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Chamberlin KW, Yuan Y, Li C, Luo Z, Reeves M, Kucharska‐Newton A, Pinto JM, Ma J, Simonsick EM, Chen H. Olfactory Impairment and the Risk of Major Adverse Cardiovascular Outcomes in Older Adults. J Am Heart Assoc 2024; 13:e033320. [PMID: 38847146 PMCID: PMC11255730 DOI: 10.1161/jaha.123.033320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/27/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Olfactory impairment is common in older adults and may be associated with adverse cardiovascular health; however, empirical evidence is sparse. We examined olfaction in relation to the risk of coronary heart disease (CHD), stroke, and congestive heart failure (CHF). METHODS AND RESULTS This study included 2537 older adults (aged 75.6±2.8 years) from the Health ABC (Health, Aging, and Body Composition) study with olfaction assessed by the 12-item Brief Smell Identification Test in 1999 to 2000, defined as poor (score ≤8), moderate (9-10), or good (11-12). The outcomes were incident CHD, stroke, and CHF. During up to a 12-year follow-up, 353 incident CHD, 258 stroke, and 477 CHF events were identified. Olfaction was statistically significantly associated with incident CHF, but not with CHD or stroke. After adjusting for demographics, risk factors, and biomarkers of CHF, the cause-specific hazard ratio (HR) of CHF was 1.32 (95% CI, 1.05-1.66) for moderate and 1.28 (95% CI, 1.01-1.64) for poor olfaction. These associations were robust in preplanned subgroup analyses by age, sex, race, and prevalent CHD/stroke. While the subgroup results were not statistically significantly different, the association of olfaction with CHF appeared to be evident among participants who reported very good to excellent health (HR, 1.47 [95% CI, 1.01-2.14] for moderate; and 1.76 [95% CI, 1.20-2.58] for poor olfaction), but not among those with fair to poor self-reported health (HR, 1.04 [95% CI, 0.64-1.70] for moderate; and 0.92 [95% CI, 0.58-1.47] for poor olfaction). CONCLUSIONS In community-dwelling older adults, a single olfaction test was associated with a long-term risk for incident CHF, particularly among those reporting very good to excellent health.
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Affiliation(s)
- Keran W. Chamberlin
- Department of Epidemiology and Biostatistics, College of Human MedicineMichigan State UniversityEast LansingMI
| | - Yaqun Yuan
- Department of Epidemiology and Biostatistics, College of Human MedicineMichigan State UniversityEast LansingMI
| | - Chenxi Li
- Department of Epidemiology and Biostatistics, College of Human MedicineMichigan State UniversityEast LansingMI
| | - Zhehui Luo
- Department of Epidemiology and Biostatistics, College of Human MedicineMichigan State UniversityEast LansingMI
| | - Mathew Reeves
- Department of Epidemiology and Biostatistics, College of Human MedicineMichigan State UniversityEast LansingMI
| | - Anna Kucharska‐Newton
- Department of EpidemiologyGillings School of Global Public Health, University of North Carolina at Chapel HillChapel HillNC
| | - Jayant M. Pinto
- Section of Otolaryngology‐Head and Neck Surgery, Department of SurgeryThe University of Chicago Medicine and Biological SciencesChicagoIL
| | - Jiantao Ma
- Division of Nutrition Epidemiology and Data Science, Gerald J. and Dorothy R. Friedman School of Nutrition Science and PolicyTufts UniversityBostonMA
| | - Eleanor M. Simonsick
- Translational Gerontology Branch, Intramural Research Program of the National Institutes of HealthNational Institute on AgingBethesdaMD
| | - Honglei Chen
- Department of Epidemiology and Biostatistics, College of Human MedicineMichigan State UniversityEast LansingMI
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Merten N, Fischer ME, Pinto AA, Chappell RJ, Schubert CR. Lifestyle and factors of vascular and metabolic health and inflammation are associated with sensorineural-neurocognitive aging in older adults. FRONTIERS IN EPIDEMIOLOGY 2024; 3:1299587. [PMID: 38455939 PMCID: PMC10910988 DOI: 10.3389/fepid.2023.1299587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/14/2023] [Indexed: 03/09/2024]
Abstract
This study's aim was to identify risk factors associated with sensorineural and neurocognitive function (brain aging) in older adults. In N = 1,478 Epidemiology of Hearing Loss Study participants (aged 64-100 years, 59% women), we conducted sensorineural and cognitive tests, which were combined into a summary measure using Principal Component Analysis (PCA). Participants with a PCA score <-1 standard deviation (SD) were considered to have brain aging. Incident brain aging was defined as PCA score <-1 SD at 5-year follow-up among participants who had a PCA score ≥-1 SD at baseline. Logistic regression and Poisson models were used to estimate associations between baseline risk factors of lifestyle, vascular and metabolic health, and inflammation and prevalent or incident brain aging, respectively. In an age-sex adjusted multivariable model, not consuming alcohol (odds ratio(OR) = 1.77, 95% confidence Interval (CI) = 1.18,2.66), higher interleukin-6 levels (OR = 1.30, 95% CI = 1.03,1.64), and depressive symptoms (OR = 2.44, 95% CI = 1.63,3.67) were associated with a higher odds of having brain aging, while higher education had protective effects (OR = 0.55, 95% CI = 0.33,0.94). A history of stroke, arterial stiffness, and obesity were associated with an increased risk of developing brain aging during the five years of follow-up. Lifestyle, vascular, metabolic and inflammatory factors were associated with brain aging in older adults, which adds to the evidence of shared pathways for sensorineural and neurocognitive declines in aging. Targeting these shared central processing etiological factors with interventions may lead to retention of better neurological function, benefiting multiple systems, i.e., hearing, smell, and cognition, ultimately helping older adults retain independence and higher quality of life longer.
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Affiliation(s)
- Natascha Merten
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Mary E. Fischer
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Aaron Alex Pinto
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Richard J. Chappell
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Carla R. Schubert
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
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Chamberlin KW, Yuan Y, Li C, Luo Z, Reeves M, Kucharska-Newton A, Pinto JM, Ma J, Simonsick EM, Chen H. Olfactory impairment and the risk of major adverse cardiovascular outcomes in older adults. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.27.23297697. [PMID: 37961698 PMCID: PMC10635221 DOI: 10.1101/2023.10.27.23297697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Background Olfactory impairment is common in older adults and may be associated with adverse cardiovascular health; however, empirical evidence is sparse. Objective To examine olfaction and the risk of coronary heart disease (CHD), stroke, and congestive heart failure (CHF). Methods This study included 2,537 older adults (aged 75.6±2.8 years) from the Health ABC Study with olfaction assessed by the 12-item Brief Smell Identification Test in 1999-2000, defined as poor (score ≤8), moderate (9-10), or good (11-12). The outcomes were incident CHD, stroke, and CHF. Results During up to 12-year follow-up, 353 incident CHD, 258 stroke, and 477 CHF events were identified. Olfaction was associated with incident CHF, but not with CHD or stroke. After adjusting for demographics, the cause-specific hazard ratio (HR) of CHF was 1.35 (95% confidence interval (CI): 1.08, 1.70) for moderate and 1.39 (95%CI: 1.09, 1.76) for poor olfaction. With additional adjustment for lifestyle, chronic diseases, and biomarkers of CHF, the HR was modestly attenuated to 1.32 (95%CI: 1.05, 1.66) for moderate and 1.28 (95%CI: 1.01, 1.64) for poor olfaction. These associations were robust in pre-planned subgroup analyses by age, sex, race, and prevalent CHD/stroke. However, the associations appeared to be evident among participants who reported very-good-to-excellent health (HR=1.47 (95%CI: 1.02, 2.13) for moderate and 1.76, (95%CI: 1.20, 2.57) for poor olfaction). In contrast, null association with CHF was found among those with fair-to-poor self-reported health. Conclusions In community-dwelling older adults, a single olfaction test was associated with a long-term risk for incident CHF, particularly among those reporting very-good-to-excellent health.
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Affiliation(s)
- Keran W. Chamberlin
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI
| | - Yaqun Yuan
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI
| | - Chenxi Li
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI
| | - Zhehui Luo
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI
| | - Mathew Reeves
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI
| | - Anna Kucharska-Newton
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jayant M. Pinto
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, The University of Chicago Medicine and Biological Sciences, Chicago, IL
| | - Jiantao Ma
- Division of Nutrition Epidemiology and Data Science, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Eleanor M. Simonsick
- Translational Gerontology Branch, Intramural Research Program of the National Institutes of Health, National Institute on Aging, Bethesda, MD
| | - Honglei Chen
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI
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Shrestha S, Zhu X, Kamath V, Sullivan KJ, Deal JA, Sharrett AR, Schneider ALC, Palta P, Gottesman RF, Windham BG, Mosley TH, Griswold ME, Chen H. Factors Associated with Poor Olfaction and Olfactory Decline in Older Adults in the ARIC Neurocognitive Study. Nutrients 2023; 15:3641. [PMID: 37630831 PMCID: PMC10459162 DOI: 10.3390/nu15163641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/13/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
Olfactory function has significant implications for human health, but few risk factors for olfactory decline have been identified. We examined the factors associated with olfactory status and decline over five years in the Atherosclerosis Risk in Communities (ARIC) Neurocognitive Study. A 12-item odor identification test was used to assess olfaction in 6053 participants in 2011-2013 (ARIC visit 5, mean age: 75.6, 41% male, 23% Black race) and in 3235 participants in 2016-2017 (visit 6). We used Poisson regression models to examine cross-sectional associations of a range of potential factors with the total odor identification errors (mean errors: 2.8 ± 2.4) in visit 5 participants. We used mixed-effect Poisson regression to examine associations with olfactory decline between visits 5 and 6. We also examined associations with visit 5 anosmia prevalence (847 cases, 14%) and incident anosmia between the two visits (510 cases, 16%) using Poisson models. Older age, male sex, lower education, Black race, APOE ε4 alleles, and diabetes were associated with higher odor identification errors and higher anosmia prevalence, and greater physical activity and hypertension with better olfaction. Age, male sex, lower education, Black race, APOE ε4 allele, and vitamin B12 levels were associated with incident anosmia over 5 years. Older age was associated with faster olfactory decline. Future studies with longer follow-ups are warranted.
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Affiliation(s)
- Srishti Shrestha
- The Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Xiaoqian Zhu
- The Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Vidyulata Kamath
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Kevin J. Sullivan
- The Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Jennifer A. Deal
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - A. Richey Sharrett
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Andrea L. C. Schneider
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Priya Palta
- Department of Neurology, University of North Carolina Chapel Hill, Chapel Hill, NC 27599, USA
| | - Rebecca F. Gottesman
- Stroke Branch, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD 20892, USA
| | - B. Gwen Windham
- The Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Thomas H. Mosley
- The Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Michael E. Griswold
- The Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Honglei Chen
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI 48824, USA
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Awwad AA, Abd Elhay OMM, Rabie MM, Awad EA, Kotb FM, Maghraby HM, Eldamarawy RH, Dawood YMA, Balat MIEI, Hasan AIM, Elsheshiny AH, El Sayed SSMM, Fouda AAB, Alkot AMF. Impact of Systemic Diseases on Olfactory Function in COVID-19 Infected Patients. Int J Gen Med 2022; 15:5681-5691. [PMID: 35747780 PMCID: PMC9212789 DOI: 10.2147/ijgm.s355974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 04/28/2022] [Indexed: 11/23/2022] Open
Abstract
Background COVID-19 (SARS-CoV-2/2019-nCoV) is now a major public health threat to the world. Olfactory dysfunctions (ODs) are considered potential indicating symptoms and early case identification triaging for coronavirus disease 2019 (COVID-19). The most common reported comorbidities are diabetes mellitus, chronic lung disease, and cardiovascular disease. The objective of this study was to evaluate prevalence of different types of smell disorders in patients with laboratory-confirmed COVID-19 infection and impact of involved systemic diseases. Methodology A cross-sectional retrospective study has been done for patients with laboratory-confirmed COVID-19 infection (mild-to-moderate). The data collected from patient's files and developed online electronic questionnaire (WhatsApp) based on the patients most common and recurrent reported data including: a) symptoms of olfactory dysfunction and associated covid19 symptoms fever and headache, cough, sore throat, pneumonia, nausea, vomiting and diarrhea, arthralgia and myalgia and taste dysfunction. b) Associated systemic diseases including: diabetes, hypertension, asthma, chronic renal disease, chorionic liver disease and hypothyroidism. Results Of 308 patients confirmed with Covid-19 infection, (72.4%) developed OD distributed as follows; complete anosmia (57.8%), troposmia (8.4%), hyposmia (2.9%), partial anosmia (2.6%) and euosmia (0.6%). Significantly increased prevalence of diabetes, hypertension asthma in the group with olfactory dysfunction (p < 0.001), chronic liver disease (p = 0.005), and hypothyroidism (p = 0.03). Conclusion The development of ODs after Covid-19 infection was associated with mild disease form and lower hospitalization. In addition, it showed significant relationship with preexisting systemic diseases. Anosmia is the common modality of ODs.
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Affiliation(s)
- Ayat A Awwad
- Otorhinolaryngology department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Osama M M Abd Elhay
- Medical Physiology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Moustafa M Rabie
- Public Health and Community Medicine Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Eman A Awad
- Internal medicine department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Fatma M Kotb
- Internal medicine department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Hend M Maghraby
- Internal medicine department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Rmadan H Eldamarawy
- Internal medicine department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Yahia M A Dawood
- Otorhinolaryngology department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mostafa I E I Balat
- Otorhinolaryngology department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed I M Hasan
- Pediatric Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed H Elsheshiny
- Neurology department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Said S M M El Sayed
- Medical Physiology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Albayoumi A B Fouda
- Medical Physiology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmad M F Alkot
- Medical Physiology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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6
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Patel ZM, Holbrook EH, Turner JH, Adappa ND, Albers MW, Altundag A, Appenzeller S, Costanzo RM, Croy I, Davis GE, Dehgani-Mobaraki P, Doty RL, Duffy VB, Goldstein BJ, Gudis DA, Haehner A, Higgins TS, Hopkins C, Huart C, Hummel T, Jitaroon K, Kern RC, Khanwalkar AR, Kobayashi M, Kondo K, Lane AP, Lechner M, Leopold DA, Levy JM, Marmura MJ, Mclelland L, Miwa T, Moberg PJ, Mueller CA, Nigwekar SU, O'Brien EK, Paunescu TG, Pellegrino R, Philpott C, Pinto JM, Reiter ER, Roalf DR, Rowan NR, Schlosser RJ, Schwob J, Seiden AM, Smith TL, Soler ZM, Sowerby L, Tan BK, Thamboo A, Wrobel B, Yan CH. International consensus statement on allergy and rhinology: Olfaction. Int Forum Allergy Rhinol 2022; 12:327-680. [PMID: 35373533 DOI: 10.1002/alr.22929] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/01/2021] [Accepted: 11/19/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The literature regarding clinical olfaction, olfactory loss, and olfactory dysfunction has expanded rapidly over the past two decades, with an exponential rise in the past year. There is substantial variability in the quality of this literature and a need to consolidate and critically review the evidence. It is with that aim that we have gathered experts from around the world to produce this International Consensus on Allergy and Rhinology: Olfaction (ICAR:O). METHODS Using previously described methodology, specific topics were developed relating to olfaction. Each topic was assigned a literature review, evidence-based review, or evidence-based review with recommendations format as dictated by available evidence and scope within the ICAR:O document. Following iterative reviews of each topic, the ICAR:O document was integrated and reviewed by all authors for final consensus. RESULTS The ICAR:O document reviews nearly 100 separate topics within the realm of olfaction, including diagnosis, epidemiology, disease burden, diagnosis, testing, etiology, treatment, and associated pathologies. CONCLUSION This critical review of the existing clinical olfaction literature provides much needed insight and clarity into the evaluation, diagnosis, and treatment of patients with olfactory dysfunction, while also clearly delineating gaps in our knowledge and evidence base that we should investigate further.
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Affiliation(s)
- Zara M Patel
- Otolaryngology, Stanford University School of Medicine, Stanford, California, USA
| | - Eric H Holbrook
- Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Justin H Turner
- Otolaryngology, Vanderbilt School of Medicine, Nashville, Tennessee, USA
| | - Nithin D Adappa
- Otolaryngology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark W Albers
- Neurology, Harvard Medical School, Boston, Massachusetts, USA
| | - Aytug Altundag
- Otolaryngology, Biruni University School of Medicine, İstanbul, Turkey
| | - Simone Appenzeller
- Rheumatology, School of Medical Sciences, University of Campinas, São Paulo, Brazil
| | - Richard M Costanzo
- Physiology and Biophysics and Otolaryngology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Ilona Croy
- Psychology and Psychosomatic Medicine, TU Dresden, Dresden, Germany
| | - Greg E Davis
- Otolaryngology, Proliance Surgeons, Seattle and Puyallup, Washington, USA
| | - Puya Dehgani-Mobaraki
- Associazione Naso Sano, Umbria Regional Registry of Volunteer Activities, Corciano, Italy
| | - Richard L Doty
- Smell and Taste Center, Otolaryngology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Valerie B Duffy
- Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | | | - David A Gudis
- Otolaryngology, Columbia University Irving Medical Center, New York, USA
| | - Antje Haehner
- Smell and Taste, Otolaryngology, TU Dresden, Dresden, Germany
| | - Thomas S Higgins
- Otolaryngology, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Claire Hopkins
- Otolaryngology, Guy's and St. Thomas' Hospitals, London Bridge Hospital, London, UK
| | - Caroline Huart
- Otorhinolaryngology, Cliniques universitaires Saint-Luc, Institute of Neuroscience, Université catholgique de Louvain, Brussels, Belgium
| | - Thomas Hummel
- Smell and Taste, Otolaryngology, TU Dresden, Dresden, Germany
| | | | - Robert C Kern
- Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ashoke R Khanwalkar
- Otolaryngology, Stanford University School of Medicine, Stanford, California, USA
| | - Masayoshi Kobayashi
- Otorhinolaryngology-Head and Neck Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Kenji Kondo
- Otolaryngology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Andrew P Lane
- Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matt Lechner
- Otolaryngology, Barts Health and University College London, London, UK
| | - Donald A Leopold
- Otolaryngology, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Joshua M Levy
- Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael J Marmura
- Neurology Thomas Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lisha Mclelland
- Otolaryngology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Takaki Miwa
- Otolaryngology, Kanazawa Medical University, Ishikawa, Japan
| | - Paul J Moberg
- Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Sagar U Nigwekar
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Erin K O'Brien
- Otolaryngology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Teodor G Paunescu
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Carl Philpott
- Otolaryngology, University of East Anglia, Norwich, UK
| | - Jayant M Pinto
- Otolaryngology, University of Chicago, Chicago, Illinois, USA
| | - Evan R Reiter
- Otolaryngology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - David R Roalf
- Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nicholas R Rowan
- Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rodney J Schlosser
- Otolaryngology, Medical University of South Carolina, Mt Pleasant, South Carolina, USA
| | - James Schwob
- Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Allen M Seiden
- Otolaryngology, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Timothy L Smith
- Otolaryngology, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Zachary M Soler
- Otolaryngology, Medical University of South Carolina, Mt Pleasant, South Carolina, USA
| | - Leigh Sowerby
- Otolaryngology, University of Western Ontario, London, Ontario, Canada
| | - Bruce K Tan
- Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Andrew Thamboo
- Otolaryngology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bozena Wrobel
- Otolaryngology, Keck School of Medicine, USC, Los Angeles, California, USA
| | - Carol H Yan
- Otolaryngology, School of Medicine, UCSD, La Jolla, California, USA
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7
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Schubert CR, Pinto AA, Paulsen AJ, Cruickshanks KJ. Exposure to Cadmium, Lead, and Tobacco Smoke and the 10-Year Cumulative Incidence of Olfactory Impairment: The Beaver Dam Offspring Study. JAMA Otolaryngol Head Neck Surg 2021; 147:510-517. [PMID: 33734283 DOI: 10.1001/jamaoto.2021.0079] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Importance Olfactory impairment is common in older adults. Identification of modifiable risk factors for olfactory impairment at midlife has the potential to reduce the burden of olfactory impairment at older ages. Objective To determine the 10-year cumulative incidence of olfactory impairment and evaluate potentially modifiable risk factors for impairment including exposure to cadmium, lead, and tobacco smoke. Design, Setting, and Participants Data from the Beaver Dam Offspring Study, a longitudinal cohort study of sensory health and aging in a general population, were available from examinations at baseline (2005-2008), 5 years (2010-2013), and 10 (2015-2017) years. A total of 2312 participants without olfactory impairment at baseline and with olfaction data available at the 5- and/or 10-year examination were included. The present study was conducted from April 28, 2020, to January 8, 2021. Main Outcomes and Measures Olfactory impairment was measured by the San Diego Odor Identification Test. Cox discrete-time proportional hazards analyses were used to model associations between baseline covariates, including blood cadmium and lead levels and tobacco smoke exposure, and the 10-year cumulative incidence of olfactory impairment. Results Of the 2312 participants, 1269 (54.9%) were women; mean age was 49 years (range, 22-84 years) at baseline. The 10-year cumulative incidence of olfactory impairment was 4.6% (95% CI, 3.7%-5.6%) and increased with age. Because of high collinearity, cadmium and tobacco smoke exposure were modeled separately. In a multivariable adjusted model, higher blood cadmium level (hazard ratio [HR], 1.70; 95% CI, 1.05-2.74) was associated with the 10-year cumulative incidence of olfactory impairment. Substituting tobacco smoke exposure for cadmium in the model, high exposure to tobacco smoke as a current smoker (HR, 2.94; 95% CI, 1.63-5.29, smoker vs no exposure) or from environmental tobacco smoke (HR, 2.65; 95% CI, 1.24-5.63, high vs no exposure) was also associated with an increased risk for developing olfactory impairment. Blood lead levels were not associated with olfactory impairment. Conclusions and Relevance Results of this longitudinal cohort study suggest that modifiable environmental exposures may contribute to olfactory impairment that occurs with aging. Identification of modifiable risk factors for olfactory impairment may lead to prevention strategies that have the potential to reduce the burden of olfactory impairment at older ages.
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Affiliation(s)
- Carla R Schubert
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison
| | - A Alex Pinto
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Adam J Paulsen
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Karen J Cruickshanks
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison.,Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison
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8
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Paulsen AJ, Fischer ME, Pinto A, Merten N, Dillard LK, Schubert CR, Huang GH, Klein BEK, Tweed TS, Cruickshanks KJ. Incidence of Hearing Impairment and Changes in Pure-Tone Average Across Generations. JAMA Otolaryngol Head Neck Surg 2021; 147:151-158. [PMID: 33211071 DOI: 10.1001/jamaoto.2020.4352] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Age-adjusted prevalence of hearing impairment (HI) decreased across generations in the 20th century, suggesting that HI is partially preventable. It is not known whether HI incidence differs by generation. Objectives To examine whether HI incidence and change in pure-tone average (PTA) differ by generation and identify factors underlying these differences. Design, Setting, and Participants This cohort study used data from the Epidemiology of Hearing Loss Study (EHLS) and Beaver Dam Offspring Study (BOSS), a pair of studies of adults in Beaver Dam, Wisconsin. Baseline examinations occurred from 1993 to 1995 in the EHLS and 2005 to 2008 in BOSS, with two 5-year follow-up examinations in each cohort. This longitudinal cohort study assessed 3651 participants without HI at baseline who had follow-up data. Main Outcomes and Measures The primary outcome was incident HI measured by pure-tone audiometry, defined as PTA greater than 25-dB hearing level (dB HL) in either ear. Associations of 5-year incidence were estimated by relative risks (RRs) and 10-year cumulative incidence with generation, as categorized by commonly used sociodemographic descriptors of year of birth, by hazard ratios (HRs). The 10-year change in PTA was investigated using a generation × time interaction term in generalized estimating equation models. Results Among the 3651 participants (mean [SD] age at baseline 53.1 [10.6] years; 2255 [61.8%] female; and 3567 [97.7%] non-Hispanic White), the 5-year HI incidence was 14.1% (95% CI, 13.0%-15.3%) and the 10-year cumulative incidence was 26.0% (95% CI, 24.6%-27.6%). The incidence increased with age. The risk of 5-year incident HI decreased by generation (RR, 0.80; 95% CI, 0.66-0.97) when adjusting for multiple covariates. The decreased risk was similar in the 10-year period (HR, 0.86; 95% CI, 0.73-1.01). The PTA change rate (per 5 years of follow-up) decreased by generation, with the Greatest Generation (born 1901-1924) experiencing the highest rate (7.03 dB HL). The rates were all significantly lower for the other generations (Silent Generation [born 1925-1945], 3.30 dB HL; Baby Boom Generation [born 1946-1964], 3.36 dB HL; and Generation X [born 1965-1984], 2.33 dB HL). Conclusions and Relevance This study suggests that the risk of HI and rate of PTA change is lower for the Silent Generation and Baby Boom Generation compared with the Greatest Generation. Part of this lower risk is likely associated with changes in modifiable factors. A potential continued benefit may exist for Generation X. Combined with the reduced risk of HI for the Silent Generation and Baby Boom Generation, this finding implies that the future HI burden may be lower than current estimates suggest.
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Affiliation(s)
- Adam J Paulsen
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Mary E Fischer
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Alex Pinto
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Natascha Merten
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Lauren K Dillard
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison.,Department of Communication Sciences and Disorders, University of Wisconsin, Madison (Dillard)
| | - Carla R Schubert
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Guan-Hua Huang
- Institute of Statistics, National Chiao Tung University, Hsinchu, Taiwan
| | - Barbara E K Klein
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Ted S Tweed
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Karen J Cruickshanks
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison.,Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
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9
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The association between olfactory dysfunction and cardiovascular disease and its risk factors in middle-aged and older adults. Sci Rep 2021; 11:1248. [PMID: 33441955 PMCID: PMC7806612 DOI: 10.1038/s41598-020-80943-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 12/30/2020] [Indexed: 12/31/2022] Open
Abstract
While previous studies have reported olfactory dysfunction (OD) in relation to cardiovascular disease (CVD), few population-based studies have investigated whether such associations differ by sex. The purpose of this study was to identify the association between CVD and its risk factors with OD, and the sex-associated differences within the general population. We examined 20,016 adults aged 40 and older from the Korean National Health and Nutrition Examination Survey. All subjects reported on their history of OD. CVD and its risk factors included coronary artery disease (CAD), stroke, hypertension, diabetes, obesity, abdominal obesity, and hypertriglyceridemia; logistic regression was used to analyse their associations with OD, and additive interaction was used to analyse the interaction between risk factors and sex. In males, CAD was more likely to be associated with OD (odds ratio [OR] 1.81, 95% confidence interval [CI] 1.05–3.14), whereas abdominal obesity was associated with OD in females (OR 1.39, 95% CI 1.06–1.84).Additive interaction were observed between abdominal obesity and female sex with a relative excess risk of interaction of 0.45 (95% CI 0.26–0.63). Our findings suggest the relationship between OD and CVD and its risk factors and sex-associated differences among middle-aged and older adults.
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10
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Palmquist E, Larsson M, Olofsson JK, Seubert J, Bäckman L, Laukka EJ. A Prospective Study on Risk Factors for Olfactory Dysfunction in Aging. J Gerontol A Biol Sci Med Sci 2020; 75:603-610. [PMID: 31724031 PMCID: PMC7021638 DOI: 10.1093/gerona/glz265] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Indexed: 12/20/2022] Open
Abstract
Background Olfactory dysfunction (OD) refers to a reduced or absent ability to smell. OD negatively impacts health and quality of life and its prevalence increases with advancing age. Since OD may be an early marker of dementia and impending death, more knowledge regarding risk factors of OD in aging is warranted. The objective was therefore to explore longitudinally which demographic, genetic, clinical, lifestyle, and cognitive factors predict the development of OD. Methods The study included participants aged 60–90 years from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K), who did not have OD at baseline and were reassessed with an odor identification task at a 6-year follow-up (n = 1,004). Risk factors of OD were assessed with multivariable logistic regression analyses. Results The percentage of incident OD cases was 14.2% over 6 years in the total sample and this number increased monotonically with age. Increasing age, carrying the ε4 allele of the APOE gene, atrial fibrillation, cerebrovascular disease, and current smoking were found to be risk factors for the development of OD, whereas better olfactory identification and verbal episodic memory proficiency at baseline were identified as protective factors. Conclusions In addition to nonmodifiable factors (age and genetic risk), several modifiable risk factors of OD were identified. This suggests that it might be possible to reduce OD incidence through the management of vascular risk factors and maintenance of a healthy lifestyle.
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Affiliation(s)
- Eva Palmquist
- Gösta Ekman's Laboratory, Department of Psychology, Stockholm University, Sweden
| | - Maria Larsson
- Gösta Ekman's Laboratory, Department of Psychology, Stockholm University, Sweden
| | - Jonas K Olofsson
- Gösta Ekman's Laboratory, Department of Psychology, Stockholm University, Sweden
| | - Janina Seubert
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Lars Bäckman
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University, Sweden
| | - Erika J Laukka
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University, Sweden.,Stockholm Gerontology Research Center, Sweden
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11
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Shah NN, Hussain RT, Mustafa H, Mushtaq M, Ali M. Evaluation of Olfactory Acuity in Patients with Coronavirus Disease 2019 (COVID-19). Indian J Otolaryngol Head Neck Surg 2020; 74:2772-2779. [PMID: 33134156 PMCID: PMC7588343 DOI: 10.1007/s12070-020-02241-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 10/19/2020] [Indexed: 01/08/2023] Open
Abstract
Aim and Objectives To describe the prevalence and characteristics of olfactory dysfunction (OD) in patients with laboratory-confirmed COVID-19 infection. Materials and Methods This monocentric study was performed at Chest Diseases Hospital during the COVID-19 pandemic and all patients testing positive for COVID-19 over a 5-month period (April to August 2020) were recruited. Detailed history was elicited from subjects and all patients were inquired about olfactory dysfunction (OD). Patients with olfactory dysfunction were asked to complete olfactory questionnaires based on the short version of the Questionnaire of Olfactory Disorders-Negative Statements (sQOD-NS). Results 655 patients with mild to moderate COVID-19 infection were included in the study. The prevalence rate of olfactory dysfunction was 18.47% (n = 121) with contribution of 11.60% (n = 76) and 6.87% (n = 45) from anosmia and hyposmia respectively, thereby suggesting olfactory dysfunction to be a significant clinical feature in COVID-19 patients. Males were significantly more affected by olfactory dysfunctions than females. Anosmic patients had significantly reduced sQOD-NS results as compared to hyposmic patients (significant at P < 0.05). The mean duration of OD was 7.7 days (± 4.3) and >90% patients in our study showed resolution within 14 days. Conclusion The early recognition of olfactory dysfunction should help to screen, identify and thereby quickly isolate mildly symptomatic COVID-19 patients from the general population and the existence of these dysfunctions may well be a prognostic factor in the course of the disease.
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Affiliation(s)
| | | | - Hena Mustafa
- Department of Respiratory Medicine, GMC, Srinagar, India
| | | | - Mariya Ali
- Department of Respiratory Medicine, GMC, Srinagar, India
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12
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Kondo K, Kikuta S, Ueha R, Suzukawa K, Yamasoba T. Age-Related Olfactory Dysfunction: Epidemiology, Pathophysiology, and Clinical Management. Front Aging Neurosci 2020; 12:208. [PMID: 32733233 PMCID: PMC7358644 DOI: 10.3389/fnagi.2020.00208] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/12/2020] [Indexed: 12/21/2022] Open
Abstract
Like other sensory systems, olfactory function deteriorates with age. Epidemiological studies have revealed that the incidence of olfactory dysfunction increases at the age of 60 and older and males are more affected than females. Moreover, smoking, heavy alcohol use, sinonasal diseases, and Down’s syndrome are associated with an increased incidence of olfactory dysfunction. Although the pathophysiology of olfactory dysfunction in humans remains largely unknown, studies in laboratory animals have demonstrated that both the peripheral and central olfactory nervous systems are affected by aging. Aged olfactory neuroepithelium in the nasal cavity shows the loss of mature olfactory neurons, replacement of olfactory neuroepithelium by respiratory epithelium, and a decrease in basal cell proliferation both in the normal state and after injury. In the central olfactory pathway, a decrease in the turnover of interneurons in the olfactory bulb (OB) and reduced activity in the olfactory cortex under olfactory stimulation is observed. Recently, the association between olfactory impairment and neurodegenerative diseases, such as Alzheimer’s disease (AD) and Parkinson’s disease (PD), has gained attention. Evidence-based pharmacotherapy to suppress or improve age-related olfactory dysfunction has not yet been established, but preliminary results suggest that olfactory training using odorants may be useful to improve some aspects of age-related olfactory impairment.
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Affiliation(s)
- Kenji Kondo
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shu Kikuta
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Rumi Ueha
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keigo Suzukawa
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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13
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Schubert CR, Cruickshanks KJ, Fischer ME, Pinto AA, Chen Y, Huang GH, Klein BEK, Klein R, Pankow JS, Paulsen AJ, Dalton DS, Tweed TS. Sensorineural Impairments, Cardiovascular Risk Factors, and 10-Year Incidence of Cognitive Impairment and Decline in Midlife: The Beaver Dam Offspring Study. J Gerontol A Biol Sci Med Sci 2020; 74:1786-1792. [PMID: 30629132 DOI: 10.1093/gerona/glz011] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sensorineural impairments and cardiovascular risk factors (CVRF) and disease (CVD) in midlife may be important predictors of future cognitive health, but longitudinal studies that include multiple sensorineural measures in middle-aged adults are lacking. METHODS Hearing, vision, and olfaction, and CVRF and CVD were measured at the Beaver Dam Offspring Study baseline (2005-2008) examination. The Mini-Mental State Examination and Trail Making Tests A and B were administered at all phases and additional cognitive function measures were obtained at 5 (2010-2013) and 10 years (2015-2017). Cox proportional hazards models were used to evaluate associations between baseline sensorineural impairments, CVRF, CVD, and 10-year cumulative incidence of cognitive impairment and decline. RESULTS There were 2,556 participants (22-84 years) without cognitive impairment at baseline and data from at least one follow-up. In a multivariable model including age, sex, education, and head injury, visual impairment (hazard ratio = 2.59, 95% confidence interval = 1.34, 5.02), olfactory impairment (hazard ratio = 3.18, 95% confidence interval = 1.53, 6.59), CVD (hazard ratio = 2.37, 95% confidence interval = 1.24, 4.52), and not consuming alcohol in the past year (hazard ratio = 2.21, 95% confidence interval = 1.16, 4.19) were associated with the 10-year cumulative incidence of cognitive impairment. Current smoking and diabetes were associated with increased risk, and exercise with decreased risk, of 10-year decline in cognitive function. CONCLUSIONS Visual and olfactory impairments, CVRF, and CVD were associated with the 10-year cumulative incidence of cognitive impairment and decline in middle-aged adults. Identifying modifiable factors associated with cognitive decline and impairment in midlife may provide opportunities for prevention or treatment and improve cognitive health later in life.
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Affiliation(s)
- Carla R Schubert
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Karen J Cruickshanks
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison.,Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Hsinchu, Taiwan
| | - Mary E Fischer
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison
| | - A Alex Pinto
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Yanjun Chen
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Guan-Hua Huang
- Institute of Statistics, National Chiao Tung University, Hsinchu, Taiwan
| | - Barbara E K Klein
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Ronald Klein
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison
| | - James S Pankow
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Adam J Paulsen
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Dayna S Dalton
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Ted S Tweed
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison
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14
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Schlosser RJ, Desiato VM, Storck KA, Nguyen SA, Hill JB, Washington BJ, Noonan TE, Lamira J, Mulligan JK, Rowan NR, Yoo F, Matthews LJ, Dubno JR, Soler ZM. A Community-Based Study on the Prevalence of Olfactory Dysfunction. Am J Rhinol Allergy 2020; 34:661-670. [PMID: 32345032 DOI: 10.1177/1945892420922771] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Olfactory dysfunction (OD) is common, affecting an estimated 13 million adults in the United States. Prior studies may underestimate OD prevalence due to use of brief smell identification tests or age-adjusted cutoff values, which concede that it is acceptable for older people to have a decreased sense of smell. OBJECTIVE To determine OD prevalence in the healthy community when the goal and expectation is ideal olfactory function, rather than age-based population norms. Secondary goals were to explore factors associated with OD. METHODS Subjects without otolaryngic complaints were recruited from the community surrounding the Medical University of South Carolina. Olfactory-specific information was collected, and olfactory function was assessed using the Sniffin' Sticks test (Burghardt, Wedel, Germany) to measure threshold, discrimination, and identification (TDI). OD was defined as a TDI score < 31. Bivariate analysis and linear regression were used to determine factors associated with OD. RESULTS In total, 176 subjects were included with mean age of 52 years (range: 20-93), 111 (63%) female, and 127 (72%) white. Mean TDI score was 28.8 (6.9) and OD was present in 94 (53%) subjects. Multivariate linear regression revealed that TDI decreased an average of 1 point every 5 years. TDI was also associated with Mini-Mental Status Examination (MMSE) score, asthma, and gastroesophageal reflux disease. Threshold was associated with age, heart problems, and gastroesophageal reflux disease. Discrimination was associated with age and MMSE scores. Identification was associated with age, heart problems, and anxiety. CONCLUSIONS In a community-based sample, OD affects greater than 50% of subjects. Aging impacts all aspects of olfaction, while the effects of factors such as asthma, MMSE scores, gastroesophageal reflux disease, heart problems, and anxiety may only be evident in specific olfactory subtests.
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Affiliation(s)
- Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina.,Department of Surgery, Ralph H. Johnson VA Medical Center, Charleston, South Carolina
| | - Vincent M Desiato
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Kristina A Storck
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Jonathan B Hill
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Brandon J Washington
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Tegan E Noonan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Jensine Lamira
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Jennifer K Mulligan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Nicholas R Rowan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Frederick Yoo
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Lois J Matthews
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Judy R Dubno
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
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15
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Van Regemorter V, Hummel T, Rosenzweig F, Mouraux A, Rombaux P, Huart C. Mechanisms Linking Olfactory Impairment and Risk of Mortality. Front Neurosci 2020; 14:140. [PMID: 32153360 PMCID: PMC7046549 DOI: 10.3389/fnins.2020.00140] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 02/04/2020] [Indexed: 12/16/2022] Open
Abstract
Olfaction is a sense involved in a complex set of tasks, influencing eating behavior, increasing awareness of environmental hazards and affecting social communication. Surprisingly, smell disorders are very frequent, especially in the elderly population. Several recent studies conducted mostly in older subjects have demonstrated a strong association between olfactory impairment and overall mortality risk, with anosmia being even more predictive of 5 years mortality risk than cardiovascular disease. Presently, the underlying pathophysiology linking olfactory impairment to mortality remains unknown and only putative mechanisms are suggested. This review aims to examine the link between olfactory impairment and mortality and to discuss existing ideas on underlying existing mechanisms including, (1) the effect of olfactory loss on nutrition, life-threatening situations and social interactions, (2) associated neurodegenerative diseases, (3) accelerated brain aging, and (4) reflection of general health status being reflected in olfactory function.
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Affiliation(s)
- Victoria Van Regemorter
- Department of Anesthesiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Thomas Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - Flora Rosenzweig
- Department of Otorhinolaryngology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - André Mouraux
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Philippe Rombaux
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
- Department of Otorhinolaryngology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Caroline Huart
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
- Department of Otorhinolaryngology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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16
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Gallo S, Byham-Gray L, Duffy VB, Hoffman HJ, Hayes JE, Rawal S. Associations of olfactory dysfunction with anthropometric and cardiometabolic measures: Findings from the 2013-2014 national health and nutrition examination survey (NHANES). Physiol Behav 2019; 215:112702. [PMID: 31629766 DOI: 10.1016/j.physbeh.2019.112702] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 10/04/2019] [Accepted: 10/06/2019] [Indexed: 12/14/2022]
Abstract
We examined associations of olfactory dysfunction with anthropometric and cardiometabolic measures in a nationally representative sample of US adults. In the 2013-2014 National Health and Nutrition Examination Survey (NHANES), 3,815 participants, 40 years and older, completed a standardized taste and smell protocol, which consisted of an 8-item odor identification test and a chemosensory questionnaire. Measured dysfunction was incorrect identification of ≥3 of 8 odors; self-reported dysfunction was affirmative response to either a recent smell problem, worse ability since age 25, or phantosmia. Survey-weighted linear regression models tested associations of olfactory dysfunction with body mass index (BMI), waist circumference (WC), blood pressure, serum total cholesterol (TC) with fractions, triglycerides, and glucose levels. Models were adjusted for age, race, education, physical activity, self-reported general health condition, smoking history, and income-to-poverty ratio, stratifying by sex and age group (middle-age 40-64 years; older ≥65 years). Relative to normal, measured olfactory dysfunction was associated with lower BMI [β=-1.6 (95% CI: -3.2, -0.01)] in older men. In middle-age women, dysfunction was associated with higher BMI and WC, whether assessed by examination [β's for BMI=3.1 (0.6, 5.5), WC=5.0 (0.3, 9.8)] or self-report [β's for BMI=2.5 (0.6, 4.3), WC=6.1 (2.2, 9.9)]. Measured dysfunction was associated with significantly higher TC [β=12.8 (7.5, 18.1)] and LDL [β=18.1 (9.1, 27.2)] among older men, but significantly lower TC [β=-15.0 (-25.0, -5.7)] and marginally lower LDL [β=-12.0 (-25.0, 1.2)] among older women. Between measured dysfunction and fasting glucose, the association was inverse [β=-7.9 (-13.0, -2.6)] among middle-age men, but positive [β=15.6 (1.5, 29.7)] among older women. No significant associations were observed with blood pressure levels. In conclusion, among US adults ≥40 years, olfactory dysfunction is associated with anthropometric and glucose and lipid levels, with associations varying by sex and age group.
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Affiliation(s)
- Samantha Gallo
- Department of Clinical and Preventive Nutrition Sciences, Rutgers School of Health Professions, 65 Bergen St., Newark, NJ 07107-1709 USA.
| | - Laura Byham-Gray
- Department of Clinical and Preventive Nutrition Sciences, Rutgers School of Health Professions, 65 Bergen St., Newark, NJ 07107-1709 USA.
| | - Valerie B Duffy
- Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Rd, Storrs, CT 06269, USA.
| | - Howard J Hoffman
- Epidemiology and Statistics Program, Division of Scientific Programs, National Institute on Deafness and Other Communication Disorders, National Institutes of Health (NIH), 10 Center Dr., Bethesda, MD 20892, USA.
| | - John E Hayes
- Sensory Evaluation Center, The Pennsylvania State University, 220 Erickson Food Science Building, University Park, PA 16802, USA; Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, 220 Erickson Food Science Building, University Park, PA 16802, USA.
| | - Shristi Rawal
- Department of Clinical and Preventive Nutrition Sciences, Rutgers School of Health Professions, 65 Bergen St., Newark, NJ 07107-1709 USA.
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17
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Siegel JK, Wroblewski KE, McClintock MK, Pinto JM. Olfactory dysfunction persists after smoking cessation and signals increased cardiovascular risk. Int Forum Allergy Rhinol 2019; 9:977-985. [PMID: 31365791 PMCID: PMC6730657 DOI: 10.1002/alr.22357] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/08/2019] [Accepted: 05/09/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Olfaction plays a critical role in health and function in older adults, and impaired sense of smell is a strong predictor of morbidity and mortality. Smoking cigarettes causes olfactory impairment, but the mechanism of damage and ability to recover after cessation are unknown. We investigated the relationship between time since quitting and olfactory dysfunction in order to elucidate the mechanism(s) by which smoking damages the olfactory system and to inform patient counseling. METHODS Using longitudinal data from the National Social Life Health and Aging Project (n = 3528 older adults, including 1526 former smokers), we analyzed the association between odor identification performance and time since smoking cessation using multivariate ordinal logistic regression, adjusting for cognition and demographic variables. To test whether vascular disease plays a role, we also assessed the relationship between olfactory decline and incidence of heart attack and heart disease. RESULTS Former smokers who quit ≤15 years before testing had significantly impaired olfaction compared to never smokers (p = 0.04), but those who quit >15 years prior did not. Olfactory decline over 5 years showed modest evidence toward predicting increased incidence of heart attack or heart disease (p = 0.08). CONCLUSION Olfactory impairment in smokers persists 15 years after quitting, which is consistent with a vascular mechanism of impairment. Indeed, olfactory decline is a predictor of the development of cardiovascular disease. Taken together, these data suggest that olfactory loss may be a useful sign of underlying vascular pathology. Further investigation of olfactory loss as an early biomarker for cardiovascular disease is warranted.
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Affiliation(s)
| | | | - Martha K. McClintock
- Department of Comparative Human Development and The Institute for Mind and Biology, The University of Chicago
| | - Jayant M. Pinto
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, The University of Chicago
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Schubert CR, Fischer ME, Pinto AA, Chen Y, Klein BE, Klein R, Tsai MY, Tweed TS, Cruickshanks KJ. Brain Aging in Midlife: The Beaver Dam Offspring Study. J Am Geriatr Soc 2019; 67:1610-1616. [PMID: 30934109 PMCID: PMC6684355 DOI: 10.1111/jgs.15886] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/22/2019] [Accepted: 02/21/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Middle age has been identified as a critical time period for health later in life. Identifying factors associated with worse brain function in middle-aged adults may help identify ways to preserve brain function with aging. Our objective was to evaluate factors associated with a novel measure of brain aging in middle-aged and older adults. DESIGN Longitudinal cohort study. SETTING Beaver Dam Offspring Study (BOSS) baseline (2005-2008), 5-year (2010-2013), and 10-year examinations (2015-2017). PARTICIPANTS A total of 2285 adults, 22 to 84 years of age, with complete sensorineural and neurocognitive data at the 5-year examination. MEASUREMENTS Principal component analysis (PCA) was performed combining 5-year sensorineural (hearing, vision, olfaction) and cognitive (Trail Making Test A and B, Digit Symbol Substitution Test, Verbal Fluency Test, Auditory Verbal Learning Test) test data. Participants with a standardized PCA score less than -1 were classified as having brain aging. Incident brain aging was defined as a PCA score less than -1 at 10 years among participants who had a PCA score of -1 or higher at 5 years. Logistic regression and Poisson models were used to estimate associations between baseline factors and prevalent or incident brain aging, respectively. RESULTS Older age, being male, current smoking, larger waist circumference, not consuming alcohol, cardiovascular disease, and interleukin-6 were associated with greater odds of prevalent brain aging, whereas more education and exercise were associated with decreased odds. In addition to age and sex, less than a college education, higher levels of soluble intercellular adhesion molecule-1, diabetes, depressive symptoms, and history of head injury were associated with an increased 5-year risk of incident brain aging. CONCLUSION In the current study, vascular and inflammatory factors were associated with a new brain aging marker in middle-aged and older adults. Many of these factors are modifiable, highlighting the importance of addressing health and lifestyle factors in midlife to potentially preserve function for better brain health later in life. J Am Geriatr Soc 67:1610-1616, 2019.
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Affiliation(s)
- Carla R. Schubert
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, 610 Walnut Street, Madison, WI 53726, USA
| | - Mary E. Fischer
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, 610 Walnut Street, Madison, WI 53726, USA
| | - A. Alex Pinto
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, 610 Walnut Street, Madison, WI 53726, USA
| | - Yanjun Chen
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, 610 Walnut Street, Madison, WI 53726, USA
| | - Barbara E.K. Klein
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, 610 Walnut Street, Madison, WI 53726, USA
| | - Ronald Klein
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, 610 Walnut Street, Madison, WI 53726, USA
| | - Michael Y. Tsai
- Department of Laboratory Medicine and Pathology, University of Minnesota, 420 Delaware Street S.E., Minneapolis, MN 55455
| | - Ted S. Tweed
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, 610 Walnut Street, Madison, WI 53726, USA
| | - Karen J. Cruickshanks
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, 610 Walnut Street, Madison, WI 53726, USA
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, 610 Walnut Street, Madison, WI 53726, USA
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Heightened olfactory dysfunction and oral irritation among chronic smokers and heightened propylthiouracil (PROP) bitterness among menthol smokers. Physiol Behav 2018; 201:111-122. [PMID: 30557565 DOI: 10.1016/j.physbeh.2018.12.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/05/2018] [Accepted: 12/13/2018] [Indexed: 12/14/2022]
Abstract
Chronic cigarette smoking may influence chemosensory function, which in turn, may affect cigarette usage. Because menthol in cigarettes can attenuate nicotine bitterness, choice of menthol/nonmenthol cigarettes may be influenced by ability to perceive bitterness. We examined chemosensory function of chronic smokers, hypothesizing they would show altered function in comparison to non-smokers and by menthol cigarette preference. In laboratory-based measures, chronic smokers (N = 135; 84 menthol smokers) self-reported their chemosensory function and participated in smell (identification task with perceived intensity) and taste (quinine and NaCl intensity on tongue-tip and whole mouth) testing. A taste genetics probe (propylthiouracil (PROP) bitterness) also was assessed. Self-reported and measured chemosensory function were compared with nationally-representative 2013-2014 National Health and Nutrition Examination Survey (NHANES) data generated with similar measures. The taste measures also were compared between smokers and age- and sex-matched non-smokers from a laboratory database. Frequencies of self-reported smell and taste alterations among smokers exceeded NHANES prevalence estimates for non-smokers. The rate of measured smell dysfunction also exceeded NHANES prevalence for hyposmia. Compared to non-smokers, smokers reported elevated tongue-tip and whole mouth intensities from 1 M NaCl, with no significant differences in whole mouth quinine or 0.32 M NaCl. Inconsistent with previous hypotheses, smokers were not more likely to report depressed PROP bitterness than non-smokers. However, as expected, menthol smokers reported greater PROP bitterness than non-menthol smokers. In conclusion, chemosensory alterations were more frequent among chronic smokers, including hyposmia and heightened intensity from NaCl at an oral-irritant concentration. PROP supertasters were most likely to prefer mentholated cigarettes.
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Paulsen AJ, Schubert CR, Johnson LJ, Chen Y, Dalton DS, Klein BEK, Klein R, Pinto A, Cruickshanks KJ. Association of Cadmium and Lead Exposure With the Incidence of Contrast Sensitivity Impairment Among Middle-aged Adults. JAMA Ophthalmol 2018; 136:1342-1350. [PMID: 30242333 PMCID: PMC6292732 DOI: 10.1001/jamaophthalmol.2018.3931] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Contrast sensitivity (CS) is an important indicator of visual function that affects daily life, including mobility, visually intensive tasks, safety, and autonomy. Understanding the risk factors for CS impairment could prevent decreases in visual function. Objective To determine the incidence of and factors associated with CS impairment in a large cohort. Design, Setting, and Participants The Beaver Dam Offspring Study is an ongoing longitudinal cohort study of aging involving adults in Beaver Dam, Wisconsin. Participants who were free of CS impairment in both eyes at baseline were included (N = 1983). Baseline data collection occurred from June 8, 2005, through August 4, 2008, when the participants ranged from 21 to 84 years of age. Two follow-up examinations occurred at 5-year intervals: one was conducted between July 12, 2010, and March 21, 2013, and the other between July 1, 2015, and November 13, 2017. Data analysis was performed from November 27, 2017, to February 27, 2018. Main Outcomes and Measures Contrast sensitivity testing was conducted with Pelli-Robson letter sensitivity charts, and incident impairment was defined as a log CS score less than 1.55 in either eye at any follow-up examination. Cadmium and lead levels were measured in whole blood with inductively coupled plasma mass spectrometry. Associations between baseline characteristics and CS impairment incidence were examined using Cox proportional hazard models and quantified as hazard ratios (HRs) with 95% CI. Results Of the 1983 participants included, 1028 (51.8%) were female and 955 (48.2%) were male, with a mean (SD) age of 48 (9.3) years. The 10-year cumulative incidence of CS impairment was 24.8% (95% CI, 22.9-26.8), similar in women (24.9%) and men (24.6%), and highest in the oldest age group (65-84 years) at 66.3%. In multivariable models, cadmium level in the highest quintile (HR, 1.35; 95% CI, 1.02-1.78), older age (HR, 1.36; 95% CI, 1.25-1.47), larger waist circumference (HR, 1.06; 95% CI, 1.01-1.11), and more plaque sites (1-3 sites: HR, 1.43; 95% CI, 1.07-1.92; 4-6 sites: HR, 2.75; 95% CI, 1.26-6.05) were among the factors associated with increased risk, while male sex (HR, 0.77; 95% CI, 0.60-0.98) and any alcohol consumption (HR, 0.61; 95% CI, 0.43-0.88) were associated with decreased risk. Results were similar when smoking status replaced cadmium exposure in the models. Lead level was not associated with increased risk. Conclusions and Relevance This study's findings suggest that incident CS impairment was common in the 10-year follow-up, with cadmium, but not lead, exposure associated with increased risk. The associations of diminished CS with other modifiable risk factors found appear to imply that changes in behavior may reduce future incidence of CS impairment.
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Affiliation(s)
- Adam J. Paulsen
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin - Madison
| | - Carla R. Schubert
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin - Madison
| | - Lauren J. Johnson
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin – Madison
| | - Yanjun Chen
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin - Madison
| | - Dayna S. Dalton
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin - Madison
| | - Barbara E. K. Klein
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin - Madison
| | - Ronald Klein
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin - Madison
| | - Alex Pinto
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin - Madison
| | - Karen J. Cruickshanks
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin - Madison
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin – Madison
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Fischer ME, Cruickshanks KJ, Dillard LK, Nondahl DM, Klein BEK, Klein R, Pankow JS, Tweed TS, Schubert CR, Dalton DS, Paulsen AJ. An Epidemiologic Study of the Association between Free Recall Dichotic Digits Test Performance and Vascular Health. J Am Acad Audiol 2018; 30:282-292. [PMID: 30461399 DOI: 10.3766/jaaa.17079] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Associations between vascular health-related factors and hearing loss defined using audiometric pure-tone thresholds have been found. Studies have not focused on a potential relationship between vascular health-related factors and central auditory processing. PURPOSE The aim of this study was to evaluate, on a population level, the relationship of vascular health-related factors with central auditory function. RESEARCH DESIGN A cross-sectional, population study. STUDY SAMPLE Subjects were participants in the Epidemiology of Hearing Loss Study (EHLS) or the Beaver Dam Offspring Study (BOSS)-prospective studies of aging and sensory loss. BOSS participants were the adult offspring of participants in the EHLS. Participants who completed the Dichotic Digits Test (DDT) during the fourth examination period of the EHLS (2008-2010) or the second examination period of the BOSS (2010-2013) were included (n = 3,655, mean age = 61.1 years). DATA COLLECTION AND ANALYSIS The DDT-free recall test was conducted using 25 sets of triple-digit pairs at a 70 dB HL presentation level. The total number of correctly repeated digits from the right and left ears was converted to a percentage correct and used as an outcome. The percentage correct in the left ear was subtracted from the percentage correct in the right ear and used as an outcome. Vascular health-related measures obtained during the examination included blood pressure, mean carotid intima-media thickness, femoral pulse wave velocity (PWV), hemoglobin A1C, and non-high-density lipoprotein (HDL) cholesterol, and, in the EHLS participants, C-reactive protein and interleukin-6. Information on vascular health-related history and behaviors was self-reported. General linear modeling produced estimates of the age- and sex-adjusted least squares means for each vascular factor, and multiple linear regression was used for multivariable modeling of each outcome. RESULTS After multivariable adjustment, participants with diabetes had a significantly lower (worse) mean DDT-free recall total score (-2.08 percentage points, p < 0.001) than those without diabetes. Participants who exercised at least once per week had a significantly higher (better) mean DDT-free recall total score (+1.07 percentage points, p < 0.01) than those who did not exercise at least once per week. Alcohol consumption was associated with a higher DDT-free recall total score (+0.15 percentage points per +25 g ethanol, p < 0.01). In multivariable modeling of the right-left ear difference in DDT-free recall scores, participants with a history of cardiovascular disease (CVD) or higher PWV demonstrated significantly larger differences (CVD: +3.11 percentage points, p = 0.02; PWV: +0.36 percentage points per 1 m/sec, p < 0.01). Higher levels of non-HDL cholesterol were associated with smaller right-left ear differences (-0.22 percentage points per 10 mg/dL, p = 0.01). Adjustment for handedness did not affect the results. CONCLUSIONS Vascular health-related factors may play a role in central auditory function.
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Affiliation(s)
- Mary E Fischer
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI
| | - Karen J Cruickshanks
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI.,Department of Population Health Sciences, University of Wisconsin, Madison, WI
| | - Lauren K Dillard
- Department of Communication Sciences and Disorders, University of Wisconsin, Madison, WI
| | - David M Nondahl
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI
| | - Barbara E K Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI
| | - Ronald Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI
| | - James S Pankow
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | - Ted S Tweed
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI
| | - Carla R Schubert
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI
| | - Dayna S Dalton
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI
| | - Adam J Paulsen
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI
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Schubert CR, Cruickshanks KJ, Fischer ME, Chen Y, Klein BEK, Klein R, Pinto AA. Sensory Impairments and Cognitive Function in Middle-Aged Adults. J Gerontol A Biol Sci Med Sci 2017; 72:1087-1090. [PMID: 28535277 PMCID: PMC5861860 DOI: 10.1093/gerona/glx067] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Hearing, visual, and olfactory impairments have been associated with cognitive impairment in older adults but less is known about associations with cognitive function in middle-aged adults. METHODS Sensory and cognitive functions were measured on participants in the baseline examination (2005-2008) of the Beaver Dam Offspring Study. Cognitive function was measured with the Trail Making tests A (TMTA) and B (TMTB) and the Grooved Peg Board test. Pure-tone audiometry, Pelli-Robson letter charts, and the San Diego Odor Identification test were used to measure hearing, contrast sensitivity, and olfaction, respectively. RESULTS There were 2,836 participants aged 21-84 years with measures of hearing, visual, olfactory, and cognitive function at the baseline examination. Nineteen percent of the cohort had one sensory impairment and 3% had multiple sensory impairments. In multivariable adjusted linear regression models that included all three sensory impairments, hearing impairment, visual impairment, and olfactory impairment were each independently associated with poorer performance on the TMTA, TMTB, and Grooved Peg Board (p < .05 for all sensory impairments in all models). Participants with a sensory impairment took on average from 2 to 10 seconds longer than participants without the corresponding sensory impairment to complete these tests. Results were similar in models that included adjustment for hearing aid use. CONCLUSION Hearing, visual and olfactory impairment were associated with poorer performance on cognitive function tests independent of the other sensory impairments and factors associated with cognition. Sensory impairments in midlife are associated with subtle deficits in cognitive function which may be indicative of early brain aging.
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Affiliation(s)
| | - Karen J Cruickshanks
- Department of Ophthalmology and Visual Sciences
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison
| | | | - Yanjun Chen
- Department of Ophthalmology and Visual Sciences
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Ajmani GS, Suh HH, Wroblewski KE, Pinto JM. Smoking and olfactory dysfunction: A systematic literature review and meta-analysis. Laryngoscope 2017; 127:1753-1761. [PMID: 28561327 PMCID: PMC6731037 DOI: 10.1002/lary.26558] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/03/2017] [Accepted: 02/06/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVES/HYPOTHESIS A systematic review and meta-analysis of the literature was undertaken, examining the association between tobacco smoking and olfactory function in humans, utilizing PubMed and Web of Science (1970-2015) as data sources. STUDY DESIGN Systematic literature review and meta-analysis. METHODS This database review of studies of smoking and olfaction, with a focus on identifying high-quality studies (based on modified versions of the Newcastle-Ottawa Scale), used validated olfactory tests among the generally healthy population. RESULTS We identified 11 studies meeting inclusion criteria. Of 10 cross-sectional studies, two were excluded from meta-analysis because the cohorts they studied were included in another article in the review. In meta-analysis, current smokers had substantially higher odds of olfactory dysfunction compared to never smokers (odds ratio [OR] = 1.59, 95% confidence interval [CI] = 1.37-1.85). In contrast, former smokers were found to have no difference in risk of impaired olfaction compared to never smokers (OR = 1.05, 95% CI = 0.91-1.21). The single longitudinal study reviewed found a trend toward increased risk of olfactory decline over time in ever smokers; this trend was stronger in current as compared to former smokers. CONCLUSIONS Current smoking, but not former smoking, is associated with significantly increased risk of olfactory dysfunction, suggesting that the effects of smoking on olfaction may be reversible. Future studies that prospectively evaluate the impact of smoking cessation on improvement in olfactory function are warranted. LEVEL OF EVIDENCE N/A. Laryngoscope, 127:1753-1761, 2017.
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Affiliation(s)
- Gaurav S. Ajmani
- Pritzker School of Medicine, The University of Chicago, Chicago, IL, United States
| | - Helen H. Suh
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA, United States
| | - Kristen E. Wroblewski
- Department of Public Health Sciences, The University of Chicago, Chicago, IL, United States
| | - Jayant M. Pinto
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, The University of Chicago, Chicago, IL, United States
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Schubert CR, Fischer ME, Pinto AA, Klein BEK, Klein R, Tweed TS, Cruickshanks KJ. Sensory Impairments and Risk of Mortality in Older Adults. J Gerontol A Biol Sci Med Sci 2017; 72:710-715. [PMID: 26946102 DOI: 10.1093/gerona/glw036] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 02/11/2016] [Indexed: 11/13/2022] Open
Abstract
Background Sensory impairments increase with age and the majority of older people will experience a sensory impairment if they live long enough. However, the relationships of hearing, visual, and olfactory impairments with mortality are not well understood. Methods Epidemiology of Hearing Loss Study participants (n = 2,418) aged 53-97 years (mean = 69 years) were examined in 1998-2000 and hearing, visual acuity, and olfaction were measured. Participants were followed for mortality for up to 17 years (mean = 12.8 years). Cox proportional hazards models were used to assess the association between prevalent sensory impairments and the 15-year cumulative incidence of death. Results A total of 1,099 (45.4%) of participants died during the follow-up period. In age- and sex-adjusted Cox models, the risk of mortality was higher among participants with one (hazard ratio [HR] = 1.40, 95% confidence interval [CI] = 1.19, 1.64) or two or more (HR = 2.12, 95% CI = 1.74, 2.58) sensory impairments than among participants with no sensory impairments. Olfactory impairment at baseline was significantly associated with mortality (HR = 1.28, 95% CI = 1.07, 1.52) after adjusting for age, sex, sensory comorbidities, cardiovascular risk factors and disease, cognitive impairment, frailty, subclinical atherosclerosis, and inflammatory marker levels (n = 1,745). Hearing and visual impairment were not associated with mortality after adjusting for subclinical atherosclerosis and inflammation. Conclusion Olfactory impairment, but not hearing or visual impairment, was associated with an increased risk of mortality. These results suggest that olfactory impairment may be a marker of underlying physiologic processes or pathology that is associated with aging and reduced survival in older adults.
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Affiliation(s)
| | | | - A Alex Pinto
- Department of Ophthalmology and Visual Sciences and
| | | | - Ronald Klein
- Department of Ophthalmology and Visual Sciences and
| | - Ted S Tweed
- Department of Ophthalmology and Visual Sciences and
| | - Karen J Cruickshanks
- Department of Ophthalmology and Visual Sciences and.,Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison
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Fischer ME, Cruickshanks KJ, Schubert CR, Pinto AA, Carlsson CM, Klein BEK, Klein R, Tweed TS. Age-Related Sensory Impairments and Risk of Cognitive Impairment. J Am Geriatr Soc 2016; 64:1981-1987. [PMID: 27611845 PMCID: PMC5073029 DOI: 10.1111/jgs.14308] [Citation(s) in RCA: 157] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate the associations between sensory impairments and 10-year risk of cognitive impairment. DESIGN The Epidemiology of Hearing Loss Study (EHLS), a longitudinal, population-based study of aging in the Beaver Dam, Wisconsin community. Baseline examinations were conducted in 1993 and follow-up examinations have been conducted every 5 years. SETTING General community. PARTICIPANTS EHLS members without cognitive impairment at EHLS-2 (1998-2000). There were 1,884 participants (mean age 66.7) with complete EHLS-2 sensory data and follow-up information. MEASUREMENTS Cognitive impairment was defined as a Mini-Mental State Examination score of <24 or history of dementia or Alzheimer's disease. Hearing impairment was a pure-tone average of hearing thresholds (0.5, 1, 2, 4 kHz) of >25 dB hearing level in either ear, visual impairment was a Pelli-Robson contrast sensitivity of <1.55 log units in the better eye, and olfactory impairment was a San Diego Odor Identification Test score of <6. RESULTS Hearing, visual, and olfactory impairment were independently associated with cognitive impairment risk (hearing: hazard ratio (HR) = 1.90, 95% confidence interval (CI) = 1.11-3.26; vision: HR = 2.05, 95% CI = 1.24-3.38; olfaction: HR = 3.92, 95% CI = 2.45-6.26)). Nevertheless, 85% of participants with hearing impairment, 81% with visual impairment, and 76% with olfactory impairment did not develop cognitive impairment during follow-up. CONCLUSION The relationship between sensory impairment and cognitive impairment was not unique to one sensory system, suggesting that sensorineural health may be a marker of brain aging. The development of a combined sensorineurocognitive measure may be useful in uncovering mechanisms of healthy brain aging.
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Affiliation(s)
- Mary E Fischer
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin.
| | - Karen J Cruickshanks
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Carla R Schubert
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Alex A Pinto
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Cynthia M Carlsson
- Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
- Division of Geriatrics and Gerontology, Department of Medicine, Geriatric Research, Education and Clinical Center, Department of Veterans Affairs, Madison, Wisconsin
| | - Barbara E K Klein
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Ronald Klein
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Ted S Tweed
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
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Hoffman HJ, Rawal S, Li CM, Duffy VB. New chemosensory component in the U.S. National Health and Nutrition Examination Survey (NHANES): first-year results for measured olfactory dysfunction. Rev Endocr Metab Disord 2016; 17:221-40. [PMID: 27287364 PMCID: PMC5033684 DOI: 10.1007/s11154-016-9364-1] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The U.S. NHANES included chemosensory assessments in the 2011-2014 protocol. We provide an overview of this protocol and 2012 olfactory exam findings. Of the 1818 NHANES participants aged ≥40 years, 1281 (70.5 %) completed the exam; non-participation mostly was due to time constraints. Health technicians administered an 8-item, forced-choice, odor identification task scored as normosmic (6-8 odors identified correctly) versus olfactory dysfunction, including hyposmic (4-5 correct) and anosmic/severe hyposmic (0-3 correct). Interviewers recorded self-reported smell alterations (during past year, since age 25, phantosmia), histories of sinonasal problems, xerostomia, dental extractions, head or facial trauma, and chemosensory-related treatment and changes in quality of life. Olfactory dysfunction was found in 12.4 % (13.3 million adults; 55 % males/45 % females) including 3.2 % anosmic/severe hyposmic (3.4 million; 74 % males/26 % females). Selected age-specific prevalences were 4.2 % (40-49 years), 12.7 % (60-69 years), and 39.4 % (80+ years). Among adults ≥70 years, misidentification rates for warning odors were 20.3 % for smoke and 31.3 % for natural gas. The highest sensitivity (correctly identifying dysfunction) and specificity (correctly identifying normosmia) of self-reported olfactory alteration was among anosmics/severe hyposmics (54.4 % and 78.1 %, respectively). In age- and sex-adjusted logistic regression analysis, risk factors of olfactory dysfunction were racial/ethnic minority, income-to-poverty ratio ≤ 1.1, education <high school, and heavy drinking. Moderate-to-vigorous physical activity reduced risk of impairment. Olfactory dysfunction is prevalent, particularly among older adults. Inexpensive, brief odor identification tests coupled with questions (smell problems past year, since age 25, phantosmia) could screen for marked dysfunction. Healthcare providers should be prepared to offer education on non-olfactory avoidance of hazardous events.
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Affiliation(s)
- Howard J Hoffman
- Epidemiology and Statistics Program, Division of Scientific Programs, National Institute on Deafness and other Communication Disorders (NIDCD) at the National Institutes of Health (NIH), Bethesda, MD, USA
| | - Shristi Rawal
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Rockville, MD, USA
- Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Road, Unit 1101, Storrs, CT, 06269, USA
| | - Chuan-Ming Li
- Epidemiology and Statistics Program, Division of Scientific Programs, National Institute on Deafness and other Communication Disorders (NIDCD) at the National Institutes of Health (NIH), Bethesda, MD, USA
| | - Valerie B Duffy
- Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Road, Unit 1101, Storrs, CT, 06269, USA.
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Abstract
Insights into risk factors for olfactory decline are needed, because knowledge about its origin is limited. This impairment has important implications for human health. Several epidemiologic studies of olfaction provide insight into the prevalence of olfactory disorders. Here, we review the major population studies carried out on this topic to date. Our purpose is to characterize knowledge about olfactory disorders from human studies. We also describe the existing methods for measuring the sense of smell in population studies, present recent insights into the epidemiology of smell disorders, and discuss the risk factors identified to date. Synthesis of these data shows that olfactory dysfunction increases as people age and is worse in men. Further study of olfaction is warranted for gaining better information on the etiologies affecting its impairment, research that will have a large public health impact.
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Affiliation(s)
- Jingpu Yang
- Department of Otolaryngology-Head and Neck Surgery, The Second Hospital of Jilin University, 218 Ziqiang Street, Changchun, Jilin Province, 130041, China
| | - Jayant M Pinto
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, The University of Chicago Medicine and Biological Sciences, 5841 South Maryland Avenue, MC1035, Chicago, IL 60637
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Correia C, Lopez KJ, Wroblewski KE, Huisingh-Scheetz M, Kern DW, Chen RC, Schumm LP, Dale W, McClintock MK, Pinto JM. Global Sensory Impairment in Older Adults in the United States. J Am Geriatr Soc 2016; 64:306-313. [PMID: 26889840 PMCID: PMC4808743 DOI: 10.1111/jgs.13955] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To determine whether there may be a common mechanism resulting in global sensory impairment of the five classical senses (vision, smell, hearing, touch, and taste) in older adults. DESIGN Representative, population-based study. SETTING National Social Life, Health, and Aging Project. PARTICIPANTS Community-dwelling U.S. adults aged 57 to 85. MEASUREMENTS The frequency with which impairment co-occurred across the five senses was estimated as an integrated measure of sensory aging. It was hypothesized that multisensory deficits would be common and reflect global sensory impairment that would largely explain the effects of age, sex, and race on sensory dysfunction. RESULTS Two-thirds of subjects had two or more sensory deficits, 27% had just one, and 6% had none. Seventy-four percent had impairment in taste, 70% in touch, 22% in smell, 20% in corrected vision, and 18% in corrected hearing. Older adults, men, African Americans, and Hispanics had greater multisensory impairment (all P < .01). Global sensory impairment largely accounted for the effects of age, sex, and race on the likelihood of impairment in each of the five senses. CONCLUSION Multisensory impairment is prevalent in older U.S. adults. These data support the concept of a common process that underlies sensory aging across the five senses. Clinicians assessing individuals with a sensory deficit should consider further evaluation for additional co-occurring sensory deficits.
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Schubert CR, Cruickshanks KJ, Fischer ME, Klein BEK, Klein R, Pinto AA. Inflammatory and vascular markers and olfactory impairment in older adults. Age Ageing 2015; 44:878-82. [PMID: 26082178 DOI: 10.1093/ageing/afv075] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 03/05/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND the incidence of olfactory impairment increases sharply in the eighth and ninth decades of life but the aetiology of age-related olfactory decline is not well understood. Inflammation and atherosclerosis are associated with many age-related conditions and atherosclerosis has been associated with olfactory decline in middle-aged adults. OBJECTIVE to determine if inflammatory markers and atherosclerosis are associated with the development of olfactory impairment in older adults. DESIGN longitudinal, population-based study. SETTING/PARTICIPANTS a total of 1,611 participants, aged 53-97 years in the Epidemiology of Hearing Loss Study without olfactory impairment at the 1998-2000 examination and with follow-up at a subsequent examination 5 and/or 10 years later. METHODS the San Diego Odor Identification Test was used to measure olfaction. High sensitivity C-reactive protein, interleukin-6 and tumour necrosis factor-α were measured in serum and carotid ultrasound images were obtained for the measurement of carotid intima media thickness (IMT) and plaque assessment. Medical history, behavioural and lifestyle information were obtained by interview. RESULTS inflammatory markers, IMT and plaque were not associated with the 10-year cumulative incidence of olfactory impairment in adjusted Cox proportional hazard models. Among those <60 years, the mean IMT [hazard ratio (HR) = 4.35, 95% confidence interval (CI) = 1.69-11.21, tertile 3 versus tertile 1] and the number of sites with plaque (HR = 1.56, 95% CI = 1.17-2.08, per site) were associated with an increased risk of developing an olfactory impairment at follow-up. CONCLUSION subclinical atherosclerosis at a younger age may be a risk factor for the development of olfactory impairment.
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Affiliation(s)
- Carla R Schubert
- Department of Ophthalmology & Visual Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Karen J Cruickshanks
- Department of Ophthalmology & Visual Sciences, University of Wisconsin-Madison, Madison, WI, USA Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Mary E Fischer
- Department of Ophthalmology & Visual Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Barbara E K Klein
- Department of Ophthalmology & Visual Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Ronald Klein
- Department of Ophthalmology & Visual Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - A Alex Pinto
- Department of Ophthalmology & Visual Sciences, University of Wisconsin-Madison, Madison, WI, USA
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