Soler Zachary M, Gregoski Mathew J, Kohli Preeti, LaPointe Kristina A, Schlosser Rodney J
Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.
Int Forum Allergy Rhinol. 2025 Mar;15(3):250-257. doi: 10.1002/alr.23476. Epub 2024 Oct 27.
Olfactory dysfunction (OD) in the elderly is common and associated with numerous comorbidities, yet often underrecognized. This study sought to develop an instrument for widespread screening of this condition.
Demographic factors, comorbidities, and olfactory-related questions were examined in a focus group (N = 20) and development cohort (N = 190). The 4-item Concise Aging adults Smell Test (4-CAST) screening instrument was then developed to predict OD on Sniffin Sticks testing. An independent validation cohort (N = 147) was then examined to confirm ability of the 4-CAST to predict OD on Smell Identification Test 40 (SIT40).
The most important variables for predicting olfactory loss in older subjects were age, type II diabetes status, Visual Analog Scale (VAS) of overall rating of smell, and VAS of impact of smell upon safety. In the development cohort, the 4-CAST model yielded predictive probability (area under the curve) of 0.805 (p < 0.001) for predicting the bottom 25th percentile on Sniffin Sticks. Results were similar in the validation cohort, as the 4-CAST accurately classified 83.8% subjects (area under the curve [AUC] 0.789, p < 0.001) in the bottom 25th percentile of SIT40 testing. The 4-CAST was able to accurately classify 89.4% of subjects with anosmia.
The 4-CAST is a quick screening instrument for predicting OD in older adults and has similar performance characteristics in independent populations using the two most common validated olfactory tests. Given the high prevalence of unrecognized olfactory loss in this population, this can be a useful tool for practitioners to determine which subjects may benefit from more extensive olfactory testing.
老年人嗅觉功能障碍（OD）很常见，且与多种合并症相关，但往往未得到充分认识。本研究旨在开发一种用于广泛筛查该病症的工具。
在一个焦点小组（N = 20）和一个开发队列（N = 190）中研究了人口统计学因素、合并症以及与嗅觉相关的问题。然后开发了4项简明老年人嗅觉测试（4-CAST）筛查工具，以预测嗅觉棒测试中的嗅觉功能障碍。随后对一个独立验证队列（N = 147）进行研究，以确认4-CAST预测嗅觉识别测试40（SIT40）中嗅觉功能障碍的能力。
预测老年受试者嗅觉丧失的最重要变量是年龄、2型糖尿病状态、嗅觉总体评分的视觉模拟量表（VAS）以及嗅觉对安全性影响的VAS。在开发队列中，4-CAST模型预测嗅觉棒测试中处于第25百分位以下的预测概率（曲线下面积）为0.805（p < 0.001）。验证队列中的结果相似，因为4-CAST在SIT40测试的第25百分位以下准确分类了83.8%的受试者（曲线下面积[AUC]为0.789，p < 0.001）。4-CAST能够准确分类89.4%的嗅觉丧失受试者。
4-CAST是一种用于预测老年人嗅觉功能障碍的快速筛查工具，在使用两种最常用的经过验证的嗅觉测试的独立人群中具有相似的性能特征。鉴于该人群中未被认识到的嗅觉丧失患病率很高，这可以成为从业者确定哪些受试者可能从更广泛的嗅觉测试中受益的有用工具。
