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Dang THT, Tran TN, Xing F, Ha ULN, Vo KCN, Nguyen TV, Nguyen KV, Le HT, Truong D. Diagnostic value of vietnamese smell identification test in Parkinson's disease. J Neurol Sci 2024; 459:122958. [PMID: 38522243 DOI: 10.1016/j.jns.2024.122958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/04/2024] [Accepted: 03/10/2024] [Indexed: 03/26/2024]
Abstract
INTRODUCTION The Vietnamese Smell Identification Test (VSIT) has been validated in determining olfactory dysfunction in the Vietnamese population; however, its value in diagnosing Parkinson's disease (PD) has not been established. METHODS This case-control study was conducted at University Medical Center HCMC, Ho Chi Minh City, Vietnam. The study sample included non-demented PD patients and healthy controls (HC) who were gender- and age-matched. All participants were evaluated for odor identification ability using the VSIT and the Brief Smell Identification Test (BSIT). RESULTS A total of 218 HCs and 218 PD patients participated in the study. The median VSIT and BSIT scores were significantly different between PD and HC groups (VSIT, 5 (3) vs. 9 (2), P < 0.0001; BSIT, 6 (3) vs 8 (2), P < 0.0001). Using the cut-off of <8 for correct answers out of 12 odorants, the VSIT had higher sensitivity (84.4%) and specificity (86.2%) than those of the BSIT (sensitivity of 81.7% and specificity of 69.3%) for the diagnosis of PD. The area under the curve (AUC) value was greater for the VSIT than for the BSIT (0.909 vs 0.818). The smell identification scores were not significantly correlated with disease duration, disease severity, or LEDD (all p > 0.05). CONCLUSION The VSIT can be a valuable ancillary tool for supporting the diagnosis of PD in Vietnam. Olfactory dysfunction in PD was unrelated to the disease duration and severity. The VSIT can be applied to improve the accuracy of clinical PD diagnosis.
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Affiliation(s)
- Thuong Huyen Thi Dang
- Movement Disorder Unit, Neurology Department, University Medical Center HCMC, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam.
| | - Tai Ngoc Tran
- Movement Disorder Unit, Neurology Department, University Medical Center HCMC, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam.
| | - Frank Xing
- The Truong Neurosciences Institute, Parkinson and Movement Disorder Institute, Orange Coast Memorial Medical Center, Fountain Valley, CA 92708, USA
| | - Uyen Le Ngoc Ha
- Movement Disorder Unit, Neurology Department, University Medical Center HCMC, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam.
| | - Khang Chung Ngoc Vo
- Movement Disorder Unit, Neurology Department, University Medical Center HCMC, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam.
| | - Thanh Vinh Nguyen
- Movement Disorder Unit, Neurology Department, University Medical Center HCMC, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam.
| | - Khang Vinh Nguyen
- Movement Disorder Unit, Neurology Department, University Medical Center HCMC, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam.
| | - Hien Thi Le
- Movement Disorder Unit, Neurology Department, University Medical Center HCMC, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam.
| | - Daniel Truong
- The Truong Neurosciences Institute, Parkinson and Movement Disorder Institute, Orange Coast Memorial Medical Center, Fountain Valley, CA 92708, USA; Department of Psychiatry and Neuroscience, University of California Riverside, Riverside, CA, USA.
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Dias CMV, Leal DAB, Brys I. Levodopa-induced dyskinesia is preceded by increased levels of anxiety and motor impairment in Parkinson's disease patients. Int J Neurosci 2023; 133:1319-1325. [PMID: 35603453 DOI: 10.1080/00207454.2022.2079501] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
Abstract
Introduction: Dopamine replacement therapy with levodopa is the gold standard treatment of Parkinson's disease (PD); however long-term levodopa use is associated with abnormal involuntary movements known as levodopa-induced dyskinesia (LID) in most patients. LID is not preventable and represents the major limitation of PD treatment.Objective: This study was aimed to find clinical and behavioral features that could be used to identify, years in advance, PD patients that are at high risk of developing LID in the future. Method: Data from PD patients enrolled in The Parkinson's progression markers initiative (PPMI, Michael J. Fox Foundation) that developed dyskinesia during their participation in the study were compared with those who did not, and with healthy controls.Result: LID was preceded byhigher levels of trait anxiety and increased motor impairment in PD patients. Additionally, younger age at PD diagnosis, earlier need for dopaminergic therapy and higher initial levodopa dose, were associated with future development of dyskinesia.Conclusion: These findings suggest that easily detectable clinical and behavioral alterations may help to identify PD patients that are more susceptible to develop LID.
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Affiliation(s)
- Carla M V Dias
- Research Group in Neuroscience and Experimental Psychology, Petrolina, Pernambuco, Brazil
- Postgraduate Program in Psychology, Federal University of Vale do São Francisco (UNIVASF), Petrolina, Brazil
| | - Denisson A B Leal
- Research Group in Neuroscience and Experimental Psychology, Petrolina, Pernambuco, Brazil
- Postgraduate Program in Health and Biological Sciences, Federal University of Vale do São Francisco (UNIVASF), Petrolina, Brazil
| | - Ivani Brys
- Research Group in Neuroscience and Experimental Psychology, Petrolina, Pernambuco, Brazil
- Postgraduate Program in Psychology, Federal University of Vale do São Francisco (UNIVASF), Petrolina, Brazil
- Postgraduate Program in Health and Biological Sciences, Federal University of Vale do São Francisco (UNIVASF), Petrolina, Brazil
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Lin YH, Fang TC, Lei HB, Chiu SC, Chang MH, Guo YJ. UPSIT subitems may predict motor progression in Parkinson's disease. Front Neurol 2023; 14:1265549. [PMID: 37936914 PMCID: PMC10625917 DOI: 10.3389/fneur.2023.1265549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/05/2023] [Indexed: 11/09/2023] Open
Abstract
Background The relationship between hyposmia and motor progression is controversial in Parkinson's disease (PD). The aim of this study was to investigate whether preserved identification of Chinese-validated University of Pennsylvania Smell Identification Test (UPSIT) odors could predict PD motor progression. Methods PD patients with two consecutive clinical visits while taking medication were recruited. Based on mean changes in Movement Disorder Society Unified Parkinson's Disease Rating Scale part 3 score and levodopa equivalent daily dosage, the participants were categorized into rapid progression, medium progression, and slow progression groups. Odors associated with the risk of PD motor progression were identified by calculating the odds ratios of UPSIT item identification between the rapid and slow progression groups. Receiver operating characteristic curve analysis of these odors was conducted to determine an optimal threshold for rapid motor progression. Results A total of 117 PD patients were screened for group classification. Preserved identification of neutral/pleasant odors including banana, peach, magnolia, and baby powder was significantly correlated with rapid motor progression. The risk of rapid progression increased with more detected risk odors. Detection of ≥1.5 risk odors could differentiate rapid progression from slow progression with a sensitivity of 85.7%, specificity of 45.8%, and area under the receiver operating characteristic curve of 0.687. Conclusion Preserved identification of neutral/pleasant odors may help to predict PD motor progression, and detection of ≥1.5 UPSIT motor progression risk odors could improve the predictive power. In PD patients with a similar level of motor disability during initial screening, preserved pleasant/neutral odor identification may imply relatively better cortical odor discriminative function, which may suggest the body-first (caudo-rostral) subtype with faster disease progression.
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Affiliation(s)
- Yu-Hsuan Lin
- The Department of Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ting-Chun Fang
- The Department of Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hsin-Bei Lei
- The Department of Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shih-Chi Chiu
- The Department of Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ming-Hong Chang
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Brain and Neuroscience Research Center, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Yi-Jen Guo
- The Department of Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
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Vaswani PA, Morley JF, Jennings D, Siderowf A, Marek K. Predictive value of abbreviated olfactory tests in prodromal Parkinson disease. NPJ Parkinsons Dis 2023; 9:103. [PMID: 37386033 DOI: 10.1038/s41531-023-00530-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 05/22/2023] [Indexed: 07/01/2023] Open
Abstract
There is disagreement in the literature whether olfaction may show specific impairments in Parkinson Disease (PD) and if olfactory tests comprised of selected odors could be more specific for diagnosis. We sought to validate previously proposed subsets of the University of Pennsylvania Smell Identification Test (UPSIT) odors for predicting conversion to PD in an independent, prodromal cohort. Conversion to PD was assessed in 229 participants in the Parkinson At Risk Study who completed baseline olfactory testing with the UPSIT and up to 12 years of clinical and imaging evaluations. No commercially available or proposed subset performed better than the full 40-item UPSIT. The proposed "PD-specific" subsets also did not perform better than expected by chance. We did not find evidence for selective olfactory impairment in Parkinson disease. Shorter odor identification tests, including commercially available 10-12 item tests, may have utility for ease of use and cost, but not for superior predictive value.
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Affiliation(s)
- Pavan A Vaswani
- Parkinson's Disease Research, Education and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - James F Morley
- Parkinson's Disease Research, Education and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Danna Jennings
- The Institute for Neurodegenerative Disorders, New Haven, CT, USA
| | - Andrew Siderowf
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kenneth Marek
- The Institute for Neurodegenerative Disorders, New Haven, CT, USA
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Screening performances of an 8-item UPSIT Italian version in the diagnosis of Parkinson's disease. Neurol Sci 2023; 44:889-895. [PMID: 36401656 PMCID: PMC9676802 DOI: 10.1007/s10072-022-06457-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 10/12/2022] [Indexed: 11/21/2022]
Abstract
Hyposmia is a common finding in Parkinson's disease (PD) and is usually tested through the University of Pennsylvania Smell Identification Test (UPSIT). The aim of our study is to provide a briefer version of the Italian-adapted UPSIT test, able to discriminate between PD patients and healthy subjects (HS). By means of several univariate and multivariate (machine-learning-based) statistical approaches, we selected 8 items by which we trained a partial-least-square discriminant analysis (PLS-DA) and a decision tree (DT) model: class predictions of both models performed better with the 8-item version when compared to the 40-item version. An area under the receiver operating characteristic (AUC-ROC) curve built with the selected 8 odors showed the best performance (sensitivity 86.8%, specificity 82%) in predicting the PD condition at a cut-off point of ≤ 6. These performances were higher than those previously calculated for the 40-item UPSIT test (sensitivity 82% and specificity 88.2 % with a cut-off point of ≤ 21). Qualitatively, our selection contains one odor (i.e., apple) which is Italian-specific, supporting the need for cultural adaptation of smell testing; on the other hand, some of the selected best discriminating odors are in common with existing brief smell test versions validated on PD patients of other cultures, supporting the view that disease-specific odor patterns may exist and deserve a further evaluation.
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Fang TC, Chang MH, Yang CP, Chen YH, Lin CH. The Association of Olfactory Dysfunction With Depression, Cognition, and Disease Severity in Parkinson's Disease. Front Neurol 2021; 12:779712. [PMID: 34880827 PMCID: PMC8645582 DOI: 10.3389/fneur.2021.779712] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 10/27/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Non-motor subtypes of Parkinson's disease (PD) include the limbic, cognitive, and brainstem phenotype, which may have different pathological pathways with olfaction. In this work, we aim to clarify the association between olfactory dysfunction, depression, cognition, and disease severity in PD. Methods: A total of 105 PD subjects were included and divided into anosmia and non-anosmic groups, using the University of Pennsylvania Smell Identification Test (UPSIT). All patients were evaluated with the movement disorder society unified Parkinson's disease rating scale (MDS-UPDRS), the Beck depression inventory (BDI)-II, and the Montreal cognitive assessment (MoCA). Results: The BDI-II and UPSIT scores had a trend of reverse correlation without statistical significance (β-coefficient −0.12, p = 0.232). However, the odds ratio (OR) in anosmia was 2.74 (95% CI 1.01–7.46) for depression and 2.58 (95% CI 1.06–6.29) for cognitive impairment. For the MDS-UPDRS total and Part 3 score, the anosmia had a β-coefficient of 12.26 (95% CI 5.69–18.82) and 8.07 (95% CI 3.46–12.67), respectively. Neither depression nor cognitive impairment is associated with motor symptoms. Conclusion: More severe olfactory dysfunction in PD is associated with cognitive impairment and greater disease severity. Depression in PD may involve complex pathways, causing relatively weak association with olfactory dysfunction.
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Affiliation(s)
- Ting-Chun Fang
- Department of Neurology, Taichung Veteran General Hospital, Taichung City, Taiwan
| | - Ming-Hong Chang
- Department of Neurology, Taichung Veteran General Hospital, Taichung City, Taiwan.,School of medicine, National Chung Hsing University, Taichung City, Taiwan
| | - Chun-Pai Yang
- Department of Neurology, Kuang Tien General Hospital, Taichung City, Taiwan
| | - Yi-Huei Chen
- Department of Medical Education and Research, Taichung Veteran General Hospital, Taichung City, Taiwan
| | - Ching-Heng Lin
- Department of Medical Education and Research, Taichung Veteran General Hospital, Taichung City, Taiwan
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Alonso CCG, Silva FG, Costa LOP, Freitas SMSF. Smell tests can discriminate Parkinson's disease patients from healthy individuals: A meta-analysis. Clin Neurol Neurosurg 2021; 211:107024. [PMID: 34823156 DOI: 10.1016/j.clineuro.2021.107024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/20/2021] [Accepted: 11/03/2021] [Indexed: 01/01/2023]
Abstract
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).
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Affiliation(s)
- Cintia C G Alonso
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Fernanda G Silva
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Leonardo O P Costa
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Sandra M S F Freitas
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil.
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Aniteli MB, Marson FAL, Cunha FR, Sakano E. Correlation and agreement of olfactory perception assessed by the Connecticut Chemosensory Clinical Research Center olfactory test and the Brief-Smell Identification Test †. Braz J Otorhinolaryngol 2020; 88:858-866. [PMID: 33408061 DOI: 10.1016/j.bjorl.2020.11.013] [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: 06/05/2020] [Revised: 11/02/2020] [Accepted: 11/24/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Assessing olfactory perception in olfactory disorders is of utmost importance in therapy management. However, the University of Pennsylvania Smell Identification Test and the Sniffin' Sticks are the only tests validated in Brazil. OBJECTIVES To evaluate the correlation and agreement between the Chemosensory Clinical Research Center olfactory test and the Brief-Smell Identification Test - University of Pennsylvania Smell Identification Test - in healthy participants and in participants with olfactory disorders based on the results and technical aspects of both tests. METHODS Fifty participants without olfactory complaints and 50 participants with olfactory disorders who underwent the Chemosensory Clinical Research Center olfactory test and the Brief-Smell Identification Test were included. The following tests were used for statistical analysis: Mann-Whitney U test, Spearman's correlation, intraclass correlation coefficient and Bland-Altman plot. An alpha error (significance level) of 0.05 was considered in the statistical analysis. RESULTS Both tests were effective in distinguishing the groups without the presence of overlapping values for the measured markers. Additionally, there was a strong correlation between Spearman's correlation and intraclass correlation coefficient between the tests and for both nostrils. However, the correlations were lower when the groups were individually evaluated. The Bland-Altman plot showed no bias when all participants were simultaneously evaluated. CONCLUSIONS The tests to assess olfactory perception presented a high level of agreement. In our sample, we could infer that the Connecticut Chemosensory Clinical Research Center olfactory test is similar to the Brief-Smell Identification Test and can be used in the routine diagnosis of patients with complaints of olfactory disorders, considering the advantage of its low cost.
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Affiliation(s)
- Marcello Bailarini Aniteli
- Universidade de Campinas, Faculdade de Ciências Médicas, Departamento de Oftalmologia e Otorrinolaringologia, Campinas, SP, Brazil
| | - Fernando Augusto Lima Marson
- Universidade São Francisco, Programa de Pós-Graduação em Ciências da Saúde, Laboratório de Genética Humana e Médica, Bragança Paulista, SP, Brazil.
| | - Fernanda Rodrigues Cunha
- Universidade de Campinas, Faculdade de Ciências Médicas, Departamento de Oftalmologia e Otorrinolaringologia, Campinas, SP, Brazil
| | - Eulália Sakano
- Universidade de Campinas, Faculdade de Ciências Médicas, Departamento de Oftalmologia e Otorrinolaringologia, Campinas, SP, Brazil.
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