University College London Medical School, London, UK.
Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK.
J Neurol. 2019 Aug;266(8):1897-1906. doi: 10.1007/s00415-019-09340-x. Epub 2019 May 3.
Hyposmia can develop with age and in neurodegenerative conditions, including Parkinson's disease (PD). The University of Pennsylvania Smell Identification Test (UPSIT) is a 40-item smell test widely used for assessing hyposmia. However, in a number of situations, such as identifying hyposmic individuals in large populations, shorter tests are preferable.
We assessed the ability of shorter UPSIT subsets to detect hyposmia in 891 healthy participants from the PREDICT-PD study. Shorter subsets included Versions A and B of the 4-item Pocket Smell Test (PST) and 12-item Brief Smell Identification Test (BSIT). Using a data-driven approach, we evaluated screening performances of 23,231,378 combinations of 1-7 smell items from the full UPSIT to derive "winning" subsets, and validated findings separately in another 191 healthy individuals. We then compared discriminatory UPSIT smells between PREDICT-PD participants and 40 PD patients, and assessed the performance of "winning" subsets containing discriminatory smells in PD patients.
PST Versions A and B achieved sensitivity/specificity of 76.8%/64.9% and 86.6%/45.9%, respectively, while BSIT Versions A and B achieved 83.1%/79.5% and 96.5%/51.8%. From the data-driven analysis, 2 "winning" 7-item subsets surpassed the screening performance of 12-item BSITs (validation sensitivity/specificity of 88.2%/85.4% and 100%/53.5%), while a "winning" 4-item subset had higher sensitivity than PST-A, -B, and even BSIT-A (validation sensitivity 91.2%). Interestingly, several discriminatory smells featured within "winning" subsets, and demonstrated high-screening performances for identifying hyposmic PD patients.
Using abbreviated smell tests could provide a cost-effective means of large-scale hyposmia screening, allowing more targeted UPSIT administration in general and PD-related settings.
嗅觉减退可随年龄增长和神经退行性疾病（包括帕金森病）而发生。宾夕法尼亚大学嗅觉识别测试（UPSIT）是一种广泛用于评估嗅觉减退的 40 项嗅觉测试。然而，在许多情况下，例如在大量人群中识别嗅觉减退个体，较短的测试更为可取。
我们评估了较短的 UPSIT 子集在来自 PREDICT-PD 研究的 891 名健康参与者中检测嗅觉减退的能力。较短的子集中包括 4 项口袋嗅觉测试（PST）的版本 A 和 B，以及 12 项简要嗅觉识别测试（BSIT）。使用数据驱动的方法，我们评估了从完整 UPSIT 中得出的 1-7 项嗅觉项目的 23231378 种组合的筛选性能，得出“获胜”子集，并在另外 191 名健康个体中分别验证了这些发现。然后，我们比较了 PREDICT-PD 参与者与 40 名帕金森病患者之间的 UPSIT 气味差异，并评估了包含有差异气味的“获胜”子集中在帕金森病患者中的表现。
PST 版本 A 和 B 的敏感性/特异性分别为 76.8%/64.9%和 86.6%/45.9%，而 BSIT 版本 A 和 B 的敏感性/特异性分别为 83.1%/79.5%和 96.5%/51.8%。从数据驱动分析中，2 个“获胜”的 7 项子集超过了 12 项 BSIT 的筛查性能（验证的敏感性/特异性分别为 88.2%/85.4%和 100%/53.5%），而一个“获胜”的 4 项子集的敏感性高于 PST-A、-B，甚至 BSIT-A（验证敏感性为 91.2%）。有趣的是，一些有差异的气味特征存在于“获胜”子集中，并且对于识别嗅觉减退的帕金森病患者具有较高的筛查性能。
使用简短的嗅觉测试可以提供一种具有成本效益的大规模嗅觉减退筛查方法，从而允许在一般和帕金森病相关环境中更有针对性地进行 UPSIT 管理。
