Silva Maren de Moraes E, Viveiros Camila Poletto, Kotsifas Nikolai José Eustátios, Duarte Alexia, Dib Evelyn, Mercer Pilar Bueno Siqueira, Pessoa Renata Ramina, Witt Maria Carolina Zavagna
Neurology Department, Hospital da Cruz Vermelha Brasileira Filial Paraná, Curitiba, PR, Brazil.
Faculdade Evangélica do Paraná, Curitiba, PR, Brazil.
Dement Neuropsychol. 2019 Apr-Jun;13(2):154-161. doi: 10.1590/1980-57642018dn13-020003.
Frontotemporal dementia (FTD) presents clinically in three variants: one behavioral and two with progressive primary aphasia - non-fluent/agrammatic and semantic. Defined by the degenerative process and cerebral atrophy, olfactory dysfunction occurs in up to 96% of previous FTD case series.
the present study aims to critically synthesize data about the relationship between FTD and olfactory impairment to analyze the usefulness of olfactory evaluation tests as a complementary element in early diagnosis.
a database search was performed using the keywords "olfactory OR smell OR olfaction AND frontotemporal dementia". We included studies that evaluated olfactory function in patients diagnosed with frontotemporal dementia, all subtypes, compared with age-matched healthy controls. For comparative purposes, the effect size was calculated using Cohen's D. The studies selected were categorized according to dementia variant and olfactory test type. A meta-analysis was performed using forest plots - homogeneity was evaluated by statistical tests (i and Cochran Q).
ten articles met the inclusion criteria. Heterogeneity was classified as low for semantic dementia olfactory identification and behavioral variant olfactory discrimination groups (i = 0 and 3.4%, respectively) and as moderate for the behavioral variant olfactory identification group (i = 32.6%).
patients with the frontotemporal dementia behavioral variant seem to present with alterations in odor identification, but with preserved discrimination. Scent identification also seems to be impaired in semantic dementia. Therefore, we conclude that olfactory evaluation in these patients is possibly impacted by cognitive alterations and not by sensory deficits. Application of olfactory tests may prove important in differentiating prodromal states from other types of dementia with more pronounced olfactory impairment.
额颞叶痴呆（FTD）临床上有三种变体：一种行为变异型，两种进行性原发性失语变异型——非流畅性/语法缺失型和语义型。根据退行性病变过程和脑萎缩定义，嗅觉功能障碍在既往FTD病例系列中发生率高达96%。
本研究旨在批判性地综合有关FTD与嗅觉障碍之间关系的数据，以分析嗅觉评估测试作为早期诊断辅助要素的有用性。
使用关键词“嗅觉或气味或嗅觉与额颞叶痴呆”进行数据库检索。我们纳入了评估诊断为额颞叶痴呆所有亚型患者嗅觉功能并与年龄匹配健康对照进行比较的研究。为了进行比较，使用科恩D值计算效应量。所选研究根据痴呆变体和嗅觉测试类型进行分类。使用森林图进行荟萃分析——通过统计检验（I²和 Cochr an Q）评估同质性。
10篇文章符合纳入标准。语义性痴呆嗅觉识别组和行为变异型嗅觉辨别组的异质性分类为低（I²分别为0和3.4%），行为变异型嗅觉识别组为中度（I²为32.6%）。
额颞叶痴呆行为变异型患者似乎存在气味识别改变，但辨别能力保留。语义性痴呆中气味识别似乎也受损。因此，我们得出结论，这些患者的嗅觉评估可能受认知改变影响而非感觉缺陷影响。嗅觉测试的应用可能在区分前驱状态与其他嗅觉障碍更明显的痴呆类型方面具有重要意义。
