From sweet to sweat: Hedonic olfactory range is impaired in Parkinson's disease

Impact of deep brain stimulation (DBS) on olfaction in Parkinson's disease: Clinical features and functional hypotheses

Deep brain stimulation (DBS) is a surgical therapy typically applied in Parkinson's disease (PD). The efficacity of DBS on the control of motor symptoms in PD is well grounded while the efficacity on non-motor symptoms is more controversial, especially on olfactory disorders (ODs). The present review shows that DBS does not improve hyposmia but can affect positively identification/discrimination scores in PD. The functional hypotheses suggest complex mechanisms in terms of cerebral connectivity and neurogenesis process which could act indirectly on the olfactory bulb and olfactory pathways related to specific cognitive olfactory tasks. The functional hypotheses also suggest complex mechanisms of cholinergic neurotransmitter interactions involved in these pathways. Finally, the impact of DBS on general cognitive functions in PD could also be beneficial to identification/discrimination tasks in PD.

Odor Hedonic Profile (OHP): a self-rating tool of everyday odors

Odor hedonic estimation (pleasant/unpleasant) is considered the first and one of the most important dimensions in odor perception. Although there are several published scales that rate odor hedonicity, most of them use odorants that induce biases related to stimulus properties or test conditions and make difficult clinical or industrial applications. Thus, this study aimed to propose a model of odor hedonic profile (OHP) based on 14 items related to everyday odors without stimulus. The OHP is a self-rating tool based on the hedonic estimate representation and allows the determination of specific profiles, i.e., "conservative," "neutral," "liberal," "negative olfactory alliesthesia," and "positive olfactory alliesthesia." It can be useful in different contexts (e.g., food studies) and general pathologies (e.g., eating disorders) or pathologies with mood/emotional disturbances (e.g., depression).

A study on the relationship between odor hedonic ratings and individual odor detection threshold

Odor hedonic perception (pleasant/unpleasant character) is considered as the first and one of the most prominent dimensions in olfaction and is known to depend on several parameters. Among them, the relation between the odorant concentration and the hedonic estimation has been widely studied. However, few studies have considered odor hedonic ratings (OHR) in relation to individual detection thresholds (IDT). Thus, the aim of this study was to determine olfactory detection thresholds and to describe hedonic rating variations from individual thresholds to higher concentrations. IDT were performed for two pleasant (apple and jasmine) and two unpleasant (durian and trimethylamine) odorant stimuli. The experimenter presented one by one in a randomized order, the different odorant concentrations above IDT. Participants rated odor hedonic valence of these stimuli on a visual analog scale. Results showed, except for trimethylamine, the same relationship between hedonic ratings and stimulus concentration, i.e., an increase of pleasantness (apple and jasmine)/unpleasantness (durian) ratings at low and middle concentrations followed by a plateau at high concentrations. Correlations between OHR and concentrations as well as between OHR and threshold steps were always significant. Moreover, comparisons between both conditions showed that the correlation coefficient was significantly higher for trimethylamine (and a trend for apple) when IDTs were considered, while no difference was found for jasmine and durian. Overall, results suggested that the relationship between OHR and IDT is odor specific. These findings contribute to explain the large variability of the hedonic tone (i.e., weakly vs. very pleasant, weakly vs. very unpleasant) at specific concentration in the general population and could serve future research in this field (e.g., olfactory preferences in nutrition studies, anhedonia in psychiatric disorders…).

Anhedonia in Neurodegenerative Diseases

Neurodegenerative diseases are increasingly recognised to be an important cause of brain disorders, particularly in late age. Associated with a wide range of pathologies, they lead to progressive loss of neurons in different regions of the nervous system. Although anhedonia is common in a variety of neurodegenerative diseases, to date it has not been extensively studied in most of these conditions. Here we review the current literature on studies assessing the association between anhedonia and neurodegenerative diseases including Parkinson's Disease, Dementia with Lewy Bodies, Parkinson's Plus Syndromes, Alzheimer's Disease, Vascular Dementia, Frontotemporal Dementia, Amyotrophic Lateral Sclerosis and Huntington's Disease. Much of the research has been conducted in Parkinson's disease where it is evident that there are strong links between apathy (loss of motivation) and anhedonia, although the two syndromes can be dissociated. Intriguingly, drugs that improve apathy can also lead to amelioration of anhedonia in some cases. Overlaps between the two syndromes may also exist across other neurodegenerative conditions, including Frontotemporal Dementia in which imaging has revealed atrophy of both common brain regions associated with anhedonia and apathy, as well as a set of unique brain regions associated with anhedonia. A transdiagnostic perspective might be helpful to investigate whether a common network of brain regions is dysfunctional with anhedonia across neurodegenerative conditions.

Smell tests can discriminate Parkinson's disease patients from healthy individuals: A meta-analysis

BACKGROUND

Olfactory impairment is common in Parkinson's disease (PD). The authors aimed to identify the clinical tests used to assess olfactory function and examine their ability to distinguish PD with different disease duration from healthy individuals with physiological aging.

METHODS

Cross-sectional studies published until May 2020 that assessed the olfaction of individuals with PD using search terms related to PD, olfactory function, and assessment were searched on PubMed, PsycInfo, Cinahl, and Web of Science databases.

RESULTS

Twelve smell tests were identified from the reviewed studies (n = 125) that assessed 8776 individuals with PD. Data of 6593 individuals with PD and 8731 healthy individuals were included in the meta-analyses. Individuals with PD presented worse performance than healthy individuals, regardless of the smell test used. The University of Pennsylvania Smell Identification Test (UPSIT) was used by most studies (n = 2310 individuals with PD) and presented smaller heterogeneity. When the studies were subclassified according to the years of PD duration, there were no significant differences.

CONCLUSION

All smell tests were able to discriminate the olfactory function of PD from that of healthy individuals, although the UPSIT was widely used. The abnormal olfaction was not related to the disease duration. Systematic review protocol registration (PROSPERO/2020-CRD42020160878).

A non-invasive olfactory bulb measure dissociates Parkinson's patients from healthy controls and discloses disease duration

Olfactory dysfunction is a prevalent non-motor symptom of Parkinson's disease (PD). This dysfunction is a result of neurodegeneration within the olfactory bulb (OB), the first processing area of the central olfactory system, and commonly precedes the characteristic motor symptoms in PD by several years. Functional measurements of the OB could therefore potentially be used as an early biomarker for PD. Here, we used a non-invasive method, so-called electrobulbogram (EBG), to measure OB function in PD and age-matched healthy controls to assess whether EBG measures can dissociate PDs from controls. We estimated the spectrogram of the EBG signal during exposure to odor in PD (n = 20) and age-matched controls (n = 18) as well as identified differentiating patterns of odor-related synchronization in the gamma, beta, and theta frequency bands. Moreover, we assessed if these PD-EBG components could dissociate PD from control as well as their relationship with PD characteristics. We identified six EBG components during the initial and later stages of odor processing which dissociated PD from controls with 90% sensitivity and 100% specificity with links to PD characteristics. These PD-EBG components were related to medication, disease duration, and severity, as well as clinical odor identification performance. These findings support using EBG as a tool to experimentally assess PD interventions, potentially aid diagnosis, and the potential development of EBG into an early biomarker for PD.

A Multisensory Deficit in the Perception of Pleasantness in Parkinson's Disease

BACKGROUND

There is growing interest in non-motor symptoms in Parkinson's disease (PD), due to the impact on quality of life. Anhedonia, the inability to experience joy and lust, has a prevalence of up to 46% in PD. The perception of pleasantness of an odor is reduced in anhedonia without PD. We previously showed a reduced hedonic olfactory perception in PD, i.e., patients evaluated odors as less pleasant or unpleasant compared to controls. This deficit correlated with anhedonia.

OBJECTIVE

We aimed to confirm these findings. Moreover, we hypothesized that the perception of pleasantness in PD is affected on a multisensory level and correlates with anhedonia. Therefore, we assessed olfactory, visual and acoustic evaluation of pleasantness in PD and healthy individuals.

METHODS

Participants had to rate the pleasantness of 22 odors, pictures, and sounds on a nine-point Likert scale. Depression, anhedonia, and apathy were assessed by means of questionnaires. Results of the pleasantness-rating were compared between groups and correlated to scores of the questionnaires.

RESULTS

In particular pleasant and unpleasant stimuli across all three modalities are perceived less intense in PD, suggesting that a reduced range of perception of pleasantness is a multisensory phenomenon. However, only a reduction of visual hedonic perception correlated with anhedonia in PD. A correlation of reduced perception of pleasantness with apathy or depression was not present.

CONCLUSION

We provide evidence for a multisensory deficit in the perception of pleasantness. Further studies should delineate the underlying neural circuity and the diagnostic value to detect neuropsychiatric symptoms in PD.

Odor hedonics coding in the vertebrate olfactory bulb

Whether an odorant is perceived as pleasant or unpleasant (hedonic value) governs a range of crucial behaviors: foraging, escaping danger, and social interaction. Despite its importance in olfactory perception, little is known regarding how odor hedonics is represented and encoded in the brain. Here, we review recent findings describing how odorant hedonic value is represented in the first olfaction processing center, the olfactory bulb. We discuss how olfactory bulb circuits might contribute to the coding of innate and learned odorant hedonics in addition to the odorant's physicochemical properties.

Assessment of odor hedonic perception: the Sniffin' sticks parosmia test (SSParoT)

Qualitative olfactory dysfunction is characterized as distorted odor perception and can have a profound effect on quality of life of affected individuals. Parosmia and phantosmia represent the two main subgroups of qualitative impairment and are currently diagnosed based on patient history only. We have developed a test method which measures qualitative olfactory function based on the odors of the Sniffin' Sticks Identification subtest. The newly developed test is called Sniffin' Sticks Parosmia Test (SSParoT). SSParoT uses hedonic estimates of two oppositely valenced odors (pleasant and unpleasant) to assess hedonic range (HR) and hedonic direction (HD), which represent qualitative olfactory perception. HR is defined as the perceivable hedonic distance between two oppositely valenced odors, while HD serves as an indicator for overall hedonic perception of odors. This multicenter study enrolled a total of 162 normosmic subjects in four consecutive experiments. Cluster analysis was used to group odors from the 16-item Sniffin' Sticks Identification test and 24-additional odors into clusters with distinct hedonic properties. Eleven odor pairs were found to be suitable for estimation of HR and HD. Analysis showed agreement between test-retest sessions for all odor pairs. SSparoT might emerge as a valuable tool to assess qualitative olfactory function in health and disease.

The Chemosensory Pleasure Scale: A New Assessment for Measuring Hedonic Smell and Taste Capacities

Anhedonia, or the inability to experience pleasure, is a key clinical feature of many mental disorders such as depression and schizophrenia. Although various valid measurements of anhedonia and pleasure experience exist, no scales exist that quantify smell and taste pleasure experiences. The Chemosensory Pleasure Scale (CPS) was therefore designed to assess the hedonic capacity for smell and taste pleasure. We examined the reliability and validity of the CPS in our study. First, we conducted exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to identify and examine the structure of the CPS. Second, the CPS's validity and test-retest stability were investigated. The CPS was correlated with other measurements of anhedonia and pleasure experience. Furthermore, the empirical validity of CPS was also examined in our study. The results indicated that the CPS is a reliable and valid measure for assessing an individual's hedonic capacity for smell and taste pleasure in nonclinical samples. Further application of the CPS for various populations is also discussed herein, especially for patients with mental disorders such as depression, schizophrenia, and autism.

Sensory neuropathy and nociception in rodent models of Parkinson's disease

Parkinson's disease (PD) often manifests with prodromal pain and sensory losses whose etiologies are not well understood. Multiple genetic and toxicity-based rodent models of PD partly recapitulate the histopathology and motor function deficits. Although far less studied, there is some evidence that rodents, similar to humans, develop sensory manifestations of the disease, which may precede motor disturbances and help to elucidate the underlying mechanisms of PD-associated pain at the molecular and neuron circuit levels. The present Review summarizes nociception and other sensory functions in frequently used rodent PD models within the context of the complex phenotypes. In terms of mechanisms, it appears that the acute loss of dopaminergic neurons in systemic toxicity models (MPTP, rotenone) primarily causes nociceptive hyperexcitability, presumably owing to a loss of inhibitory control, whereas genetic models primarily result in a progressive loss of heat perception, reflecting sensory fiber neuropathies. At the molecular level, neither α-synuclein deposits alone nor failure of mitophagy alone appear to be strong enough to result in axonal or synaptic pathology of nociceptive neurons that manifest at the behavioral level, and peripheral sensory loss may mask central ‘pain’ in behavioral tests. Hence, allostatic combinations or additional challenges and novel behavioral assessments are needed to better evaluate PD-associated sensory neuropathies and pain in rodents.

Summary: Rodent models of Parkinson's disease partially develop prodromal somatosensory and olfactory dysfunctions reminiscent of sensory neuropathies in patients and reveal mechanistic insight, but data are incomplete and fragmented.

Mapping anticipatory anhedonia: an fMRI study

Anhedonia-broadly defined as loss of interest and/or an inability to experience pleasure-is an important feature of several psychiatric disorders. Research into the clinical presentation and neurobiology of this symptom has identified components related to motivation, learning, anticipation, and experience of pleasure as important constructs that inform therapeutic interventions. The experimental study of anhedonia is largely based on incentive processing paradigms, most often with monetary rewards, though studies have also used pleasantness ratings of various stimuli. However, linking an individual's own system of reinforcers and ability to enjoy them with anhedonia and neural activity remains comparatively under-explored. A previous study of participants with major depressive disorder (MDD) and healthy controls found that activity word ratings correlated with measures of anhedonia, depression, and motivation. The present study collected functional magnetic resonance imaging (fMRI) images in healthy controls while they rated activity words and pictures showing activities in order to identify networks differentially responsive to subjective decisions about the appetitive value of activities. The study sought to measure individually-relevant hedonic capacity as demonstrated by correlations between task measures and anticipatory anhedonia ratings. Ratings of potential pleasure were associated with neural activity in areas previously identified as relevant to pleasure and reward processing, such as anterior and posterior cingulate, middle frontal areas, and dorsal and ventral striatum. Although the study included only healthy controls, the results demonstrate a link between anhedonia measures, behavior, and brain responses and also test a paradigm that could be used to study anhedonia in clinical populations.

Small-chain fatty acid activates astrocytic odorant receptor Olfr920

Odorant receptors are the largest subfamily of G protein-coupled receptors and were recently suggested to play critical roles in nonolfactory tissues. However, the expression and function of odorant receptors in astrocytes, the most abundant cells in the brain, are not well known. We demonstrate that Olfr920 is highly expressed and propose that it functions as a short-chain fatty acid sensor in primary cortical astrocytes. The short-chain fatty acid isobutyric acid (IBA) was identified via a luciferase assay as an Olfr920 ligand. We show that IBA activates the G_s protein-adenylyl cyclase-cAMP pathway via Olfr920 in primary cortical astrocytes by using cAMP and knockdown analyses. In addition, IBA reduces lipopolysaccharide-induced glial fibrillary acidic protein expression in reactive astrocytes. These results suggest that astrocytic Olfr920 is a potential novel target for increased reactive astrocytes.

Anhedonia is associated with suicidal ideation independently of depression: A meta-analysis

BACKGROUND

Anhedonia is considered a suicide risk factor in patients with major affective disorders. Here, we wanted to quantify the association between anhedonia and current suicidal ideation according to the absence/presence of between-group differences for depressive scores and psychiatric disorders.

METHODS

We performed a meta-analysis of data on studies retrieved from Medline, Web of Science, and PsycINFO from 1965 to 2016 using, among others, the terms (suicid* or depression) and anhedonia.

RESULTS

We identified 15 observational case-control studies that investigated the anhedonia differences in individuals with and without current (i.e., within the past week, independently of the lifetime suicidality status) suicidal ideation (defined as thoughts of killing oneself). Overall, 657 subjects with and 6,690 subjects without current suicidal ideation could be compared. Anhedonia level was higher in the group with current suicidal ideation than in the group without, with a medium effect size (standardized mean difference = 0.57, z = 5.43, P < 0.001, 95% confidence interval, CI = 0.37-0.79). The association between anhedonia and current suicidal ideation remained significant when controlling for depression and psychiatric disorders. The anhedonia scales used in the selected studies did not allow investigating consummatory and motivational anhedonia separately.

CONCLUSION

Our major finding is the robust association between anhedonia and current suicidal ideation, independently of depression. This is highly relevant for the clinicians' daily practice and might help improving suicidal risk detection and the development of new therapeutic strategies for suicide prevention.

The olfactory bulb as the entry site for prion-like propagation in neurodegenerative diseases

Olfactory deficits are present in numerous neurodegenerative disorders and are accompanied by pathology in related brain regions. In several of these disorders, olfactory disturbances appear early and are considered as prodromal symptoms of the disease. In addition, pathological protein aggregates affect olfactory regions prior to other regions, suggesting that the olfactory system might be particularly vulnerable to neurodegenerative diseases. Exposed to the external environment, the olfactory epithelium and olfactory bulb allow pathogen and toxin penetration into the brain, a process that has been proposed to play a role in neurodegenerative diseases. Determining whether the olfactory bulb could be a starting point of pathology and of pathology spread is crucial to understanding how neurodegenerative diseases evolve. We argue that pathological changes following environmental insults contribute to the initiation of protein aggregation in the olfactory bulb, which then triggers the spread of the pathology within the brain by a templating mechanism in a prion-like manner. We review the evidence for the early involvement of olfactory structures in neurodegenerative diseases and the relationship between neuropathology and olfactory function. We discuss the vulnerability and putative underlying mechanisms by which pathology could be initiated in the olfactory bulb, from the entry of pathogens (promoted by increased permeability of the olfactory epithelium with aging or inflammation) to the sensitivity of the olfactory system to oxidative stress and inflammation. Finally, we review changes in protein expression and neural excitability triggered by pathogenic proteins that can promote pathogenesis in the olfactory bulb and beyond.

A Card-type Odor Identification Test for Japanese Patients with Parkinson's Disease and Related Disorders

Objective The characteristics of olfactory impairment in Parkinson's disease (PD), multiple system atrophy (MSA) and progressive supranuclear palsy (PSP) have not been determined in detail. We assessed the olfactory function among PD, MSA and PSP patients. Methods A card-type odor identification test, Open Essence (OE, Wako, Japan), which consists of 12 different odorants familiar to Japanese subjects, was administered to 98 PD patients, 32 MSA patients, 17 PSP patients and 96 control subjects ≥50 years of age. Results The PD patients had significantly lower OE scores than the other groups. The OE scores of the MSA and PSP patients fell between those of the PD patients and the control subjects. A cut-off OE score of 6 was beneficial for differentiating PD patients from controls with 84.7% sensitivity and 85.4% specificity. A cut-off OE score of 4 had 60.2% sensitivity and 77.6% specificity for differentiating PD patients from MSA and PSP patients. The correct answer rates for the curry, Japanese orange and perfume odorants in the PD patients were lower than those in the MSA and PSP patients and controls. The PD patients also had the highest ratio of "not detected" choices across the 12 odors. Conclusion Marked olfactory impairment was a feature of the patients with PD, while mild olfactory impairment was observed in those with MSA or PSP. The answer patterns and the specific odorants may also be useful in differentiating PD from related disorders.

Trigeminal system in Parkinson's disease: A potential avenue to detect Parkinson-specific olfactory dysfunction

BACKGROUND

Olfactory dysfunction (OD) is very frequent in Parkinson's disease (PD) and observed years before diagnosis. The trigeminal system, a chemosensory system allowing for the perception of spiciness, freshness, etc., is intimately connected to the olfactory system and although usually reduced in OD the trigeminal system is not well characterized in PD. We hypothesize that measuring trigeminal sensitivity potentially allows to discriminate between OD due to PD and OD due to other causes to potentially help the development of an early diagnostic tool.

OBJECTIVE

To evaluate olfactory and trigeminal sensitivity and perception in PD patients and compare them to participants with non-parkinsonian OD (NPOD) and to healthy controls.

METHODS

We assessed olfactory function using "Sniffin' Sticks test" and trigeminal function with the localization task in 28 PD patients, 27 healthy controls and 21 patients with OD unrelated to PD.

RESULTS

PD patients exhibited significantly higher trigeminal sensitivity than NPOD patients (p = 0.002) and performed similar to healthy controls. In contrast, PD and NPOD patients had both similar olfactory scores, significantly below healthy controls.

CONCLUSION

The trigeminal system seems not to be impaired in PD patients even in the presence of OD. Measuring trigeminal sensitivity may therefore allow to differentiate PD-related OD from other forms of OD.

Misperceptions and Parkinson's disease

Most of the neurobehavioral aspects of Parkinson's disease have been well established and studied, but many are not well known, and hardly studied. This article focuses on several behavioral abnormalities that are common, and frequently cause difficulty for the patient and family due to lack of recognition as part of the disease. While it is well known that L-Dopa dyskinesias are frequently not recognized or under appreciated by patients, a similar lack of recognition may affect the patient's own speech volume, where their center of gravity is located, whether they are tilted to one side, and their under-recognition of others' emotional displays. In addition, PD patients are often misperceived by others incorrect impression of their emotional and cognitive state based purely on facial expression. These changes and others are briefly reviewed.

The Habituation/Cross-Habituation Test Revisited: Guidance from Sniffing and Video Tracking

The habituation/cross-habituation test (HaXha) is a spontaneous odor discrimination task that has been used for many decades to evaluate olfactory function in animals. Animals are presented repeatedly with the same odorant after which a new odorant is introduced. The time the animal explores the odor object is measured. An animal is considered to cross-habituate during the novel stimulus trial when the exploration time is higher than the prior trial and indicates the degree of olfactory patency. On the other hand, habituation across the repeated trials involves decreased exploration time and is related to memory patency, especially at long intervals. Classically exploration is timed using a stopwatch when the animal is within 2 cm of the object and aimed toward it. These criteria are intuitive, but it is unclear how they relate to olfactory exploration, that is, sniffing. We used video tracking combined with plethysmography to improve accuracy, avoid observer bias, and propose more robust criteria for exploratory scoring when sniff measures are not available. We also demonstrate that sniff rate combined with proximity is the most direct measure of odorant exploration and provide a robust and sensitive criterion.