Smell test challenge suggests clinical benefit for some before development of Alzheimer's

November 10, 2017

New York, NY (November 10, 2017) - Researchers at Columbia University Medical Center (CUMC) and the New York State Psychiatric Institute (NYSPI) may have discovered a way to use a patient's sense of smell to treat Alzheimer's disease before it ever develops. Having an impaired sense of smell is recognized as one of the early signs of cognitive decline, before the clinical onset of Alzheimer's disease. The researchers at CUMC and NYSPI have found a way to use that effect to determine if patients with mild cognitive impairment may respond to cholinesterase inhibitor drugs to treat Alzheimer's disease.

The findings were published online this week in the Journal of Alzheimer's Disease.

Cholinesterase inhibitors, such as donepezil, enhance cholinergic function by increasing the transmission of the neurotransmitter acetylcholine in the brain. Cholinergic function is impaired in individuals with Alzheimer's disease. Cholinesterase inhibitors, which block an enzyme that breaks down acetylcholine, have shown some effectiveness in improving the cognitive symptoms of Alzheimer's disease. However, they have not been proven effective as a treatment for individuals with mild cognitive impairment (MCI), a condition that markedly increases the risk of Alzheimer's disease.

"We know that cholinesterase inhibitors can make a difference for Alzheimer's patients, so we wanted to find out if we could identify patients at risk for Alzheimer's who might also benefit from this treatment," said D.P. Devanand, MBBS, MD, professor of psychiatry, scientist in the Gertrude H. Sergievsky Center at CUMC, and co-director of the Memory Disorders Clinic and the Late Life Depression Clinic at NYSPI. "Since odor identification tests have been shown to predict progression to Alzheimer's, we hypothesized that these tests would also allow us to discover which patients with MCI would be more likely to improve with donepezil treatment."

In this year-long study, 37 participants with MCI underwent odor identification testing with the University of Pennsylvania Smell Identification Test (UPSIT). The test was administered before and after using an atropine nasal spray that blocks cholinergic transmission.

The patients were then treated with donepezil for 52 weeks, and were periodically reevaluated with the UPSIT and with memory and cognitive function tests. Those who had a greater decline in UPSIT scores, indicating greater cholinergic deficits in the brain, after using the anticholinergic nasal spray test saw greater cognitive improvement with donepezil.

In addition, short-term improvement in odor identification from baseline to eight weeks tended to predict longer-term cognitive improvement with donepezil treatment over one year.

"These results, particularly if replicated in larger populations, suggest that these simple inexpensive strategies have the potential to improve the selection of patients with mild cognitive impairment who are likely to benefit from treatment with cholinesterase inhibitors like donepezil," said Dr. Devanand.
-end-
The study is titled: "Change in Odor Identification Impairment is Associated with Improvement with Cholinesterase Inhibitor Treatment in Mild Cognitive Impairment." The other contributors are Cody Lentz (CUMC), Richard E. Chunga (NYSPI), Adam Ciarlegilio (CUMC, NYSPI), Jennifer M. Scodes (Columbia's Mailman School of Public Health), Howard Andrews (CUMC, Mailman), Peter W. Schofield (University of Newcastle, Callaghan, Australia), Yaakov Stern (CUMC), Edward D. Huey (CUMC), Karen Bell (CUMC), and Gregory H. Pelton (NYSPI, CUMC).

This study was supported in part by the Department of Defense grant W81XWH-12-1-0142 and the National Institute on Aging (R01AG041795).

Disclosures

Dr. Bell owns stock in Baxter. Dr. Devanand has received consulting fees for serving on Astellas' Scientific Advisory Board, Axovant's Educational Advisory Board, Eisai's Data Safety Monitoring Board, and Genentech's Scientific Advisory Board, and has received grants from Avanir. Dr. Stern has received consulting fees from Lilly USA, LLC, Takeda Global Research & Development Center, Inc, and Axovant Sciences, Inc. The other contributors report no financial or other conflicts of interest.

New York State Psychiatric Institute and Columbia University Department of Psychiatry (NYSPI/Columbia Psychiatry)

New York State Psychiatric Institute (founded in 1896) and the Columbia University Department of Psychiatry have been closely affiliated since 1925. Their co-location in a New York State facility on the New York-Presbyterian/Columbia University Medical Center campus provides the setting for a rich and productive collaborative relationship among scientists and physicians in a variety of disciplines. NYSPI/Columbia Psychiatry is ranked among the best departments and psychiatric research facilities in the nation and has contributed greatly to the understanding of and current treatment for psychiatric disorders. The Department and Institute are home to distinguished scientists noted for their clinical and research advances in the diagnosis and treatment of depression, suicide, schizophrenia, bipolar and anxiety disorders and childhood psychiatric disorders. Their combined expertise provides state of the art clinical care for patients, and training for the next generation of psychiatrists and psychiatric researchers.

Columbia University Medical Center provides international leadership in basic, preclinical, and clinical research; medical and health sciences education; and patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Columbia University Medical Center is home to the largest medical research enterprise in New York City and State and one of the largest faculty medical practices in the Northeast. The campus that Columbia University Medical Center shares with its hospital partner, NewYork-Presbyterian, is now called the Columbia University Irving Medical Center. For more information, visit cumc.columbia.edu or columbiadoctors.org.

Columbia University Medical Center

Related Mild Cognitive Impairment Articles from Brightsurf:

Weekly physical activity may help prevent mild cognitive impairment conversion to dementia
Exercising more than once per week is associated with a lower risk of developing Alzheimer's disease in patients with mild cognitive impairment, research published in the open access journal Alzheimer's Research and Therapy suggests.

A randomized clinical trial of Greek High Phenolic Early Harvest Extra Virgin Olive Oil in mild cognitive impairment: the MICOIL pilot study
Greek researchers and clinicians investigated for the first time the effect of High Phenolic Early Harvest Extra Virgin Olive Oil (HP-EH-EVOO) versus Moderate Phenolic (MP-EVOO) and Mediterranean Diet (MeDi) as a therapeutic pharmaceutical natural compound for older adults with amnestic Mild Cognitive Impairment (aMCI).

Mild cognitive impairment, ISS produces the first epidemiological estimation
In a study published in the Journal of Alzheimer's Disease, ISS researchers estimated about 680,000 cases of mild cognitive impairment (MCI), in a total of 12,730,960 migrants, aged between 60 and 89 years, living in the European Union (EU) in 2018.

UC study estimates mild cognitive impairment among diverse Latino populations at 10%
The first and largest study of its kind has estimated the prevalence of mild cognitive impairment in diverse Latino populations.

Heart attack patients with mild cognitive impairment get fewer treatments
University of Michigan research finds people with mild cognitive impairment don't always receive the same, established medical treatment that patients with normal cognitive functioning get when they have a heart attack.

Adults with mild cognitive impairment can learn and benefit from mindfulness meditation
Pilot study shows promising evidence that adults with MCI can learn to practice mindfulness meditation, and by doing so may boost their cognitive reserve.

Research underscores value of cognitive training for adults with mild cognitive impairment
Researchers at the Center for BrainHealth®, part of The University of Texas at Dallas, combined two non-pharmacological interventions for adults with Mild Cognitive Impairment (MCI): eight sessions of Strategic Memory Advanced Reasoning Training (SMART), a cognitive training program shown to improve reasoning and ability to extract bottom-line messages from complex information; and Transcranial Direct Current Stimulation (tDCS) over the left frontal region, associated with cognitive control and memory recovery success in people with Alzheimer's.

Antioxidants may prevent cognitive impairment in diabetes
Cognitive difficulties in patients with diabetes, caused by repeated episodes of low blood sugar, could be reduced with antioxidants, according to a new study presented at the Society for Endocrinology annual conference in Glasgow.

Researchers develop combined data model to better evaluate for mild cognitive impairment
A new study has shown that by combining imaging and neuropsychological testing, one can more accurately assess the cognitive status of individuals.

Study: Intensive blood pressure control reduces risk of mild cognitive impairment
Significant reductions in the risk of mild cognitive impairment (MCI), and the combination of MCI and dementia, have been shown for the first time through aggressive lowering of systolic blood pressure in new research results from the federally funded SPRINT MIND Study reported at the Alzheimer's Association International Conference (AAIC) 2018 in Chicago.

Read More: Mild Cognitive Impairment News and Mild Cognitive Impairment Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.