Olfaction in patients with suspected Parkinsonism and scans without evidence of dopaminergic deficit (SWEDDs)

• Published in: Journal of Neurology, Neurosurgery & Psychiatry
• Language: English
• Published: BMJ Publishing Group Ltd. 2011
• Subjects: PARKINSON'S DISEASE; SMELL; SPECT; TREMOR; Pablo; Eastman; Wakefield; Avda; Terranova
• Online Access: http://hdl.handle.net/2262/48770; https://doi.org/10.1136/jnnp.2009.172825

Abstract Background: PET and SPECT scanning have 87%-94% sensitivity and 80%-100% specificity to differentiate patients with Parkinson?s disease (PD) from control subjects and patients with essential (ET) or atypical tremor. More than 10% of patients diagnosed as early PD can have scans without evidence of dopaminergic deficiency (SWEDDs). We investigated whether smell tests can help identify possible cases with SWEDDs. Methods: The 40 item University of Pennsylvania Smell Test (UPSIT) was used to evaluate the sense of smell in 21 SWEDDs patients. We also tested 26 ET patients, 16 patients with a diagnosis of idiopathic adult-onset dystonia (D), 191 non-demented PD patients and 136 control subjects. We used multiple regression analyses to compare the mean UPSIT score in the SWEDDs group with the other 4 groups (ET, D, PD and controls) after adjusting for the effects of relevant covariates. Results: The mean UPSIT score for the SWEDDs group was greater than in the PD group (p<0.001) and not different from the mean UPSIT in the control (p=0.7), ET (p=0.4), or D (p=0.9) groups. Smell tests indicated a high probability of PD in only 23.8% of SWEDDs as opposed to 85.3% of PD patients. Conclusions: In a patient with suspected PD, a high PD probability on smell testing favours the diagnosis of PD, and a low PD probability strengthens the indication for dopamine transporter imaging. [e-mail] (Silveira-Moriyama, Laura) [e-mail] (Schwingenschuh, Petra) angela.o'[e-mail] (O'Donnell, Angela) [e-mail] (Schneider, Susanne A) [e-mail] (Mir, Pablo) [e-mail] (Carrillo, Fatima) [e-mail] (Terranova, Carmen) [e-mail] (Petrie, Aviva) [e-mail] (Grosset, Donald) [e-mail] (Quinn, Niall) [e-mail] (Bathia, Kailash) [e-mail] (Lees, Andrew J) Reta Lila Weston Institute, UCL Institute of Neurology - Reta Lila Weston Institute--> , 1 Wakefield Street--> , London--> , WC1N 1PJ--> - UNITED KINGDOM (Silveira-Moriyama, Laura) Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London - 33 Queen Square--> , Box 13--> , London--> , WC1N 3BG--> - UNITED KINGDOM (Schwingenschuh, Petra) Institute of Neurological Sciences, Department of Neurology, Southern General Hospital, Glasgow - UNITED KINGDOM (O'Donnell, Angela) Neurogenetics Unit, University Hospital Luebeck - Maria Goeppert Str 1--> , Neurogenetics--> , Luebeck--> , 23562--> - GERMANY (Schneider, Susanne A) Hospital Universitario Virgen del Rocio - Avda. de la Filosofia 9, Portal 1, 3C--> , Mairena del Aljarafe (Seville)--> , 41927--> - SPAIN (Mir, Pablo) Hospital Universitario Virgen del Rocio - UNITED KINGDOM (Carrillo, Fatima) Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London - UNITED KINGDOM (Terranova, Carmen) Biostatistics Unit, UCL Eastman Dental Institute, London - UNITED KINGDOM (Petrie, Aviva) Institute of Neurological Sciences - Dept of Neurology Ground Floor--> , Southern General Hospital--> , 1345 Govan Rd--> , Glasgow--> , G51 4TF--> - UNITED KINGDOM (Grosset, Donald) Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London - Institute of Neurology--> , Queen Square--> , London--> , WC1N 3BG--> - UNITED KINGDOM (Quinn, Niall) Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London - University Dept of Clinical Neurology--> , Institute of Neurology--> , Queen Square--> , London--> , WC1N 3BG--> - UNITED KINGDOM (Bathia, Kailash) Reta Lila Weston Institute, UCL Institute of Neurology - Reta Lila Weston Institute of Neurological Sciences--> , Institute of Neurology, UCL--> , 1 Wakefield Street--> , London--> , WC1N 1PJ--> - UNITED KINGDOM (Lees, Andrew J) GERMANY SPAIN UNITED KINGDOM Received: 2009-01-16 Revised: 2009-02-18 Accepted: 2009-02-26