Different patterns of age-related central olfactory decline in men and women as quantified by olfactory fMRI

Olfactory Dysfunction as a Clinical Marker of Early Glymphatic Failure in Neurodegenerative Diseases

An abnormal accumulation of misfolded proteins is a common feature shared by most neurodegenerative disorders. Olfactory dysfunction (OD) is common in the elderly population and is present in 90% of patients with Alzheimer's or Parkinson's disease, usually preceding the cognitive and motor symptoms onset by several years. Early Aβ, tau, and α-synuclein protein aggregates deposit in brain structures involved in odor processing (olfactory bulb and tract, piriform cortex, amygdala, entorhinal cortex, and hippocampus) and seem to underly OD. The glymphatic system is a glial-associated fluid transport system that facilitates the movement of brain fluids and removes brain waste during specific sleep stages. Notably, the glymphatic system became less functional in aging and it is impaired in several conditions, including neurodegenerative diseases. As the nasal pathway has been recently described as the main outflow exit of cerebrospinal fluid and solutes, we hypothesized that OD may indeed be a clinical marker of early glymphatic dysfunction through abnormal accumulation of pathological proteins in olfactory structures. This effect may be more pronounced in peri- and postmenopausal women due to the well-documented impact of estrogen loss on the locus coeruleus, which may disrupt multiple mechanisms involved in glymphatic clearance. If this hypothesis is confirmed, olfactory dysfunction might be considered as a clinical proxy of glymphatic failure in neurodegenerative diseases.

Functional connectivity differences of the olfactory network in Parkinson's Disease, mild cognitive impairment and cognitively normal individuals: A resting-state fMRI study

Olfactory dysfunction is an early sign of such neurodegenerative diseases as Parkinson's (PD) and Alzheimer's (AD), and is often present in Mild Cognitive Impairment (MCI), a precursor of AD. Understanding neuro-temporal relationships, i.e., functional connectivity, between olfactory eloquent structures in such disorders, could shed light on their basic pathophysiology. To this end, we employed region-based analyses using resting-state functional magnetic resonance imaging (rs-fMRI) obtained from cognitively normal (CN), MCI, and PD patients with cognitive impairment (PD-CogImp). Using machine learning (linear and ensemble learning), we determined whether the identified functional patterns could classify abnormal function from normal function. Olfaction, as measured by objective testing, was found to be most strongly associated with diagnostic status, emphasizing the fundamental association of this primary sensory system with these conditions. Consistently lower functional connectivity was observed in the PD-CogImp cohort compared to the CN cohort among all identified brain regions. Differences were also found between PD-CogImp and MCI at the level of the orbitofrontal and cingulate cortices. MCI and CN subjects had different functional connectivity between the posterior orbitofrontal cortex and thalamus. Regardless of study group, males showed significantly higher connectivity than females in connections involving the orbitofrontal cortex. The logistic regression model trained using the top discriminatory features revealed that caudate was the most involved olfaction-related brain structure (accuracy = 0.88, Area under the Receiver operator characteristic curve of 0.90). In aggregate, our study demonstrates that resting functional connectivity among olfactory eloquent structures has potential value in better understanding the pathophysiology of several neurodegenerative diseases.

A Review of the Role of Estrogens in Olfaction, Sleep and Glymphatic Functionality in Relation to Sex Disparity in Alzheimer's Disease

Several risk factors contribute to the development of Alzheimer's disease (AD), including genetics, metabolic health, cardiovascular history, and diet. It has been observed that women appear to face a higher risk of developing AD. Among the various hypotheses surrounding the gender disparity in AD, one pertains to the potential neuroprotective properties of estrogen. Compared to men, women are believed to be more susceptible to neuropathology due to the significant decline in circulating estrogen levels following menopause. Studies have shown, however, that estrogen replacement therapies in post-menopausal women do not consistently reduce the risk of AD. While menopause and estrogen levels are potential factors in the elevated incidence rates of AD among women, this review highlights the possible roles estrogen has in other pathways that may also contribute to the sex disparity observed in AD such as olfaction, sleep, and glymphatic functionality.

Natural and Pathological Aging Distinctively Impacts the Pheromone Detection System and Social Behavior

Normal aging and many age-related disorders such as Alzheimer's disease cause deficits in olfaction; however, it is currently unknown how natural and pathological aging impacts the detection of social odors which might contribute to the impoverishment of social behavior at old age further worsening overall health. Analysis of the vomeronasal organ, the main gateway to pheromone-encoded information, indicated that natural and pathological aging distinctively affects the neurogenic ability of the vomeronasal sensory epithelium. Whereas cell proliferation remained majorly preserved in 1-year-old APP/PS1 mice, naturally aged animals exhibited significant deficiencies in the number of mature, proliferative, and progenitor cells. These alterations may support age-related deficits in the recognition of social cues and the display of social behavior. Our findings indicate that aging disrupts the processing of social olfactory cues decreasing social odor exploration, discrimination, and habituation in both wild-type senescent (2-year-old) mice and in 1-year-old double mutant model of Alzheimer's disease (APP/PS1). Furthermore, social novelty was diminished in 1-year-old APP/PS1 mice, indicating that alterations in the processing of social cues are accelerated during pathological aging. This study reveals fundamental differences in the cellular processes by which natural and pathological aging disrupts the exploration of social information and social behavior.

Olfaction and Anxiety Are Differently Associated in Men and Women in Cognitive Physiological and Pathological Aging

BACKGROUND

Olfaction impairment in aging is associated with increased anxiety. We explored this association in cognitively healthy controls (HCs), Mild Cognitive Impairment (MCI) and Parkinson's disease (PD) patients. Both olfaction and anxiety have sex differences, therefore we also investigated these variances.

OBJECTIVES

Investigate the association of olfaction with anxiety in three distinct clinical categories of aging, exploring the potential role of sex.

METHODS

117 subjects (29 HCs, 43 MCI, and 45 PD patients) were assessed for olfaction and anxiety. We used regression models to determine whether B-SIT predicted anxiety and whether sex impacted that relationship.

RESULTS

Lower olfaction was related to greater anxiety traits in all groups (HCs: p = 0.015; MCI: p = 0.001 and PD: p = 0.038), significantly differed by sex. In fact, in HCs, for every unit increase in B-SIT, anxiety traits decreased by 7.63 in men (p = 0.009) and 1.5 in women (p = 0.225). In MCI patients for every unit increase in B-SIT, anxiety traits decreased by 1.19 in men (p = 0.048) and 3.03 in women (p = 0.0036). Finally, in PD patients for every unit increase in B-SIT, anxiety traits decreased by 1.73 in men (p = 0.004) and 0.41 in women (p = 0.3632).

DISCUSSION

Olfaction and anxiety are correlated in all three distinct diagnostic categories, but differently in men and women.

Functional Connectivity of the Chemosenses: A Review

Functional connectivity approaches have long been used in cognitive neuroscience to establish pathways of communication between and among brain regions. However, the use of these analyses to better understand how the brain processes chemosensory information remains nascent. In this review, we conduct a literature search of all functional connectivity papers of olfaction, gustation, and chemesthesis, with 103 articles discovered in total. These publications largely use approaches of seed-based functional connectivity and psychophysiological interactions, as well as effective connectivity approaches such as Granger Causality, Dynamic Causal Modeling, and Structural Equation Modeling. Regardless of modality, studies largely focus on elucidating neural correlates of stimulus qualities such as identity, pleasantness, and intensity, with task-based paradigms most frequently implemented. We call for further "model free" or data-driven approaches in predictive modeling to craft brain-behavior relationships that are free from a priori hypotheses and not solely based on potentially irreproducible literature. Moreover, we note a relative dearth of resting-state literature, which could be used to better understand chemosensory networks with less influence from motion artifacts induced via gustatory or olfactory paradigms. Finally, we note a lack of genomics data, which could clarify individual and heritable differences in chemosensory perception.

Olfactory dysfunction at six months after coronavirus disease 2019 infection

Objective

This study aimed to assess olfactory dysfunction in patients at six months after confirmed coronavirus disease 2019 infection.

Methods

Coronavirus disease 2019 positive patients were assessed six months following diagnosis. Patient data were recoded as part of the adapted International Severe Acute Respiratory and Emerging Infection Consortium Protocol. Olfactory dysfunction was assessed using the University of Pennsylvania Smell Identification Test.

Results

Fifty-six patients were included. At six months after coronavirus disease 2019 diagnosis, 64.3 per cent of patients (n = 36) were normosmic, 28.6 per cent (n = 16) had mild to moderate microsmia and 7 per cent (n = 4) had severe microsmia or anosmia. There was a statistically significant association between older age and olfactory dysfunction. Hospital or intensive care unit admission did not lead to worse olfactory outcomes compared to those managed in the out-patient setting.

Conclusion

At six months after coronavirus disease 2019 diagnosis, approximately two-thirds of patients will be normosmic. This study is the first to describe six-month outcomes for post-coronavirus disease 2019 patients in terms of olfactory dysfunction.

Field-testing olfactory ability to understand human olfactory ecology

OBJECTIVES

We know little about human olfactory ability in natural settings because current knowledge derives from lab-based studies using nonrepresentative samples of convenience. The primary objective was to use a validated lab tool, the five-item odor identification test, to assess variation in olfactory ability in different environments.

METHODS

Using the five-item test, we conducted two repeated measures experiments that assessed participant ability to correctly identify an odor source in different odor environments. We also examined consistency in odor labelling due to documented potential bias from idiosyncrasies in odor terms.

RESULTS

We found no variation in olfactory ability due to environment, but this may be due to methodological biases. First, subjective bias results from idiosyncratic differences in participant labelling and researcher coding of answer correctness. Second, better ability to learn odors may provide an advantage to women. Third, reducing positive female learning bias by analyzing consistency in response (regardless of correct odor source identification) results in no sex differences but fails to assess the functional aspect of olfactory ability (naming the correct odor source). Fourth, functional olfactory ability is significantly better in women, especially in food-rich odor environments.

CONCLUSIONS

Environment was not a significant factor in olfactory ability in this study but that result may be confounded by methodological biases. We do not recommend odor identification as a field tool. Functional olfactory ability exhibits a sex-based pattern but consistency in recognizing the same odor does not. Food-rich odors may enhance olfactory ability in females. We discuss evolutionary and ecological implications of superior female functional olfactory ability relative to food foraging activity.

Sex Differences in Human Olfaction: A Meta-Analysis

Although the view that women's olfactory abilities outperform men's is taken for granted, some studies involving large samples suggested that male and female olfactory abilities are actually similar. To address this discrepancy, we conducted a meta-analysis of existing studies on olfaction, targeting possible sex differences. The analyzed sample comprised n = 8 848 (5 065 women and 3 783 men) for olfactory threshold (as measured with the Sniffin Sticks Test; SST), n = 8 067 (4 496 women and 3 571 men) for discrimination (SST), n = 13 670 (7 501 women and 6 169 men) for identification (SST), and a total sample of n = 7 154 (3 866 women and 3 288 men) for works using University of Pennsylvania Smell Identification Test (UPSIT). We conducted separate meta-analyses for each aspect of olfaction: identification, discrimination and threshold. The results of our meta-analysis indicate that women generally outperform men in olfactory abilities. What is more, they do so in every aspect of olfaction analyzed in the current study. However, the effect sizes were weak and ranged between g = 0.08 and g = 0.30. We discuss our findings in the context of factors that potentially shape sex differences in olfaction. Nevertheless, although our findings seem to confirm the "common knowledge" on female olfactory superiority, it needs to be emphasized that the effect sizes we observed were notably small.

Detectability and reproducibility of the olfactory fMRI signal under the influence of magnetic susceptibility artifacts in the primary olfactory cortex

For human olfactory functional MRI studies, the primary olfactory cortex (POC) suffers severe magnetic susceptibility artifacts, which adversely influences the detectability and reproducibility of the olfactory fMRI data and its clinical applications. The goal of this work is to assess the impacts of the image artifacts on the detectability and reproducibility of the olfactory activation in the POC. The severity of artifacts in the POC were classified into three levels using a Subjective Artifact score (SA_score). The mean temporal signal-to-noise ratio (tSNR) of the fMRI data acquired by a given MRI sequence and olfactory activation (β value) in POC were evaluated and compared to the concurrent activations in the primary visual cortex (Brodmann area 17, BA17) by an odor-visual association paradigm using ninety-nine normal human subjects. Our study revealed that the mean tSNR in POC was above the threshold for reliable detection of the functional activation signal, and, consequently, the mean olfactory activations in the POC were not significantly different from those in BA17. The reproducibility of the activation in the POC was assessed by a random half-split stimulation of a test-retest experiment. The overlap of the activation maps for all the trials (n = 1000) in the POC were not statistically different from that observed in BA17. These results show that the detectability and reproducibility of olfactory activation in the presence of susceptibility artifacts in the POC was at similar level of that in the visual cortex.

Age-related resting-state functional connectivity in the olfactory and trigeminal networks

Brain networks for intranasal chemosensation have been shown to be intrinsically organized in humans . However, little is known about how changes in the intrinsic functional connectivity (FC) in chemosensory networks are related to aging. We, therefore, investigated the impact of age on resting-state FC in the olfactory and trigeminal networks (ON and TN) by combining two freely available resting-state fMRI data sets (obtained from the NITRC.org; Atlanta and New York) with data collected in our lab to generate a large sample size (N=103; 51 women) spanning the age range of 20-61 years. Seed regions were defined using Montreal Neurological Institute's coordinates that anchor ON and TN in activation studies and meta-analyses. The ON included the piriform cortex and the oribtofrontal cortex. The TN included the anterior insula and the cingulate cortex. Scanner site, sex, and age were used as covariates in group-level analyses. The FC between the ON and the parahippocampal gyrus was correlated negatively with age. The FC between the TN and the parahippocampal gyrus, however, was positively correlated. Similarly, age was correlated positively with the ON FC to the ventral striatum and the TN FC to the default mode network. These results reflect divergent age-related alterations in the intrinsic FC of the human chemosensory system.