TY - JOUR
T1 - Olfactory deficits predict cognitive decline and Alzheimer dementia in an urban community
AU - Devanand, D. P.
AU - Lee, Seonjoo
AU - Manly, Jennifer
AU - Andrews, Howard
AU - Schupf, Nicole
AU - Doty, Richard L.
AU - Stern, Yaakov
AU - Zahodne, Laura B.
AU - Louis, Elan D.
AU - Mayeux, Richard
N1 - Publisher Copyright:
© 2014 American Academy of Neurology.
PY - 2015
Y1 - 2015
N2 - Objective: To determine the predictive utility of baseline odor identification deficits for future cognitive decline and the diagnosis of Alzheimer disease (AD) dementia. Methods: In a multiethnic community cohort in North Manhattan, NY, 1,037 participants without dementia were evaluated with the 40-item University of Pennsylvania Smell Identification Test (UPSIT). In 757 participants, follow-up occurred at 2 years and 4 years. Results: In logistic regression analyses, lower baseline UPSIT scores were associated with cognitive decline (relative risk 1.067 per point interval; 95% confidence interval [CI] 1.040, 1.095; < , 0.0001), and remained significant (relative risk 1.065 per point interval; 95% CI 1.034, 1.095; < , 0.0001) after including covariates. UPSIT, but not Selective Reminding Test-total immediate recall, predicted cognitive decline in participants without baseline cognitive impairment. During follow-up, 101 participants transitioned to AD dementia. In discrete time survival analyses, lower baseline UPSIT scores were associated with transition to AD dementia (hazard ratio 1.099 per point interval; 95% CI 1.067, 1.131; < , 0.0001), and remained highly significant (hazard ratio 1.072 per point interval; 95% CI 1.036, 1.109; < , 0.0001) after including demographic, cognitive, and functional covariates. Conclusions: Impairment in odor identification was superior to deficits in verbal episodic memory in predicting cognitive decline in cognitively intact participants. The findings support the crosscultural use of a relatively inexpensive odor identification test as an early biomarker of cognitive decline and AD dementia. Such testing may have the potential to select/stratify patients in treatment trials of cognitively impaired patients or prevention trials in cognitively intact individuals.
AB - Objective: To determine the predictive utility of baseline odor identification deficits for future cognitive decline and the diagnosis of Alzheimer disease (AD) dementia. Methods: In a multiethnic community cohort in North Manhattan, NY, 1,037 participants without dementia were evaluated with the 40-item University of Pennsylvania Smell Identification Test (UPSIT). In 757 participants, follow-up occurred at 2 years and 4 years. Results: In logistic regression analyses, lower baseline UPSIT scores were associated with cognitive decline (relative risk 1.067 per point interval; 95% confidence interval [CI] 1.040, 1.095; < , 0.0001), and remained significant (relative risk 1.065 per point interval; 95% CI 1.034, 1.095; < , 0.0001) after including covariates. UPSIT, but not Selective Reminding Test-total immediate recall, predicted cognitive decline in participants without baseline cognitive impairment. During follow-up, 101 participants transitioned to AD dementia. In discrete time survival analyses, lower baseline UPSIT scores were associated with transition to AD dementia (hazard ratio 1.099 per point interval; 95% CI 1.067, 1.131; < , 0.0001), and remained highly significant (hazard ratio 1.072 per point interval; 95% CI 1.036, 1.109; < , 0.0001) after including demographic, cognitive, and functional covariates. Conclusions: Impairment in odor identification was superior to deficits in verbal episodic memory in predicting cognitive decline in cognitively intact participants. The findings support the crosscultural use of a relatively inexpensive odor identification test as an early biomarker of cognitive decline and AD dementia. Such testing may have the potential to select/stratify patients in treatment trials of cognitively impaired patients or prevention trials in cognitively intact individuals.
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U2 - 10.1212/wnl.0000000000001132
DO - 10.1212/wnl.0000000000001132
M3 - Article
C2 - 25471394
AN - SCOPUS:84925958949
SN - 0028-3878
VL - 84
SP - 182
EP - 189
JO - Neurology
JF - Neurology
IS - 2
ER -