Null Effect of Olfactory Training With Patients Suffering From Depressive Disorders-An Exploratory Randomized Controlled Clinical Trial

Low odor awareness predicts reduced olfactory abilities in women with depressive symptoms, but not with anxiety symptoms

BACKGROUND

Olfactory disorders and affective symptoms are tightly related. However, the factors underlying this association are not yet understood. One candidate factor is "odor awareness": the degree of attention individuals pays to the odors. However, the association between odor awareness and olfactory abilities in individuals with affective symptoms has not been clarified yet.

METHOD

The present study examined whether odor awareness may moderate (a) the relation between olfactory dysfunctions and depressive and anxiety symptoms; (b) the relation between the perceptual ratings of the odors and depressive and anxiety symptoms in a sample of healthy women (n = 214). Self-report measures of depression and anxiety were collected, whereas the Sniffin' Stick test was employed to measure olfactory abilities.

RESULTS

Linear regression analysis revealed that individuals with higher depressive symptoms presented lower olfactory abilities and that odor awareness was a significant moderator of the association between depressive symptoms and olfactory abilities. Anxiety symptoms were not related to any of the olfactory abilities considered, and this relationship did not change according to odor awareness. The familiarity rating of the odor was significantly predicted by odor awareness. These results were confirmed by Bayesian statistics.

LIMITATIONS

The sample was composed only of women.

CONCLUSIONS

In a healthy population of women, only the presence of depressive symptoms is related to reduced olfactory performance. Odor awareness may be implicated in the development and maintenance of olfactory dysfunction; hence it could be used as a useful target for specific treatments in clinical settings.

Olfactory brain activations in patients with Major Depressive Disorder

Depression is associated with reduced olfactory function. This relationship is assumed to be based on either a reduced olfactory bulb volume or diminished functioning of higher cortical areas. As previous results are controversial, we aimed to re-evaluate central olfactory processing in depression. We recorded the BOLD signal of 21 patients with Major Depressive Disorder and 21 age and gender matched healthy controls during odor presentation. In addition, we measured the individual olfactory bulb volume, tested odor identification and odor threshold, and asked for hedonic odor perception. In both groups, odor presentation led to a pronounced activation of primary olfactory areas. However, secondary olfactory areas were significantly less activated in depressed individuals. The two groups did not differ in olfactory bulb volume. Our results point towards altered olfactory processing in patients in those regions that relate to sensory integration and attention allocation. Difficulties in cognitive processing could impact olfactory function in depression. We are therefore in favor of a top-down mechanism originating in higher cortical areas explaining parts of the relation between depression and olfaction.

Olfactory Dysfunction in Mental Illness

PURPOSE OF REVIEW

Olfactory dysfunction contributes to the psychopathology of mental illness. In this review, we describe the neurobiology of olfaction, and the most common olfactory alterations in several mental illnesses. We also highlight the role, hitherto underestimated, that the olfactory pathways play in the regulation of higher brain functions and its involvement in the pathophysiology of psychiatric disorders, as well as the effect of inflammation on neurogenesis as a possible mechanism involved in olfactory dysfunction in psychiatric conditions.

RECENT FINDINGS

The olfactory deficits present in anxiety, depression, schizophrenia or bipolar disorder consist of specific alterations of different components of the sense of smell, mainly the identification of odours, as well as the qualifications of their hedonic valence (pleasant or unpleasant). Epidemiological findings have shown that both environmental factors, such as air pollutants, and inflammatory disease of the upper respiratory tract, can contribute to an increased risk of mental illness, at least in part, due to peripheral inflammatory mechanisms of the olfactory system. In this review, we describe the neurobiology of olfaction, and the most common olfactory function alterations in several psychiatric conditions and its role as a useful symptom for the differential diagnosis. We also highlight the effect of inflammation on neurogenesis as a possible mechanism involved in olfactory dysfunction in these psychiatric conditions.

Olfactory loss is a predisposing factor for depression, while olfactory enrichment is an effective treatment for depression

The loss of olfactory stimulation correlates well with at least 68 widely differing neurological disorders, including depression, and we raise the possibility that this relationship may be causal. That is, it seems possible that olfactory loss makes the brain vulnerable to expressing the symptoms of these neurological disorders, while daily olfactory enrichment may decrease the risk of expressing these symptoms. This situation resembles the cognitive reserve that is thought to protect people with Alzheimer’s neuropathology from expressing the functional deficit in memory through the cumulative effect of intellectual stimulation. These relationships also resemble the functional response of animal models of human neurological disorders to environmental enrichment, wherein the animals continue to have the induced neuropathology, but do not express the symptoms as they do in a standard environment with restricted sensorimotor stimulation.

Odor Identification Ability as a Mediator of Schizotypal Traits and Odor Hedonic Capacity in Non-Clinical Children and Adolescents

Background: Previous studies have investigated the relationship between schizotypal traits and odor identification ability as well as the relationship between schizotypal traits and odor hedonic capacity in adults. However, very little is known about the relationship among these three factors, especially in children and adolescents. The current study aimed to explore the relationship among these three factors in children and adolescents as well as the potential role of odor identification ability. Method: A total of 355 non-clinical children and adolescents (aged 9−16 years) were recruited in the study. They were asked to complete the Universal Sniff Test (U-Sniff), the Chemosensory Pleasure Scale for Children (CPS-C), and the Schizotypal Personality Questionnaire—Child (SPQ-C). Results: The SPQ-C scores were negatively correlated with both the odor identification scores and the odor hedonic scores (p = 0.022 and p < 0.001, respectively). Only the interpersonal−affective factor of the SPQ-C was negatively correlated with the odor identification scores (p = 0.031). The odor identification scores were significantly positively associated with the odor hedonic scores (p < 0.001). Moreover, the relationship between odor hedonic capacity and schizotypal traits, especially the interpersonal−affective factor, was mediated by odor identification ability. Conclusions: Schizotypal traits were negatively correlated with both odor identification ability and odor hedonic capacity in children and adolescents, while odor identification ability was found to mediate the relationship between odor hedonic capacity and schizotypal traits, especially the interpersonal−affective factor. Our study indicated that improving odor identification ability through olfactory training may have a positive influence on odor hedonic capacity in individuals with schizotypal traits.

Symptoms of depression change with olfactory function

Olfactory loss is associated with symptoms of depression. The present study, conducted on a large cohort of mostly dysosmic patients, aimed to investigate whether improvement in olfactory performance would correspond with a decrease in depression severity. In 171 participants (157 dysosmic), we assessed olfactory function and severity of depression before and after an average interval of 11 months, with many patients showing improvement in olfactory function. Separate analyses were conducted for (a) the whole group of patients and (b) the group of dysosmic patients using both classic and Bayesian approaches. For odor identification, Student t test demonstrated that the whole sample improved consistently, especially within the group of dysosmic patients. The dysosmic group also improved in odor threshold and overall olfactory function. Pearson correlation showed that an increase in olfactory function was associated with a decrease in depression severity, particularly in dysosmic patients. To conclude, the present results indicate that symptoms of depression change with olfactory function in general and odor identification in particular.

The Effect of Olfactory Training on Olfaction, Cognition, and Brain Function in Patients with Mild Cognitive Impairment

BACKGROUND

The olfactory system is affected very early in Alzheimer's disease and olfactory loss can already be observed in patients with mild cognitive impairment (MCI), an early stage of AD.

OBJECTIVE

The aim of this randomized, prospective, controlled, blinded study was to evaluate whether olfactory training (OT) may have an effect on olfactory function, cognitive impairment, and brain activation in MCI patients after a 4-month period of frequent short-term exposure to various odors.

METHODS

A total of 38 MCI outpatients were randomly assigned to OT or a control training condition, which were performed twice a day for 4 months. Olfactory testing, comprehensive neuropsychological assessment, and magnetic resonance imaging were performed before and after training.

RESULTS

The results suggested that OT exhibited no significant effect on olfaction and cognitive function. However, OT exhibited a positive effect on frontal lobe activation (left middle frontal gyrus and orbital-frontal cortex) but exhibited no effect on grey matter volume. Moreover, the change of olfactory scores was positively associated with the change of frontal activation.

CONCLUSION

OT was found to have a limited effect on olfaction and cognition in patients with MCI compared to a non-OT condition but increased their functional response to odors in frontal area.

Odours count: human olfactory ecology appears to be helpful in the improvement of the sense of smell

Odours modify human behaviour. Research in this field develops rapidly, providing more and more exciting discoveries. In this context, our daily odorous environment has been surprisingly poorly explored. The aim of our study was to quantify olfactory perception and preliminarily identify factors affecting the frequency of odorous experiences. We were also interested in knowing whether human olfactory ecology relates with olfactory performance. In this study, patients with olfactory deficits (n = 62) and healthy controls (n = 97) had their olfactory threshold and odour identification abilities measured before and after a two-week intervention comprising counting of conscious perception of odours naturally occurring in the environment. In both groups, we observed enhanced olfactory performance after the intervention suggesting that (1) the conscious focus on odours may change its perception, and that (2) social and physical environment can effectively stimulate the human olfactory system, presumably supporting the improvement of olfactory sensitivity.

Olfactory training with Aromastics: olfactory and cognitive effects

Purpose

The olfactory system can be successfully rehabilitated with regular, intermittent stimulation during multiple daily exposures to selected sets of odors, i.e., olfactory training (OT). OT has been repeatedly shown to be an effective tool of olfactory performance enhancement. Recent advancements in studies on OT suggest that its beneficial effects exceed olfaction and extend to specific cognitive tasks. So far, studies on OT provided compelling evidence for its effectiveness, but there is still a need to search for an optimal OT protocol. The present study examined whether increased frequency of OT leads to better outcomes in both olfactory and cognitive domains.

Method

Fifty-five subjects (28 females; M_age = 58.2 ± 11.3 years; 26 patients with impaired olfaction) were randomly assigned to a standard (twice a day) or intense (four times a day) OT. Olfactory and cognitive measurements were taken before and after OT.

Results

OT performed twice a day was more effective in supporting olfactory rehabilitation and interventions targeted to verbal semantic fluency than OT performed four times a day, even more so in subjects with lower baseline scores.

Conclusions

OT is effective in supporting olfactory rehabilitation and interventions targeted to verbal semantic fluency. However, it may be prone to a ceiling effect, being efficient in subjects presenting with lower baseline olfactory performance and lower verbal semantic fluency.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00405-021-06810-9.

Olfactory Dysfunction Predicts the Development of Depression in Older US Adults

Neuroanatomic connections link the olfactory and limbic systems potentially explaining an association between olfactory dysfunction and depression. Some previous studies have demonstrated that olfactory dysfunction is associated with increased depressive symptoms. However, these studies were cross-sectional and unable to establish which develops first. We used longitudinal data to determine if impaired odor identification increased subsequent depressive symptoms or vice versa. We assessed olfaction and depression in the National Social Life, Health, and Aging Project, a nationally representative, 15-year longitudinal study of older US adults. Olfaction was measured using a validated odor identification test (Sniffin' Sticks). Depressive symptoms were measured using a modified version of the validated Center for Epidemiological Studies Depression Scale. Multivariable logistic regression models examined the temporal relationships between developing olfactory dysfunction and depression while accounting for demographics, disease comorbidities, alcohol use, smoking, and cognition. Older adults with olfactory dysfunction had concurrent frequent depressive symptoms (odds ratio [OR] = 1.20, 95% confidence interval [CI] = 1.00-1.43). Among healthy adults at baseline, those who had olfactory dysfunction were more likely to develop frequent depressive symptoms 5 or 10 years later (OR = 2.22, 95% CI = 1.13-4.37). Conversely, those with frequent depressive symptoms at baseline were not more likely to develop olfactory dysfunction 5 or 10 years later. We show for the first time that olfactory dysfunction predicts subsequent development of depression in older US adults. These data support screening for depression in older adults with chemosensory impairment and set the stage for disentangling the relationship between olfaction and depression.