical olfactory tests performed by an examiner are very difficult in these highly infectious patients. This study aimed to develop and validate a questionnaire for olfactory function that can be readily used to evaluate olfactory loss. METHODS Fourteen smell-related questions were created based on smells familiar to Koreans. Among them, questions with a κ value of 0.6 or higher were finally selected through a test-retest reliability analysis. The correlations between the scores of the olfactory questionnaire and those of olfactory function tests (Butanol Threshold Test [BTT] and Cross Cultural Smell Identification Test [CCSIT]) were analyzed. To evaluate the predictive ability of the questionnaire and elicit cutoff values, receiver operating characteristic (ROC) curves were generated. RESULTS Out of the 14 questions in the questionnaire, 11 (κ > 0.6) were selected for the olfactory questionnaire. We analyzed 2,273 subjects, and there was a significant correlation between the total score of the olfactory questionnaire and the BTT (r = 0.643, P < 0.001) or CCSIT (r = 0.615, P < 0.001) scores. ROC curves for the olfactory questionnaire, BTT, and CCSIT all demonstrated high predictive power to discriminate anosmia and severe hyposmia from normosmia. Regarding mild to moderate hyposmia, however, ROC curve for the olfactory questionnaire alone showed high predictive power of discrimination from normosmia. Based on the results of ROC curves among the subclasses, we suggest the classification of the total score of the questionnaire as 0-4, 5-17, 18-27, 28-41, and 42-44, for anosmia, severe hyposmia, moderate hyposmia, mild hyposmia, and normosmia, respectively. CONCLUSION The total scores of the questionnaires correlated with the BTT and CCSIT scores. The symptom questionnaire for olfactory dysfunction may be useful as an alternative tool for olfactory function testing, when unavailable.
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Affiliation(s)
- Jeong Whun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyo Sang Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Minju Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Su Hwan Kim
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Woo Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin Youp Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
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de Tommaso M, Betti V, Bocci T, Bolognini N, Di Russo F, Fattapposta F, Ferri R, Invitto S, Koch G, Miniussi C, Piccione F, Ragazzoni A, Sartucci F, Rossi S, Valeriani M. Pearl and pitfalls in brain functional analysis by event-related potentials: a narrative review by the Italian Psychophysiology and Cognitive Neuroscience Society on methodological limits and clinical reliability-part II. Neurol Sci 2020; 41:3503-3515. [PMID: 32683566 DOI: 10.1007/s10072-020-04527-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 06/21/2020] [Indexed: 12/13/2022]
Abstract
This review focuses on new and/or less standardized event-related potentials methods, in order to improve their knowledge for future clinical applications. The olfactory event-related potentials (OERPs) assess the olfactory functions in time domain, with potential utility in anosmia and degenerative diseases. The transcranial magnetic stimulation-electroencephalography (TMS-EEG) could support the investigation of the intracerebral connections with very high temporal discrimination. Its application in the diagnosis of disorders of consciousness has achieved recent confirmation. Magnetoencephalography (MEG) and event-related fields (ERF) could improve spatial accuracy of scalp signals, with potential large application in pre-surgical study of epileptic patients. Although these techniques have methodological limits, such as high inter- and intraindividual variability and high costs, their diffusion among researchers and clinicians is hopeful, pending their standardization.
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Affiliation(s)
- Marina de Tommaso
- Applied Neurophysiology and Pain Unit-AnpLab-University of Bari Aldo Moro, Bari, Italy
| | - Viviana Betti
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,Fondazione Santa Lucia, Istituto Di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Tommaso Bocci
- Dipartimento di Scienze della Salute, University of Milano, Milan, Italy
| | - Nadia Bolognini
- Department of Psychology & NeuroMi, University of Milano Bicocca, Milan, Italy.,Laboratory of Neuropsychology, IRCCS Istituto Auxologico, Milan, Italy
| | - Francesco Di Russo
- Dept. of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | | | | | - Sara Invitto
- INSPIRE - Laboratory of Cognitive and Psychophysiological Olfactory Processes, University of Salento, Lecce, Italy
| | - Giacomo Koch
- Fondazione Santa Lucia, Istituto Di Ricovero e Cura a Carattere Scientifico, Rome, Italy.,Neuroscience Department, Policlinico Tor Vergata, Rome, Italy
| | - Carlo Miniussi
- Center for Mind/Brain Sciences - CIMeC, University of Trento, Rovereto, Italy.,Cognitive Neuroscience Section, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Francesco Piccione
- Brain Imaging and Neural Dynamics Research Group, IRCCS San Camillo Hospital, Venice, Italy
| | - Aldo Ragazzoni
- Unit of Neurology and Clinical Neurophysiology, Fondazione PAS, Scandicci, Florence, Italy
| | - Ferdinando Sartucci
- Section of Neurophysiopathology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,CNR Institute of Neuroscience, Pisa, Italy
| | - Simone Rossi
- Department of Medicine, Surgery and Neuroscience Siena Brain Investigation and Neuromodulation LAb (SI-BIN Lab), University of Siena, Siena, Italy
| | - Massimiliano Valeriani
- Neurology Unit, Bambino Gesù Hospital, Rome, Italy. .,Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark.
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Gudziol H, Guntinas-Lichius O. Electrophysiologic assessment of olfactory and gustatory function. HANDBOOK OF CLINICAL NEUROLOGY 2020; 164:247-262. [PMID: 31604551 DOI: 10.1016/b978-0-444-63855-7.00016-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This chapter reviews approaches for assessing human and gustatory function using electrophysiologic methods. Its focus is on changes in electrical signals, including summated generator potentials that occur after nasal or oral stimulation. In the first part of the review, we describe tools available to the clinician for assessing olfactory and nasotrigeminal function, including modern electroencephalography (EEG) analysis of brain responses both in the time domain and in the time-frequency (TF) domain. Particular attention is paid to chemosensory event-related potentials (CSERPs) and their potential use in medical-legal cases. Additionally, we focus on the changes of summated generator potentials from the olfactory and respiratory nasal epithelium that could provide new diagnostic insights. In the second part, we describe gustatory event-related potentials (gCSERPs) obtained using a relatively new computer controlled gustometer. A device for presenting different pulses of electrical current to the tongue is also described, with weaker pulses likely reflecting gCSERPs and stronger ones trigeminal CSERPs. Finally, summated generator potentials from the surface of the tongue during gustatory stimulation are described that may prove useful for examining peripheral taste function.
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Affiliation(s)
- Hilmar Gudziol
- Department of Otorhinolaryngology, University Hospital, Jena, Germany.
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Rapp PE, Keyser DO, Albano A, Hernandez R, Gibson DB, Zambon RA, Hairston WD, Hughes JD, Krystal A, Nichols AS. Traumatic brain injury detection using electrophysiological methods. Front Hum Neurosci 2015; 9:11. [PMID: 25698950 PMCID: PMC4316720 DOI: 10.3389/fnhum.2015.00011] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 01/07/2015] [Indexed: 11/20/2022] Open
Abstract
Measuring neuronal activity with electrophysiological methods may be useful in detecting neurological dysfunctions, such as mild traumatic brain injury (mTBI). This approach may be particularly valuable for rapid detection in at-risk populations including military service members and athletes. Electrophysiological methods, such as quantitative electroencephalography (qEEG) and recording event-related potentials (ERPs) may be promising; however, the field is nascent and significant controversy exists on the efficacy and accuracy of the approaches as diagnostic tools. For example, the specific measures derived from an electroencephalogram (EEG) that are most suitable as markers of dysfunction have not been clearly established. A study was conducted to summarize and evaluate the statistical rigor of evidence on the overall utility of qEEG as an mTBI detection tool. The analysis evaluated qEEG measures/parameters that may be most suitable as fieldable diagnostic tools, identified other types of EEG measures and analysis methods of promise, recommended specific measures and analysis methods for further development as mTBI detection tools, identified research gaps in the field, and recommended future research and development thrust areas. The qEEG study group formed the following conclusions: (1) Individual qEEG measures provide limited diagnostic utility for mTBI. However, many measures can be important features of qEEG discriminant functions, which do show significant promise as mTBI detection tools. (2) ERPs offer utility in mTBI detection. In fact, evidence indicates that ERPs can identify abnormalities in cases where EEGs alone are non-disclosing. (3) The standard mathematical procedures used in the characterization of mTBI EEGs should be expanded to incorporate newer methods of analysis including non-linear dynamical analysis, complexity measures, analysis of causal interactions, graph theory, and information dynamics. (4) Reports of high specificity in qEEG evaluations of TBI must be interpreted with care. High specificities have been reported in carefully constructed clinical studies in which healthy controls were compared against a carefully selected TBI population. The published literature indicates, however, that similar abnormalities in qEEG measures are observed in other neuropsychiatric disorders. While it may be possible to distinguish a clinical patient from a healthy control participant with this technology, these measures are unlikely to discriminate between, for example, major depressive disorder, bipolar disorder, or TBI. The specificities observed in these clinical studies may well be lost in real world clinical practice. (5) The absence of specificity does not preclude clinical utility. The possibility of use as a longitudinal measure of treatment response remains. However, efficacy as a longitudinal clinical measure does require acceptable test-retest reliability. To date, very few test-retest reliability studies have been published with qEEG data obtained from TBI patients or from healthy controls. This is a particular concern because high variability is a known characteristic of the injured central nervous system.
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Affiliation(s)
- Paul E. Rapp
- Uniformed Services University of the Health Sciences School of Medicine, Bethesda, MD, USA
| | - David O. Keyser
- Uniformed Services University of the Health Sciences School of Medicine, Bethesda, MD, USA
| | | | - Rene Hernandez
- US Navy Bureau of Medicine and Surgery, Frederick, MD, USA
| | | | | | - W. David Hairston
- U. S. Army Research Laboratory, Aberdeen Proving Ground, Aberdeen, MD, USA
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Parma V, Straulino E, Zanatto D, Cantagallo A, Tirindelli R, Castiello U. Implicit olfactory abilities in traumatic brain injured patients. J Clin Exp Neuropsychol 2012; 34:977-88. [PMID: 22905854 DOI: 10.1080/13803395.2012.711811] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
To investigate implicit olfactory abilities in a group of anosmic traumatic brain injured (TBI) patients, an olfactomotor priming paradigm was administered. A group of matched normosmic/mildly microsmic TBI patients and a group of neurologically healthy participants served as controls. For all the groups, an interference effect was evident on the peak velocity of grip aperture when participants grasped a large target preceded by a "small" odor. The present results suggest that some form of implicit olfactory processing is preserved in TBI patients even when diagnosed as anosmic on the basis of explicit olfactory testing.
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Affiliation(s)
- Valentina Parma
- Department of General Psychology, University of Padova, Padova, Italy.
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Ruhin-Poncet B, Guerre A, Goudot P, Escande C. [Post-traumatic taste and smell disorders: forensic aspects]. REVUE DE STOMATOLOGIE ET DE CHIRURGIE MAXILLO-FACIALE 2010; 111:296-298. [PMID: 21111435 DOI: 10.1016/j.stomax.2010.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 07/06/2010] [Accepted: 10/08/2010] [Indexed: 05/30/2023]
Abstract
The impact of anosmia or ageusia may be considerable for some occupations. Expert assessment shows how difficult it is to prove the diagnosis. A specialist is usually needed to demonstrate the asserted disorder. Damage compensation is based on the patient's occupation and coverage.
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Affiliation(s)
- B Ruhin-Poncet
- Service de stomatologie et chirurgie maxillofaciale, hôpital de la Pitié-Salpêtrière, AP-HP, université Pierre-et-Marie-Curie-Paris 6, 47-83 boulevard de l'Hôpital, 75651 Paris cedex 13, France.
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Roberts RJ, Sheehan W, Thurber S, Roberts MA. Functional neuro-imaging and post-traumatic olfactory impairment. Indian J Psychol Med 2010; 32:93-8. [PMID: 21716782 PMCID: PMC3122553 DOI: 10.4103/0253-7176.78504] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate via a research literature survey the anterior neurological significance of decreased olfactory functioning following traumatic brain injuries. MATERIALS AND METHODS A computer literature review was performed to locate all functional neuro-imaging studies on patients with post-traumatic anosmia and other olfactory deficits. RESULTS A convergence of findings from nine functional neuro-imaging studies indicating evidence for reduced metabolic activity at rest or relative hypo-perfusion during olfactory activations. Hypo-activation of the prefrontal regions was apparent in all nine post-traumatic samples, with three samples yielding evidence of reduced activity in the temporal regions as well. CONCLUSIONS The practical ramifications include the reasonable hypothesis that a total anosmic head trauma patient likely has frontal lobe involvement.
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Nonlinear Dynamical Analysis of the Effect by Six Stimuli on Electroencephalogram. J Clin Neurophysiol 2009; 26:24-38. [DOI: 10.1097/wnp.0b013e31819862db] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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