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Randomized Controlled Trial
. 2015 Sep;78(3):401-11.
doi: 10.1002/ana.24447. Epub 2015 Jul 3.

Olfactory identification deficits and increased mortality in the community

Davangere P Devanand  1 , Seonjoo Lee  2 , Jennifer Manly  3 , Howard Andrews  3 , Nicole Schupf  3 , Arjun Masurkar  3 , Yaakov Stern  3 , Richard Mayeux  3 , Richard L Doty  4
Affiliations
Randomized Controlled Trial

Olfactory identification deficits and increased mortality in the community

Davangere P Devanand et al. Ann Neurol. 2015 Sep.

Abstract

Objective: To examine the association between odor identification deficits and future mortality in a multiethnic community cohort of older adults.

Methods: Participants were evaluated with the 40-item University of Pennsylvania Smell Identification Test (UPSIT). Follow-up occurred at 2-year intervals with information on death obtained from informant interviews and the National Death Index.

Results: During follow-up (mean = 4.1 years, standard deviation = 2.6), 349 of 1,169 (29.9%) participants died. Participants who died were more likely to be older (p < 0.001), be male (p < 0.001), have lower UPSIT scores (p < 0.001), and have a diagnosis of dementia (p < 0.001). In a Cox model, the association between lower UPSIT score and mortality (hazard ratio [HR] = 1.07 per point interval, 95% confidence interval [CI] = 1.05-1.08, p < 0.001) persisted after controlling for age, gender, education, ethnicity, language, modified Charlson medical comorbidity index, dementia, depression, alcohol abuse, head injury, smoking, body mass index, and vision and hearing impairment (HR = 1.05, 95% CI = 1.03-1.07, p < 0.001). Compared to the fourth quartile with the highest UPSIT scores, HRs for mortality for the first, second, and third quartiles of UPSIT scores were 3.81 (95% CI = 2.71-5.34), 1.75 (95% CI = 1.23-2.50), and 1.58 (95% CI = 1.09-2.30), respectively. Participant mortality rate was 45% in the lowest quartile of UPSIT scores (anosmia) and 18% in the highest quartile of UPSIT scores.

Interpretation: Impaired odor identification, particularly in the anosmic range, is associated with increased mortality in older adults even after controlling for dementia and medical comorbidity.

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Conflict of interest statement

Potential Conflicts of Interest

D.P. Devanand has received consulting fees from AbbVie and Lundbeck. Richard Doty is President and major shareholder of Sensonics, Inc., a manufacturer and distributor of tests of taste and smell, including the UPSIT. Richard Doty has received publishing royalties from Cambridge University Press and Johns Hopkins University Press, and an honorarium from the University of Florida and lodging reimbursement as Chairperson of the Other Non-Motor Features of Parkinson’s Disease working group of the Parkinson Study Group. He has received consulting fees from Pfizer, Inc., Acorda Therapeutics and several law offices. There are no other conflicts of interest.

Figures

Figure 1
Figure 1
Mortality rates during follow-up by baseline UPSIT score quartiles. UPSIT (range 0–40) quartile scores: [0–20], [20–26], [26–31] and [31–40]. For maximum available follow-up, the UPSIT score was significantly associated with mortality (chisq=54.25, p < .001). For study participants, mortality rates were 45.36% in the highest quartile, 28.75% and 20.63% in the next two quartiles, respectively, and 18.39% in participants with the lowest quartile of UPSIT scores as shown in the four bar charts in the figure.
Figure 2
Figure 2
Cumulative Hazard Function for mortality during follow-up for participants with baseline UPSIT scores at the 10th and 90th percentiles in the sample (total n=1169). Cumulative hazard function from Cox proportional hazard regression analyses for baseline UPSIT scores at the 10th percentile (UPSIT score=15, solid line) and the 90th percentile (UPSIT score=34, dotted line) with death as the outcome, adjusted for the following covariates: age, gender, education, race/ethnicity, language of test administration, Charlson comorbidity index, dementia status, depression, head injury, alcohol use, BMI, smoking history. The gray shaded areas are the 95% confidence intervals of the cumulative hazard functions.
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