Bohnen Nicolaas I, Gedela Satyanarayana, Kuwabara Hiroto, Constantine Gregory M, Mathis Chester A, Studenski Stephanie A, Moore Robert Y
Dept. of Neurology, University of Pittsburgh, Pittsburgh, PA, USA.
J Neurol. 2007 Jan;254(1):84-90. doi: 10.1007/s00415-006-0284-y. Epub 2007 Feb 14.
Olfactory dysfunction is a frequent and early feature of Parkinson's disease (PD), often preceding the motor symptoms by several years. Assessment of olfactory deficits may be used in the diagnostic assessment of PD. In this study we investigated the relationship between selective deficits in smell identification and nigrostriatal dopaminergic denervation in patients with PD. Twenty-seven PD patients (Hoehn and Yahr stages I-III) and 27 healthy controls matched for gender and age underwent olfactory testing using the 40-odor University of Pennsylvania Smell Identification Test (UPSIT). PD patients underwent (11)C-beta-CFT dopamine transporter (DAT) positron emission tomography (PET) imaging and clinical motor examination. We found that total UPSIT scores were significantly lower in the PD than in the control subjects (z=4.7, p<0.0001). Analysis of the individual smell scores identified 3 odors with an accuracy of >0.75 for the diagnosis of PD. These odors were banana, licorice, and dill pickle. A PD-specific smell identification score (UPSIT-3) was calculated for these 3 odors. Analysis of the patient PET data demonstrated significant correlations between dorsal striatal DAT activity and the UPSIT-3 (R(S)=0.53, p=0.0027) and total UPSIT (R(S)=0.44, p=0.023) scores. UPSIT-3 (R(S)=0.43, p=0.027) but not total UPSIT (R(S)=0.20, ns) correlated with nigral DAT activity. We conclude that patients with PD have selective hyposmia. A simplified UPSIT smell identification test consisting of 3 PD-selective odors had more robust correlation with nigral and dorsal striatial dopaminergic activity compared with the full UPSIT scores in patients with PD. Assessment of selective olfactory deficits may be used as a simplified olfactory screening test in the evaluation of subjects with possible PD.
嗅觉功能障碍是帕金森病（PD）常见的早期特征，通常在运动症状出现前数年就已存在。嗅觉缺陷评估可用于PD的诊断评估。在本研究中，我们调查了PD患者嗅觉识别选择性缺陷与黑质纹状体多巴胺能去神经支配之间的关系。27例PD患者（霍恩和雅尔分期I - III期）和27名年龄及性别匹配的健康对照者接受了使用40种气味的宾夕法尼亚大学嗅觉识别测试（UPSIT）进行的嗅觉测试。PD患者接受了（11）C-β-CFT多巴胺转运体（DAT）正电子发射断层扫描（PET）成像及临床运动检查。我们发现，PD患者的UPSIT总分显著低于对照组（z = 4.7，p < 0.0001）。对个体嗅觉分数的分析确定了3种气味，其诊断PD的准确率> 0.75。这些气味是香蕉、甘草和莳萝泡菜。针对这3种气味计算了一个PD特异性嗅觉识别分数（UPSIT - 3）。对患者PET数据的分析表明，背侧纹状体DAT活性与UPSIT - 3（R(S)=0.53，p = 0.0027）及UPSIT总分（R(S)=0.44，p = 0.023）之间存在显著相关性。UPSIT - 3（R(S)=0.43，p = 0.027）与黑质DAT活性相关，而UPSIT总分（R(S)=0.20，无统计学意义）与黑质DAT活性不相关。我们得出结论，PD患者存在选择性嗅觉减退。与PD患者的完整UPSIT分数相比，由3种PD选择性气味组成的简化UPSIT嗅觉识别测试与黑质和背侧纹状体多巴胺能活性的相关性更强。选择性嗅觉缺陷评估可作为一种简化的嗅觉筛查测试，用于评估可能患有PD的受试者。
