Chemical complexity of odors increases reliability of olfactory threshold testing

A New Method for a Shorter and Valid Assessment of Olfactory Threshold in Repeated Measurement Designs Based on the Sniffin’ Sticks Test

Introduction

The Sniffin’ Sticks threshold test is widely used to assess olfactory threshold due to its high reliability and validity. Nevertheless, this test procedure is quite long with an average duration of 10 to 20 min. In study designs that require multiple olfactory threshold tests on short intervals, this could exhaust participants. To counteract this limitation, we developed the informed-four-reversal (INFOUR) short version of the Sniffin’ Sticks threshold test for repeated measurement designs and piloted it in a sample of normosmic participants.

Methods

Forty-two participants performed the original Sniffin’ Sticks version before being assigned either to the control group that repeated the original version or to the test group that conducted the INFOUR short version.

Results

The correlation between the original version at T1 and INFOUR at T2 was r = .75 and did not differ significantly from the retest reliability of the original version. Compared to the original version, the INFOUR took 42% less time to perform.

Conclusion

The INFOUR leads to a significant time saving, while maintaining good validity.

Implications

Therefore, this approach has the potential to be a useful tool for study protocols with repeated olfactory threshold measurements. In particular, when research protocols are time intensive or testing needs to the shortened, because the interventional effects are short or subtle.

Olfaction in patients with Parkinson's disease: a new threshold test analysis through turning points trajectories

Olfactory deficit is a widely documented non-motor symptom in Parkinson’s disease (PD). Abnormal turning points trajectories through olfactory threshold testing have been recently reported in patients with olfactory dysfunction, who seem to adapt faster to olfactory stimuli, but data on PD patients are lacking. The aim of this study is to perform olfactory threshold test and explore the turning points trajectories in PD patients in comparison to normal controls. We recruited 59 PD patients without dementia, and no conditions that could influence evaluation of olfaction and cognition. Sixty healthy subjects served as controls. Patients and controls underwent a comprehensive olfactory evaluation with the Sniffin’ Sticks extended test assessing threshold, discrimination and identification and a full neuropsychological evaluation. Besides, threshold test data were analyzed examining all the turning points trajectories. PD patients showed a different olfactory threshold test pattern, i.e., faster olfactory adaptation, than controls with no effect of age. Normosmic PD patients showed different olfactory threshold test pattern, i.e., better threshold score, than normosmic controls. Visuospatial dysfunction was the only factor that significantly influenced this pattern. Olfactory threshold trajectories suggested a possible adaptation phenomenon in PD patients. Our data offered some new insights on normosmic PD patients, which appear to be a subset with a specific psychophysical profile. The analysis of the turning points trajectories, through an olfactory threshold test, could offer additional information on olfactory function in PD patients. Future larger studies should confirm these preliminary findings.

Duality of Smell: Route-Dependent Effects on Olfactory Perception and Language

Olfactory research in humans has largely focused on odors perceived via sniffing, orthonasal olfaction, whereas odors perceived from the mouth, retronasal olfaction, are less well understood. Prior work on retronasally presented odors involves animal models and focus mainly on odor sensitivity, but little is known about retronasal olfactory perception and cognition in humans. In this study, we compared orthonasal and retronasal odor presentation routes to investigate differences in odor descriptions and evaluations. Thirty-six individuals participated in a within-subjects study using twelve odors (varying in pleasantness and edibility) in perceptual and semantic tasks. Orthonasal presentation was associated with a better ability to identify odors, and with more concrete (and source-based) language. Exploratory analyses revealed that whereas orthonasal odors were described with words that had visual associations, retronasal odors were described with words that had interoceptive associations. Interestingly, these route-dependent differences in descriptor usage were not explained by differences in sensitivity and intensity, suggesting instead a cognitive and linguistic processing difference between odors presented orthonasally and retronasally. Our results indicate that olfaction is, in fact, a dual sense, in which the routes change the perception of an odor.

Validation of Olfactory Network Based on Brain Structural Connectivity and Its Association With Olfactory Test Scores

Olfactory perception is a complicated process involving multiple cortical and subcortical regions, of which the underlying brain dynamics are still not adequately mapped. Even in the definition of the olfactory primary cortex, there is a large degree of variation in parcellation templates used for investigating olfaction in neuroimaging studies. This complicates comparison between human olfactory neuroimaging studies. The present study aims to validate an olfactory parcellation template derived from both functional and anatomical data that applies structural connectivity (SC) to ensure robust connectivity to key secondary olfactory regions. Furthermore, exploratory analyses investigate if different olfactory parameters are associated with differences in the strength of connectivity of this structural olfactory fingerprint. By combining diffusion data with an anatomical atlas and advanced probabilistic tractography, we found that the olfactory parcellation had a robust SC network to key secondary olfactory regions. Furthermore, the study indicates that higher ratings of olfactory significance were associated with increased intra- and inter-hemispheric SC of the primary olfactory cortex. Taken together, these results suggest that the patterns of SC between the primary olfactory cortex and key secondary olfactory regions has potential to be used for investigating the nature of olfactory significance, hence strengthening the theory that individual differences in olfactory behaviour are encoded in the structural network fingerprint of the olfactory cortex.

Development of the Spanish Version of Sniffin's Sticks Olfactory Identification Test: Normative Data and Validity of Parallel Measures

The Sniffin' Sticks Olfactory Identification Test is a tool for measurement of olfactory performance developed in Germany and validated in several countries. This research aims to develop the Spanish version of the Sniffin' Sticks Olfactory Identification Test and obtain normative values for the Spanish population. The parameters are free recall and subjective intensity of odorants are included. The influence of possible demographic covariates such as sex, age, smoking, or educational level are analyzed, and the items that best discriminate are studied. In addition, the internal structure validity of the blue and purple versions is studied as a parallel measure, and a cultural adaptation of the purple version is carried out. For this, three independent samples of normosmic healthy volunteers were studied. To obtain normative values, the sample was of 417 participants (18-89 years). For the internal structure validity study of both versions, the sample was 226 (18-70 years), and for familiarity of the purple version, the sample was 75 participants (21-79 years). Results indicated that men and women and smokers and non-smokers perform equally. However, differences were found as age progresses, being more pronounced after 60 years old in all three measurements of the identification test. This research also provides the items that best discriminate in the blue version and a cultural adaptation for the purple version. In conclusion, the Sniffin' Sticks Odor Identification Test is a suitable tool for olfactory assessment in the Spanish population. The instrument has been expanded with two new scores, and normative data as a function of age are provided. Its parallel version also seems appropriate for testing, as items have been culturally adapted and evidence of internal structure validity for both versions is reported.

Clinical assessment of olfactory function

Approximately 5% of the general population is affected by functional anosmia with approximately additional 15% exhibiting decreased olfactory function. Many of these individuals ask for help. Because the subjective rating of olfactory function is biased, assessment of olfactory function is important. Olfactory measurements are needed for patient counseling and the tracking of changes in the sense of smell over time. The present review provides an overview of frequently used psychophysical tests for olfactory function, discusses differences between threshold and suprathreshold aspects of olfactory function, and gives examples on how to apply psychophysical tests.

Spanish Validation for Olfactory Function Testing Using the Sniffin' Sticks Olfactory Test: Threshold, Discrimination, and Identification

The assessment of olfactory function is becoming increasingly relevant, especially in cases of cognitive decline (i.e., neurodegenerative diseases), where olfactory alterations may be relevant as potential early biomarkers. The Sniffin' Sticks Olfactory Test, developed in Germany and validated in several countries, is an objective measure of olfactory performance. This study aims to validate this test in a Spanish sample. This study included 209 healthy normosmic volunteers (154 females and 55 males) aged between 20 to 79 years (mean age = 50.11 ± 15.18 years) as the normative sample. From this group, 22 participants were retested in order to obtain test-retest reliability evidence. Odor familiarity for descriptors in the olfactory identification test was also studied on an independent healthy sample (n = 69), and required cultural modifications were applied. Results indicate that men and women, as well as smokers and non-smokers, performed equally in every test. However, significant differences were found between age groups in every score. The general trend is that olfactory function progressively decreases as a function of age, the elderly group (+60 years) being the one with the lowest scores. In conclusion, this normative data, in addition to the test's cultural modifications, allows the Sniffin' Sticks Olfactory Test to be administered on a Spanish population.

A network model of affective odor perception

The affective appraisal of odors is known to depend on their intensity (I), familiarity (F), detection threshold (T), and on the baseline affective state of the observer. However, the exact nature of these relations is still largely unknown. We therefore performed an observer experiment in which participants (N = 52) smelled 40 different odors (varying widely in hedonic valence) and reported the intensity, familiarity and their affective appraisal (valence and arousal: V and A) for each odor. Also, we measured the baseline affective state (valence and arousal: BV and BA) and odor detection threshold of the participants. Analyzing the results for pleasant and unpleasant odors separately, we obtained two models through network analysis. Several relations that have previously been reported in the literature also emerge in both models (the relations between F and I, F and V, I and A; I and V, BV and T). However, there are also relations that do not emerge (between BA and V, BV and I, and T and I) or that appear with a different polarity (the relation between F and A for pleasant odors). Intensity (I) has the largest impact on the affective appraisal of unpleasant odors, while F significantly contributes to the appraisal of pleasant odors. T is only affected by BV and has no effect on other variables. This study is a first step towards an integral study of the affective appraisal of odors through network analysis. Future studies should also include other factors that are known to influence odor appraisal, such as age, gender, personality, and culture.

Odor Mixtures in Identification Testing Using Sniffin' Sticks: The SSomix Test

Clinical tests assessing olfactory performance have become indispensable for diagnosing olfactory dysfunction. As time and personnel resources are limited, it would be advantageous to have shorter protocols focusing on singular aspects of olfactory performance, such as odor identification. However, such a unidimensional approach is often inconclusive and needs further tests (and tools). Hence, new testing methods with high levels of sensitivity, specificity, and reproducibility are required for clinical practice. Here, we developed a Sniffin’ Sticks odor mixture identification test method (SSomix), with emphasis on resource efficiency and simplicity of administration. SSomix consists of mixtures of two and three odors applied onto a piece of paper using 11 out of 16 items from the original Sniffin’ Sticks identification test kit. A total of 66 healthy subjects and 22 patients with olfactory dysfunction were included in the study. SSomix showed good to excellent test-retest reliability and validity. The area under the receiver operating characteristics curves indicated good diagnostic accuracy in identifying patients with reduced and severely impaired olfactory function. SSomix was a suitable downsizing of the original kit, especially regarding resource efficiency.

Updated Sniffin' Sticks normative data based on an extended sample of 9139 subjects

Purpose

To provide up-to-date and detailed normative data based on a large-scale sample, increasing diagnostic validity by reference to narrow age groups as previous normative values were based upon smaller sample sizes—especially in the group of older subjects.

Method

Data were obtained from 9139 healthy subjects (4928 females aged 5–96 years and 4211 males aged 5–91 years). The standard “Sniffin’ Sticks” test was applied, comprising threshold (T), discrimination (D) and identification (I) subtests, and yielding a TDI sum score.

Results

Hyposmia was established at a TDI score of less than 30.75. Age-related changes were found in each domain, most pronounced for thresholds. Individuals aged 20–30 years performed best, whereas children below the age of 10 and adults above the age of 71 scored only half as well. Sex-related differences were in favor of women.

Conclusions

Data provide guidance for assessing individual olfactory performance in relation to specific age groups. Significant gender and age effects were observed, with a most pronounced increase of olfactory test scores between age 5 through 20 years and a dramatic decrease at the age of 60 through 71 years.

Scents in the stack: olfactometric proficiency testing with an emission simulation apparatus

Olfactometry is globally acknowledged as a technique to determine odor concentrations, which are used to characterize odors for regulatory purposes, e.g., to protect the general public against harmful effects of air pollution. Although the determination procedure for odor concentrations is standardized in some countries, continued research is required to understand uncertainties of odor monitoring and prediction. In this respect, the present paper strives to provide answers of paramount importance in olfactometry. To do so, a wealth of measurement data originating from six large-scale olfactometric stack emission proficiency tests conducted from 2015 to 2017 was retrospectively analyzed. The tests were hosted at a unique emission simulation apparatus-a replica of an industry chimney with 23 m in height-so that for the first time, conventional proficiency testing (no sampling) with real measurements (no reference concentrations) was combined. Surprisingly, highly variable recovery rates of the odorants were observed-no matter, which of the very different odorants was analyzed. Extended measurement uncertainties with roughly 30-300% up to 20-520% around a single olfactometric measurement value were calculated, which are way beyond the 95% confidence interval given by the widely used standard EN 13725 (45-220%) for assessment and control of odor emissions. Also, no evidence has been found that mixtures of odorants could be determined more precisely than single-component odorants. This is an important argument in the intensely discussed topic, whether n-butanol as current reference substance in olfactometry should be replaced by multi-component odorants. However, based on our data, resorting to an alternative reference substance will not solve the inherent problem of high uncertainty levels in dynamic olfactometry. Finally, robust statistics allowed to calculate reliable odor thresholds, which are an important prerequisite to convert mass concentrations to odor concentrations and vice versa.

The confounding effect of background odors on olfactory sensitivity testing

BACKGROUND

Human olfactory sensitivity is known to vary significantly across subjects. Furthermore, environmental factors such as background noise and odor are known to affect target odor threshold scores but have not yet been fully delineated. We aimed to determine whether congruent and non-congruent background odor impaired target odor threshold scores.

NEW METHOD

We performed odor threshold testing in 103 normosmic adults, using phenylethylalcohol (PEA) or linalool as target odors, under three conditions: (a) congruent target and background odors (e.g., PEA in the test and PEA in the background), (b) non-congruent target and background odors (e.g. PEA in the test and Linalool in the background) and (c) no background odor. Background odor was applied to the investigator's glove and testing was performed in an otherwise odorless room.

RESULTS

We found that congruent background odors significantly impaired target odor threshold scores. Non-congruent background odors also impaired target odor threshold, but significantly more so with PEA as target and Linalool as background odor. The best threshold scores were obtained with no background odor. Comparison with Existing Method(s). At present, many testing environments may be contaminated with ambient background odors. We have shown that this may negatively affect odor threshold scores, particularly where background and target odors are congruent.

CONCLUSIONS

We suggest that investigators performing odor threshold testing do so in well ventilated, odor free environments.

SMELL-S and SMELL-R: Olfactory tests not influenced by odor-specific insensitivity or prior olfactory experience

Smell dysfunction is a common and underdiagnosed medical condition that can have serious consequences. It is also an early biomarker of neurodegenerative diseases, including Alzheimer's disease, where olfactory deficits precede detectable memory loss. Clinical tests that evaluate the sense of smell face two major challenges. First, human sensitivity to individual odorants varies significantly, so test results may be unreliable in people with low sensitivity to a test odorant but an otherwise normal sense of smell. Second, prior familiarity with odor stimuli can bias smell test performance. We have developed nonsemantic tests for olfactory sensitivity (SMELL-S) and olfactory resolution (SMELL-R) that use mixtures of odorants that have unfamiliar smells. The tests can be self-administered by healthy individuals with minimal training and show high test-retest reliability. Because SMELL-S uses odor mixtures rather than a single molecule, odor-specific insensitivity is averaged out, and the test accurately distinguished people with normal and dysfunctional smell. SMELL-R is a discrimination test in which the difference between two stimulus mixtures can be altered stepwise. This is an advance over current discrimination tests, which ask subjects to discriminate monomolecular odorants whose difference in odor cannot be quantified. SMELL-R showed significantly less bias in scores between North American and Taiwanese subjects than conventional semantically based smell tests that need to be adapted to different languages and cultures. Based on these proof-of-principle results in healthy individuals, we predict that SMELL-S and SMELL-R will be broadly effective in diagnosing smell dysfunction.

Measuring Olfactory Processes in Mus musculus

This paper briefly reviews the literature that describes olfactory acuity and odour discrimination learning. The results of current studies that examined the role of the neurotransmitters noradrenalin and acetylcholine in odour discrimination learning are discussed as are those that investigated pattern recognition and models of human disease. The methodology associated with such work is also described and its role in creating disparate results assessed. Recommendations for increasing the reliability and validity of experiments so as to further our understanding of olfactory processes in both healthy mice and those modelling human disease are made throughout the paper.