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Hyposmia in progressive supranuclear palsy.

Laura Silveira-Moriyama1, Graham Hughes, Alistair Church

  • 1Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, United Kingdom.

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Summary

Olfactory dysfunction is present in progressive supranuclear palsy (PSP), contrary to previous beliefs. Smell tests like the University of Pennsylvania Smell Identification Test (UPSIT) may aid in distinguishing PSP from Parkinson

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Area of Science:

  • Neuroscience
  • Neurology
  • Olfactory Research

Background:

  • Previous research indicated normal olfactory function in progressive supranuclear palsy (PSP).
  • Olfactory deficits are a known characteristic of Parkinson's disease (PD).
  • Distinguishing between PSP and PD can be challenging, especially in early stages.

Purpose of the Study:

  • To investigate olfactory function in patients with progressive supranuclear palsy (PSP).
  • To compare olfactory test results between PSP, non-demented Parkinson's disease (PD), and control groups.
  • To explore the relationship between olfactory function and cognitive/motor assessments in PSP.

Main Methods:

  • The University of Pennsylvania Smell Identification Test (UPSIT) was administered to 36 PSP patients (MMSE > 18), 140 non-demented PD patients, and 126 controls.
  • Statistical analyses adjusted for age, gender, and smoking history.
  • Postmortem brain examination of six PSP patients assessed for neurofibrillary tangles and tau accumulation in the rhinencephalon.

Main Results:

  • Mean UPSIT scores were significantly lower in PSP patients compared to controls (P < 0.001).
  • Mean UPSIT scores were significantly higher in PSP patients compared to PD patients (P < 0.001).
  • In PSP, UPSIT scores correlated with Mini Mental State Examination (MMSE) scores (r = 0.44, P = 0.006) but not with disease duration or specific motor/cognitive scales.
  • Postmortem analysis revealed tau pathology in the rhinencephalon of all examined PSP brains, though only half exhibited hyposmia.

Conclusions:

  • Olfactory impairment is present in PSP, challenging prior assumptions.
  • Smell identification tests show potential utility in differentiating PSP from PD.
  • Further prospective studies with early-stage PSP and PSP-P, including postmortem confirmation, are warranted to validate the diagnostic role of olfactory testing.