Memory problems, inability to detect smells may be linked

http://web.tallahasseedemocrat.com/content/tallahassee/2001/11/07/health/1107.health.smell.htm

Wednesday, November 7, 2001, updated at 8:28PM
By Janie Nelson
DEMOCRAT SENIOR WRITER

Are you having trouble smelling that fresh lemon pie in the oven?

Are you having a memory problem?

The two could be related.

Tallahassee Memorial Hospital's Memory Disorder Clinic has added a smell test to its battery of methods for early detection of Alzheimer's disease, Parkinson's disease and multiple sclerosis.

"One of the things we know about Parkinson's," said Dr. Larry Kubiak, "is the loss of smell, many times, will show up even before the tremors. . . . So it can be a very early indicator."

Kubiak, director of psychological services at TMH, discovered the test last fall when he went to a workshop led by the neuropsychologist from the University of Pennsylvania who developed it.

TMH added the test in February and, so far, has used it on about 120 people.

Kubiak is quick to point out that the smell test alone can't prove that a person is destined to develop Alzheimer's.

"It's not something that . . . we give in isolation," he said. "It's part of an overall battery."

There are several components to the test.

In the first, a person is given three odors to identify. Each odor is on a scratch-and-sniff patch on separate pages of a booklet. There are four choices for each smell - for instance, lilac, chili, coconut or whiskey.

The patient scratches the patch with a pencil and chooses from among the four.

"If the person misses any of them," Kubiak said, "that could be a trigger to give them a more extensive one, one where there might be just 12 odors and another one where you have four booklets that each have 10 odors in them."

The neuropsychologist said knowing a person's history is important, too. A previous stroke could cause a temporary loss of smell. A heavy smoker or someone with a serious sinus infection can't smell as well.

Some of the baggage brought along by natural aging also includes a decline in the sense of smell - and it's gender-specific, said Kubiak.

Women have a better sense of smell than men. Out of 40 scents, a woman would probably get one more right than a man would.

And, when they do lose the ability to smell certain things, they're different.

Men, as they get older, sometimes can't smell lemon, pizza, grass, chocolate and grape. Women can lose the smell for lemon and pizza, too, as well as fruit punch and gingerbread.

"So God was looking out after women," Kubiak said, "because men are the ones that lose the sense of smell of chocolate - women don't."

Knowledge is power

Why would anyone want to look into the future and know whether she's going to have a debilitating disease?

You don't need to be a psychologist or neurologist to identify people in the last stages of Alzheimer's, Kubiak said. "But, as with any condition, the earlier that you identify it, the more options you have for treatment," he said. "Fortunately we have some medications - Aricept, Exelon, Reminyl - that can be very helpful in delaying that decline, particularly in the memory area, which can make such a difference in quality of life."

Although most of the people who come to the Memory Disorder Clinic are in their 60s, 70s or 80s, more younger people are starting to show up for tests.

"We're starting to get people in their 50s who're concerned," Kubiak said. "They may have parents or grandparents that had Alzheimer's or some other kind of dementia, so they feel like they're at higher risk themselves."

These people begin to be afraid when they start developing what is usually normal memory loss - what the experts call age-related cognitive decline.

"There are a lot more people that are fearful than are experiencing it," the doctor said. "Many of the times when we're testing people in their 50s, they don't have (Alzheimer's). . . . Maybe it's more depression or anxiety."

Still, some people do develop some form of dementia in their 50s, and screening can be helpful.

The University of Pennsylvania says smell-test research shows it's especially useful for early detection.

"Our research indicates that smell loss is among the first signs of Alzheimer's disease, Parkinson's disease and several other neurodegenerative disorders," said Dr. Richard Doty, director of the university's Smell and Taste Center.

That's why Kubiak added it to the battery given at TMH.

"We're just committed to using the best tools out there to identify (dementia) as early as possible," he said, "because there's so much more that can be done."
 

Contact Janie Nelson at (850) 599-2370 or jnelson@taldem.com.
 

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