Smell Test Challenge may Benefit Alzheimer's Prone Patients

Smell tests may help detect patients with mild cognitive impairment, one of the early signs of Alzheimer’s disease

Highlights

Smell test challenge may help identify patients with mild cognitive impairment
Impaired sense of smell is one of the early signs of cognitive decline, before the clinical onset of Alzheimer's disease
Odor identification may help trace improvement in mild cognitive impaired patients undergoing Cholinesterase inhibitors treatment

Smell tests can help treat patient’s susceptible to Alzheimer's disease before it ever develops found a new study published in Journal of Alzheimer's Disease.

Having an impaired sense of smell is recognized as one of the early signs of cognitive decline, before the clinical onset of Alzheimer's disease.

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‘Patients with mild cognitive impairment may respond to cholinesterase inhibitor drugs to treat Alzheimer's disease.’

The researchers at CUMC and NYSPI have found a way to use that effect to determine if patients with mild cognitive impairment may respond to cholinesterase inhibitor drugs to treat Alzheimer's disease.

Cholinesterase inhibitors, such as donepezil, enhance cholinergic function by increasing the transmission of the neurotransmitter acetylcholine in the brain. Cholinergic function is impaired in individuals with Alzheimer's disease.

Cholinesterase inhibitors, which block an enzyme that breaks down acetylcholine, have shown some effectiveness in improving the cognitive symptoms of Alzheimer's disease.

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However, they have not been proven effective as a treatment for individuals with mild cognitive impairment (MCI), a condition that markedly increases the risk of Alzheimer's disease.

"We know that cholinesterase inhibitors can make a difference for Alzheimer's patients, so we wanted to find out if we could identify patients at risk for Alzheimer's who might also benefit from this treatment," said D.P. Devanand, MBBS, MD, professor of psychiatry, scientist in the Gertrude H. Sergievsky Center at CUMC, and co-director of the Memory Disorders Clinic and the Late Life Depression Clinic at NYSPI.

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"Since odor identification tests have been shown to predict progression to Alzheimer's, we hypothesized that these tests would also allow us to discover which patients with MCI would be more likely to improve with donepezil treatment."

In this yearlong study, 37 participants with MCI underwent odor identification testing with the University of Pennsylvania Smell Identification Test (UPSIT). The test was administered before and after using an atropine nasal spray that blocks cholinergic transmission.

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The patients were then treated with donepezil for 52 weeks and were periodically re-evaluated with the UPSIT and with memory and cognitive function tests.

Those who had a greater decline in UPSIT scores, indicating greater cholinergic deficits in the brain, after using the anticholinergic nasal spray test saw greater cognitive improvement with donepezil.

Also, short-term improvement in odor identification from baseline to eight weeks tended to predict longer-term cognitive improvement with donepezil treatment over one year.

"These results, particularly if replicated in larger populations, suggest that these simple, inexpensive strategies have the potential to improve the selection of patients with mild cognitive impairment who are likely to benefit from treatment with cholinesterase inhibitors like donepezil," said Dr. Devanand.

Reference

Change in Odor Identification Impairment is Associated with Improvement with Cholinesterase Inhibitor Treatment in Mild Cognitive Impairment

( https://content.iospress.com/articles/journal-of-alzheimers-disease/jad170497?resultNumber=0&totalResults=3413&start=0&q=Change+in+Odor+Identification+Impairment+is+Associated+with+Improvement+with+Cholinesterase+Inhibitor+Treatment+in+Mild+Cognitive)