Olfactory Dysfunction As a Marker for Cognitive Impairment in General Paresis of the Insane: A Clinical Study

Overview

Journal Med Sci Monit

Specialties General Medicine
Pathology

Date 2024 Jul 25

PMID 39049468

Authors

Shuang Liang

Ben Chen

Meiling Liu

Qiang Wang

Mingfeng Yang

Gaohong Lin

Danyan Xu

Yijie Zeng

Jingyi Lao

Jiafu Li

Qin Liu

Kexin Yao

Zhangying Wu

Min Zhang

Wenyue Shi

Linglong Qin

Xiaomei Zhong

Yuping Ning

Affiliations

Soon will be listed here.

Abstract

BACKGROUND General paresis of the insane (GPI) is characterized by cognitive impairment, neuropsychiatric symptoms, and brain structural abnormalities, mimicking many neuropsychiatric diseases. Olfactory dysfunction has been linked to cognitive decline and neuropsychiatric symptoms in numerous neuropsychiatric diseases. Nevertheless, it remains unclear whether patients with GPI experience olfactory dysfunction and whether olfactory dysfunction is associated with their clinical manifestations. MATERIAL AND METHODS Forty patients with GPI and 37 healthy controls (HCs) underwent the "Sniffin Sticks" test battery, Mini-Mental State Examination, and Neuropsychiatric Inventory to measure olfactory function, cognitive function, and neuropsychiatric symptoms, respectively. Brain structural abnormalities were evaluated using visual assessment scales including the medial temporal lobe atrophy (MTA) visual rating scale and Fazekas scale. RESULTS Compared with HCs, patients with GPI exhibited significant olfactory dysfunction, as indicated by deficits in the odor threshold (OT) (P=0.001), odor discrimination (OD) (P<0.001), and odor identification (OI) (P<0.001). In patients with GPI, the OI was positively correlated with cognitive function (r=0.57, P<0.001), but no significant correlation was found between olfactory function and neuropsychiatric symptoms, blood, or cerebrospinal fluid biomarkers (rapid plasma reagin circle card test and Treponema pallidum particle agglutination test), or brain structural abnormalities (MTA and Fazekas scale scores). Mediation analysis indicated that the impaired OI in patients with GPI was mediated by cognitive impairment and impaired OT respectively. CONCLUSIONS Patients with GPI exhibited overall olfactory dysfunction. OI is correlated with cognitive function and the impaired OI is mediated by cognitive impairment in patients with GPI. Thus, OI may serve as a marker for reflecting cognitive function in patients with GPI.

References

Drago F, Merlo G, Ciccarese G, Agnoletti A, Cozzani E, Rebora A . Changes in neurosyphilis presentation: a survey on 286 patients. J Eur Acad Dermatol Venereol. 2016; 30(11):1886-1900. DOI: 10.1111/jdv.13753. View

Growdon M, Schultz A, Dagley A, Amariglio R, Hedden T, Rentz D . Odor identification and Alzheimer disease biomarkers in clinically normal elderly. Neurology. 2015; 84(21):2153-60. PMC: 4451046. DOI: 10.1212/WNL.0000000000001614. View

Kamath V, Paksarian D, Cui L, Moberg P, Turetsky B, Merikangas K . Olfactory processing in bipolar disorder, major depression, and anxiety. Bipolar Disord. 2018; 20(6):547-555. DOI: 10.1111/bdi.12625. View

Marin C, Vilas D, Langdon C, Alobid I, Lopez-Chacon M, Haehner A . Olfactory Dysfunction in Neurodegenerative Diseases. Curr Allergy Asthma Rep. 2018; 18(8):42. DOI: 10.1007/s11882-018-0796-4. View

Mao C, Gao J, Jin L, Peng B, Guo Y . Postmortem Histopathologic Analysis of Neurosyphilis: A Report of 3 Cases With Clinicopathologic Correlations. J Neuropathol Exp Neurol. 2018; . DOI: 10.1093/jnen/nly004. View

Mehrabian S, Raycheva M, Traykova M, Stankova T, Penev L, Grigorova O . Neurosyphilis with dementia and bilateral hippocampal atrophy on brain magnetic resonance imaging. BMC Neurol. 2012; 12:96. PMC: 3517431. DOI: 10.1186/1471-2377-12-96. View

Scheltens P, Leys D, Barkhof F, Huglo D, Weinstein H, Vermersch P . Atrophy of medial temporal lobes on MRI in "probable" Alzheimer's disease and normal ageing: diagnostic value and neuropsychological correlates. J Neurol Neurosurg Psychiatry. 1992; 55(10):967-72. PMC: 1015202. DOI: 10.1136/jnnp.55.10.967. View

Croy I, Hummel T . Olfaction as a marker for depression. J Neurol. 2016; 264(4):631-638. DOI: 10.1007/s00415-016-8227-8. View

Han P, Zang Y, Akshita J, Hummel T . Magnetic Resonance Imaging of Human Olfactory Dysfunction. Brain Topogr. 2019; 32(6):987-997. DOI: 10.1007/s10548-019-00729-5. View

10.

Heinrich J, Vidal J, Simon A, Rigaud A, Hanon O, Epelbaum J . Relationships Between Lower Olfaction and Brain White Matter Lesions in Elderly Subjects with Mild Cognitive Impairment. J Alzheimers Dis. 2018; 61(3):1133-1141. DOI: 10.3233/JAD-170378. View

11.

Folstein M, Folstein S, McHugh P . "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12(3):189-98. DOI: 10.1016/0022-3956(75)90026-6. View

12.

Good K, Tibbo P, Milliken H, Whitehorn D, Alexiadis M, Robertson N . An investigation of a possible relationship between olfactory identification deficits at first episode and four-year outcomes in patients with psychosis. Schizophr Res. 2010; 124(1-3):60-5. DOI: 10.1016/j.schres.2010.07.010. View

13.

Lotsch J, Reichmann H, Hummel T . Different odor tests contribute differently to the evaluation of olfactory loss. Chem Senses. 2007; 33(1):17-21. DOI: 10.1093/chemse/bjm058. View

14.

Gao J, Li W, Xu D, Zheng B, Huang Y, Wu W . Clinical Manifestations, Fluid Changes and Neuroimaging Alterations in Patients with General Paresis of the Insane. Neuropsychiatr Dis Treat. 2021; 17:69-78. PMC: 7812051. DOI: 10.2147/NDT.S279265. View

15.

LISS L . Neuritis syphilitica of the olfactory nerve; report of a case. Ann Otol Rhinol Laryngol. 1958; 67(3):585-94. DOI: 10.1177/000348945806700301. View

16.

Devanand D, Lee S, Luchsinger J, Andrews H, Goldberg T, Huey E . Intact global cognitive and olfactory ability predicts lack of transition to dementia. Alzheimers Dement. 2019; 16(2):326-334. PMC: 7007828. DOI: 10.1016/j.jalz.2019.08.200. View

17.

Wang Q, Chen B, Zhong X, Zhou H, Zhang M, Mai N . Neuropsychiatric Symptoms Mediated the Relationship Between Odor Identification and Cognition in Alzheimer's Disease Spectrum: A Structural Equation Model Analysis. Front Aging Neurosci. 2022; 13:732840. PMC: 8789652. DOI: 10.3389/fnagi.2021.732840. View

18.

Haehner A, Rodewald A, Gerber J, Hummel T . Correlation of olfactory function with changes in the volume of the human olfactory bulb. Arch Otolaryngol Head Neck Surg. 2008; 134(6):621-4. DOI: 10.1001/archotol.134.6.621. View

19.

VAN BOGAERT L, David M, de Ajuriaguerra J, HECAEN H, TALAIRACH R . [A case of degenerative syndrome of the distonic type with cerebellar onset corresponding to a spino-striated abiotrophia with degeneration of the olfactory system]. Monatsschr Psychiatr Neurol. 1951; 121(2-3):143-62. View

20.

Zhang H, Lin L, Liu G, Zeng Y, Wu J, Zheng W . Clinical spectrum of neurosyphilis among HIV-negative patients in the modern era. Dermatology. 2013; 226(2):148-56. DOI: 10.1159/000347109. View