Shill Holly A, Hentz Joseph G, Caviness John N, Driver-Dunckley Erika, Jacobson Sandra, Belden Christine, Sabbagh Marwan N, Beach Thomas G, Adler Charles H
Banner Sun Health Research Institute Sun City Arizona USA.
University of Arizona College of Medicine-Phoenix Phoenix Arizona USA.
Mov Disord Clin Pract. 2015 Jul 17;3(1):43-47. doi: 10.1002/mdc3.12220. eCollection 2016 Jan-Feb.
Hyposmia is common in Parkinson's disease (PD) and is also observed with normal aging. It can be ascertained through objective testing, but it is unclear whether patients are aware of deficits and whether this has implications for cognitive status.
Subjects in the Arizona Study of Aging and Neurodegenerative Disorders were studied with annual motor and cognitive testing with objective smell testing (University of Pennsylvania Smell Identification Test; UPSIT) done every third year beginning in 2002. Those with a baseline UPSIT <25th percentile (hyposmia) were studied for presence of unawareness of hyposmia and cognitive status.
There were 75 subjects with PD and 143 nonparkinsonian controls with hyposmia. Lack of awareness of hyposmia was present in 16% of PD subjects and 47% of those without PD. In PD, there was no increase in unawareness in PD with dementia. In non-PD controls, unawareness was correlated with presence of dementia. Unawareness of hyposmia correlated most strongly with the neuropsychiatric tests of learning and memory. In controls without dementia or PD, 48% were unaware.
Querying patients about anosmia might be useful in parkinsonian disorders without objective testing. However, in elderly controls, it should be followed by objective testing and lack of awareness has implications for worsened cognitive status.
嗅觉减退在帕金森病（PD）中很常见，在正常衰老过程中也会出现。它可以通过客观测试来确定，但尚不清楚患者是否意识到嗅觉缺陷，以及这是否对认知状态有影响。
对参与亚利桑那州衰老与神经退行性疾病研究的受试者进行年度运动和认知测试，并从2002年开始每三年进行一次客观嗅觉测试（宾夕法尼亚大学嗅觉识别测试；UPSIT）。对那些基线UPSIT低于第25百分位数（嗅觉减退）的受试者，研究其是否存在嗅觉减退未察觉情况及认知状态。
有75名PD患者和143名嗅觉减退的非帕金森病对照者。16%的PD患者和47%的非PD患者存在嗅觉减退未察觉情况。在PD患者中，痴呆患者的未察觉情况没有增加。在非PD对照者中，未察觉情况与痴呆的存在相关。嗅觉减退未察觉情况与学习和记忆的神经心理学测试相关性最强。在无痴呆或PD的对照者中，48%未察觉。
在没有客观测试的情况下，询问帕金森病患者嗅觉减退情况可能有用。然而，在老年对照者中，随后应进行客观测试，且未察觉情况对认知状态恶化有影响。
