Jennifer Zervakis

Taste, smell and neuropsychological performance of individuals at familial risk for Alzheimer's disease.

The purpose of the study was to determine whether there are chemosensory and neuropsychological changes that predate the onset of Alzheimers disease in individuals at enhanced risk of developing the condition. To study this question, a unique sample of individuals (n = 33) was studied who were genetically at-risk for AD by virtue of documented multigenerational evidence of the disease (so-called multiplex families). The performance of at-risk individuals was evaluated on various smell, taste, and neuropsychological measures at baseline and 18 months later. Their performance was compared to a control group (n = 32) that was matched in age, gender, education, and race. At baseline the at-risk group performed worse than the control group on the chemosensory measures of phenethyl alcohol smell detection, smell memory, and taste memory, and on a memory measure involving recall of narrative information (Logical Memory I from the Wechsler Memory Scale- Revised). Across both sessions, the at-risk group had lower smell memory scores than the control group. At-risk status was not significantly associated with APOE status. The results of this and other studies suggest that individuals who are genetically at risk for developing AD may perform more poorly on memory and smell measures compared to those not at risk. This effect may be separate from one known genetic risk factor of AD, APOE, and supports that multiple genes are likely responsible for the disease and its associated memory and other neurocognitive symptoms.

Taste and smell perception in the elderly: Effect of medications and disease

Publisher Summary This chapter describes the changes in the senses of taste and smell that occur with advancing age. The incidence of taste and smell disorders will increase significantly over the coming decades due to the rapid growth in the elderly segment of the population. Furthermore, elderly individuals will likely experience taste and smell losses for a greater proportion of their lives due to the increase in life expectancy. Taste and smell disorders in the elderly present a public health challenge because they can increase the risk of malnutrition and food poisoning. Furthermore, taste and smell impairments reduce the quality of life. Deficits in taste or smell perception are a consequence of normal aging, certain disease states (especially Alzheimers disease), medications, surgical interventions, and/or environmental exposure. Impaired taste and smell perception in the elderly can lead to poor appetite, inappropriate food choices, lower nutrient intake, and impaired nutritional status and immunity. Methods for compensating for taste and smell losses with flavor-enhanced foods is also described to improve appetite, food palatability and/or intake, increase salivary flow and immunity, and reduce oral complaints in both sick and healthy elderly.

Effect of Protease Inhibitors on the Sense of Taste

The purpose of this study was to investigate the taste properties of protease inhibitors which are essential components of drug regimes used to treat human immunodeficiency virus (HIV) infection. In this study, the taste properties of four protease inhibitors (indinavir, ritonavir, saquinavir, and nelfinavir) were investigated in unmedicated HIV-infected patients and healthy controls. Three of the four protease inhibitors (indinavir, ritonavir, and saquinavir) were found to be predominantly bitter (with additional qualities of medicinal, metallic, astringent, sour, and burning). Nelfinavir was found to be relatively tasteless. HIV-infected and uninfected control subjects detected protease inhibitors at similar concentrations, but HIV-infected subjects perceived suprathreshold concentrations as more bitter than controls. Detection thresholds ranged from 0.0061 mM for saquinavir in HIV-infected patients to 0.0702 mM for ritonavir in uninfected control subjects. Suprathreshold studies indicated that protease inhibitors modified the taste perception of a variety of other taste compounds. These results are consistent with clinical findings that protease inhibitors produce taste complaints that can impact patient compliance.

Effect of tricyclic antidepressants on taste responses in humans and gerbils.

One of the side effects of antidepressant pharmacotherapy reported clinically is impairment of the sense of taste. In this study, the taste effects of four tricyclic antidepressant compounds (clomipramine HCl, desipramine HCl, doxepin HCl, and imipramine HCl) were evaluated experimentally by topical application of the drugs to the tongue. Taste detection threshold concentrations for all four medications ranged from 0.1 mM to 0.2 mM in young persons but were elevated by as much as 7.71 times that in elderly individuals who were taking no concurrent medications. Each compound had a predominantly bitter taste with other qualities including metallic, sour, and sharp-pungent. In addition, each tricyclic antidepressant at concentrations from 1 mM to 5 mM blocked responses to a wide range of taste stimuli in both humans and gerbils. The differential suppression of other tastes by tricyclic antidepressants at the level of the taste receptors may contribute to the clinical reports of dysgeusia and hypogeusia.

Effect of Medications on Taste: Example of Amitriptyline HCl

Use of medications is a major factor that contributes to taste losses in the elderly. Epidemiological studies suggest that community-dwelling elderly over the age of 65 use an average of 2.9 to 3.7 medications, and this number increases significantly for elderly living in retirement and nursing homes. The tricyclic antidepressant amitriptyline HCl is used by at least half a million people aged 65 years or more. In human studies performed here, amitriptyline HCl was found to have a bitter, unpleasant taste of its own. In addition, it blocked responses to other taste stimuli in both humans and gerbils. This blockage in humans was greater when amitriptyline HCl was applied continuously to the tongue than when it was applied intermittently. Continuous application of the drug affected all of the taste qualities to varying degrees, while intermittent application led to taste decrements only for salts. Electrophysiological studies in gerbils also revealed taste decrements after a short adaptation to amitriptyline HCl.

Effect of antimicrobial and anti-inflammatory medications on the sense of taste.

Elderly individuals and HIV-infected patients have a disproportionate number of taste complaints relative to the general population, and these taste alterations are correlated with the use of medications. Clinical reports of taste disorders have been associated with many drugs, including antimicrobial and anti-inflammatory medications. The purpose of this study was to quantify the taste effects of 6 nonsteroidal anti-inflammatory drugs (NSAIDS) and 13 antimicrobial drugs. The six NSAIDS were: diclofenac sodium salt, fenoprofen calcium salt, ibuprofen, ketoprofen, nabumetone, and sulindac. The 13 antimicrobials were: acyclovir, ampicillin, atovaquone, dapsone, enoxacin, ethambutol, lomefloxacin HCl, ofloxacin, pentamidine isethionate, pyrimethamine, sulfamethoxazole, tetracycline HCl, and trimethoprim. These 19 medications were applied topically to the tongues of unmedicated young and elderly volunteers as well as unmedicated HIV-infected patients to measure the direct effect of the drug on taste receptors. Topical application of drugs to the apical tongue surface was used to mimic the situation in which the drug is secreted into the saliva. The main finding was that the taste qualities of these drugs were perceived as predominantly bitter, metallic, and/or sour, although several did not have a taste. Elderly subjects had higher thresholds than young subjects for one-third of the drugs that were tested. Thresholds for HIV-infected patients were statistically equivalent to young controls; however, HIV-infected patients rated the drugs as more intense at four times above the detection threshold than young subjects. Most of these drugs when applied directly to the tongue also modified the taste intensity of other tastants (e.g., NaCl, citric acid).

Effect of the nucleoside analogs zidovudine didanosine, stavudine, and lamivudine on the sense of taste

The purpose of this study was to investigate the taste properties of nucleoside analogs, which are among the current medications used to treat human immunodeficiency virus (HIV) infection. Eighteen unmedicated HIV-positive subjects and 41 healthy control subjects participated in threshold and suprathreshold experiments. All of the nucleoside medications tested were perceived as predominantly bitter (along with other qualities such as metallic, medicinal, sour, astringent, and cooling). The nucleoside analog with the lowest detection thresholds was zidovudine; the detection threshold was 1.47 mM for HIV-infected patients and 2.15 mM for control subjects. Detection thresholds for lamivudine were 4.41 mM for HIV-infected patients and 4.36 mM for control subjects. Detection thresholds for stavudine were 6.39 mM for HIV-infected patients and 5.99 mM for control subjects. Detection thresholds for didanosine were 14.29 mM for HIV-infected patients and 24.0 mM for control subjects. The nucleoside analogs also modified the taste perception of KCl and CaCl2. There were no significant differences between HIV-infected subjects and control subjects for detection threshold values for any of the drugs. However, HIV-infected subjects rated lamivudine, zidovudine, and stavudine as significantly more bitter than did the control subjects at concentrations four times higher than their detection thresholds. This result was not due to use of medications by HIV-infected subjects because none of the subjects (neither HIV-infected nor control) were taking medications.

Loss of Taste, Smell, and Other Senses with Age

There is an increasing awareness of the potential for maintaining functional status and quality of life to very old age. Integral to that aim is retaining the function of the senses, which are vital for learning, interacting, taking pleasure from the outside world, and overall health. All sensory modalities (including taste, smell, vision, hearing, and touch) undergo age-related declines, although the time of onset and degree of loss for a particular sensory modality varies among individuals. Many changes in the senses are not an inevitable consequence of aging, but rather are influenced by such factors as disease, medication use, and environmental factors including nutrition. Current research aims to better understand the mechanisms of age-related sensory losses and to develop methods that compensate for these changes so that the elderly can maximize their remaining abilities.

Effect of repeated evaluation and repeated exposure on acceptability ratings of sentences.

This study investigated the effect of repeated evaluation and repeated exposure on grammatical acceptability ratings for both acceptable and unacceptable sentence types. In Experiment 1, subjects in the Experimental group rated multiple examples of two ungrammatical sentence types (ungrammatical binding and double object with dative-only verb), and two difficult to process sentence types [center-embedded (2) and garden path ambiguous relative], along with matched grammatical/non-difficult sentences, before rating a final set of experimental sentences. Subjects in the control group rated unrelated sentences during the exposure period before rating the experimental sentences. Subjects in the Experimental group rated both grammatical and ungrammatical sentences as more acceptable after repeated evaluation than subjects in the Control group. In Experiment 2, subjects answered a comprehension question after reading each sentence during the exposure period. Subjects in the experimental group rated garden path and center-embedded (1) sentences as higher in acceptability after comprehension exposure than subjects in the control group. The results are consistent with increased fluency of comprehension being misattributed as a change in acceptability.

Memory and learning for a novel written style.

Subjects read and recalled a series of five short stories in one of four plot and style combinations. The stories were written in one of two styles that consisted of opposing clause orders (i.e., independent-dependent vs. dependent-independent), tense forms (i.e., past vs. present), and descriptor forms (modifier modifier vs. modifier as a noun). The subjects incorporated both plot and style characteristics into their recalls. Other subjects, who, after five recalls, either generated a new story or listed the rules that had been followed by the stories read, included the marked forms of the characteristics they learned more often, except for tense. The subjects read and recalled four stories of the same plot and style and then read and recalled a fifth story of the same plot and style or of one of the other three plot/style combinations. Ability to switch style depended on both the characteristic and the markedness.