Schmidt Nele, Paschen Laura, Witt Karsten
Department of Neurology, University Oldenburg, Steinweg 13-17, Oldenburg 26122, Germany.
Department of Neurology, University Medical Center Schleswig-Holstein, Arnold-Heller-Street 3, Kiel 24105, Germany.
Parkinsons Dis. 2020 Nov 16;2020:7548394. doi: 10.1155/2020/7548394. eCollection 2020.
Olfactory dysfunction (OD) is a prominent nonmotor symptom in Parkinson's disease (PD), and OD is a supportive diagnostic criterion for PD. Physicians often ask their patients if they have noticed a smell disorder. This study evaluates the diagnostic validity of OD self-assessment in PD. To this end, 64 PD patients and 33 age-matched healthy controls were enrolled in a study assessing subjective and objective olfactory functioning. To examine subjective olfactory abilities, first, patients and controls had to classify their olfactory sense as "impaired" or "unimpaired," comparable to a realistic situation in an outpatient setting. Second, to evaluate subjective olfactory acuity, a visual analogue scale (VAS) was used. Third, the Sniffin' Sticks test battery was used as an objective instrument to diagnose OD. Categorical olfactory self-assessment predicts the classification normosmic versus hyposmic based on the global Sniffin' Sticks score (TDI) with a sensitivity of 0.79 and a specificity of 0.45. TDI correlated significantly with the VAS ( = 0.297, = 0.017). The ROC curve analysis, using the VAS rating as a predictor for objective olfaction, revealed 42 as the best possible cutoff score with an area under the curve of 0.63. These results demonstrate that olfactory self-assessments show a low accuracy and are not suitable for the diagnosis of a smell disorder in PD. Objective measures are necessary to evaluate olfactory sense in clinical and research settings.
嗅觉功能障碍（OD）是帕金森病（PD）中一种突出的非运动症状，且OD是PD的一项支持性诊断标准。医生经常询问患者是否注意到嗅觉障碍。本研究评估了OD自我评估在PD中的诊断效度。为此，64名PD患者和33名年龄匹配的健康对照者参与了一项评估主观和客观嗅觉功能的研究。为了检查主观嗅觉能力，首先，患者和对照者必须将他们的嗅觉分类为“受损”或“未受损”，这类似于门诊环境中的实际情况。其次，为了评估主观嗅觉敏锐度，使用了视觉模拟量表（VAS）。第三，使用嗅棒测试组合作为诊断OD的客观工具。基于嗅棒测试的总体得分（TDI），分类嗅觉自我评估对嗅觉正常与嗅觉减退的分类预测的灵敏度为0.79，特异度为0.45。TDI与VAS显著相关（r = 0.297，P = 0.017）。以VAS评分作为客观嗅觉的预测指标进行ROC曲线分析，结果显示42为最佳截断分数，曲线下面积为0.63。这些结果表明，嗅觉自我评估的准确性较低，不适用于诊断PD中的嗅觉障碍。在临床和研究环境中，需要客观测量方法来评估嗅觉。
