Parkinson's Disease Research, Education and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA.
Mov Disord. 2011 Sep;26(11):2051-7. doi: 10.1002/mds.23792. Epub 2011 May 24.
Hyposmia, psychiatric disorders, and cognitive problems are common nonmotor manifestations in Parkinson's disease, but how they are related remains unclear. We investigated the relationship between olfactory dysfunction and neuropsychiatric manifestations and performed a cross-sectional study of 248 patients at two movement disorders clinics at academic medical centers. Psychiatric measures were the Geriatric Depression Scale-15, Inventory of Depressive Symptomatology, State Anxiety Inventory, Apathy Scale, and Parkinson's Psychosis Rating Scale. Cognitive measures were the Mini-Mental State Examination, Hopkins Verbal Learning Test-Revised, Digit Span, Tower of London-Drexel, and the Stroop Color Word Test. Olfaction was tested with the University of Pennsylvania Smell Identification Test. There was no significant association between olfaction and mood measures, but psychotic symptoms were more common in patients with olfaction scores below the median (30% vs. 12%; P < 0.001). Worse olfaction was associated with poorer memory (Hopkins Verbal Learning Test-Revised delayed recall items: mean [standard deviation], 6.2 [3.2] vs. 8.4 [2.8]; P < 0.001) and executive performance (Tower of London total moves, 52 [38] vs. 34 [21]; P < 0.001). Odor-identification score was a significant predictor of abnormal performance on these cognitive tests after adjustment for age, sex, and disease characteristics in logistic regression models. The relationship between hyposmia, psychosis, and specific cognitive impairments may reflect the anatomic distribution of Lewy pathology and suggests that olfactory dysfunction could be a biomarker of additional extranigral disease. Future prospective studies are warranted to assess whether hyposmia, a very early feature of Parkinson's disease, might be used to predict the appearance of other common nonmotor symptoms.
嗅觉减退、精神障碍和认知问题是帕金森病常见的非运动表现，但它们之间的关系尚不清楚。我们研究了嗅觉功能障碍与神经精神表现之间的关系，并在两个学术医学中心的运动障碍诊所对 248 例患者进行了横断面研究。精神科评估包括老年抑郁量表-15、抑郁症状清单、状态焦虑量表、淡漠量表和帕金森精神病评定量表。认知评估包括简易精神状态检查、霍普金斯词语学习测验修订版、数字跨度、伦敦塔德雷尔、Stroop 色词测验。嗅觉测试采用宾夕法尼亚大学嗅觉识别测试。嗅觉与情绪测量之间没有显著相关性，但嗅觉评分低于中位数的患者出现精神病症状的比例更高（30%比 12%；P < 0.001）。嗅觉越差，记忆力越差（霍普金斯词语学习测验修订版延迟回忆项目：平均值[标准差]，6.2[3.2]比 8.4[2.8]；P < 0.001），执行功能越差（伦敦塔总移动次数，52[38]比 34[21]；P < 0.001）。在逻辑回归模型中，经年龄、性别和疾病特征校正后，气味识别得分是这些认知测试异常表现的显著预测因子。嗅觉减退、精神病与特定认知障碍之间的关系可能反映了路易体病理的解剖分布，并表明嗅觉功能障碍可能是额外的非神经疾病的生物标志物。未来的前瞻性研究需要评估嗅觉减退（帕金森病的早期特征）是否可用于预测其他常见非运动症状的出现。
