Marco Fusetti

Olfactory screening test in mild cognitive impairment

AbstractMild cognitive impairment (MCI) is a transient status between physiologic ageing and dementia. Each year more than 12% of subjects with MCI develop Alzheimer’s disease. This study evaluated the presence of an olfactory deficit in amnesic MCI (aMCI) patients. Twenty–nine patients diagnosed with aMCI and a homogeneous control group of 29 subjects were enrolled in the study. Olfactory function was assessed by the Sniffin’ Sticks Screening Test (SSST) and the Mini Mental State Examination, the Clinical Dementia Rating, the Geriatric Depression Scale and the Mental Deterioration Battery were used to evaluate the neurocognitive status. aMCI patients showed a significant impairment of their olfactory identification compared to controls (SSST score: 8.3±2.1 vs. 10.8±0.9; p<0.001). These results suggest that olfactory tests should be part of the diagnostic armamentarium of pre–clinical dementia. A long–term follow up might confirm the olfactory identification function as an early and reliable marker in the diagnosis of pre–clinical dementia.

Modern psychophysical tests to assess olfactory function.

AbstractThe sense of smell significantly contributes to quality of life. In recent years much progress has been made in understanding the biochemistry, physiology and pathology of the human olfactory system. Olfactory disorders may arise not only from upper airway phlogosis but also from neurodegenerative disease. Hyposmia may precede motor signs in Parkinson’s disease and cognitive deficit in Alzheimer’s disease. These findings suggest the complementary role of olfactory tests in the diagnosis and management of neurodegenerative diseases. In this report we present a review of modern olfactory tests and their clinical applications. Although rarely employed in routine clinical practice, the olfactory test evaluates the ability of odour identification and is a useful diagnostic tool for olfaction evaluation. Olfactory screening tests are also available. In this work we strongly recommend the importance of an ENT evaluation before the test administration and dissuade from a self–administration of an olfactory test.

New Trends in Tinnitus Management

Tinnitus is a perception of sound in absence of sound stimulation. Tinnitus in many cases cannot be eliminated by conventional medical treatment with drugs or surgery. Some people who begin to notice tinnitus, whether spontaneous or induced by noise, trauma or other insult, will experience spontaneous resolution, but many patients will have persistent tinnitus. For some of them, tinnitus sensation will be joined by tinnitus suffering, with many adverse effects like anxiety, depression and sleep disorders. For these tinnitus sufferers the psychological and acoustic approach proposed by the Tinnitus Retraining Therapy and Acoustic Desensitization Protocol may be helpful. Periodically new treatments are suggested like low-frequency repetitive transcranial magnetic stimulation and sequential phase shift sound cancellation treatment based on the frequency and loudness matching of the tinnitus. The aim of this work is to review modern considerations for the treatment of tinnitus.

Olfactory Deficit and Hippocampal Volume Loss for Early Diagnosis of Alzheimer Disease A Pilot Study

Background:The aim of this pilot study was to verify the role of olfactory test and volumetric magnetic resonance imaging measure of hippocampus to predict conversion from mild cognitive impairment to Alzheimer disease (AD). Materials and Methods:Eighteen patients with amnesic mild cognitive impairment, broadly defined, were followed at 12 months. Hypothesized baseline predictors for follow-up conversion to AD were olfactory deficit and hippocampal volumes loss. Results:In the 1-year follow-up, 5 patients converted to AD. The 2 clinical predictors olfactory test and hippocampal volume loss showed the same sensitivity of 92.3% but the olfactory test showed a higher specificity than the hippocampal volume loss (75% vs. 60%). Conclusions:Our findings suggest the potential utility of olfactory test and hippocampal volume loss for early detection of AD.

Inactivation of Human Salivary Glutathione Transferase P1-1 by Hypothiocyanite: A Post-Translational Control System in Search of a Role

Glutathione transferases (GSTs) are a superfamily of detoxifying enzymes over-expressed in tumor tissues and tentatively proposed as biomarkers for localizing and monitoring injury of specific tissues. Only scarce and contradictory reports exist about the presence and the level of these enzymes in human saliva. This study shows that GSTP1-1 is the most abundant salivary GST isoenzyme, mainly coming from salivary glands. Surprisingly, its activity is completely obscured by the presence of a strong oxidizing agent in saliva that causes a fast and complete, but reversible, inactivation. Although salivary α-defensins are also able to inhibit the enzyme causing a peculiar half-site inactivation, a number of approaches (mass spectrometry, site directed mutagenesis, chromatographic and spectrophotometric data) indicated that hypothiocyanite is the main salivary inhibitor of GSTP1-1. Cys47 and Cys101, the most reactive sulfhydryls of GSTP1-1, are mainly involved in a redox interaction which leads to the formation of an intra-chain disulfide bridge. A reactivation procedure has been optimized and used to quantify GSTP1-1 in saliva of 30 healthy subjects with results of 42±4 mU/mg-protein. The present study represents a first indication that salivary GSTP1-1 may have a different and hitherto unknown function. In addition it fulfills the basis for future investigations finalized to check the salivary GSTP1-1 as a diagnostic biomarker for diseases.

Myxoid Liposarcoma of the Oral Cavity: Case Report and Review of the Literature

Liposarcomas very rarely affect the oral cavity; in such cases the cheek is typically involved. Differential diagnosis between lipoma and other sarcomas is sometimes challenging because the macroscopic and histological features may be difficult to distinguish. Neoplasms with the morphology of lipoma should always receive a careful postoperative histopathologic evaluation. Complete surgical excision is the most effective treatment. We present a case of myxoid liposarcoma of the cheek, together with a literature review of intraoral liposarcomas reported during the last 60 years.Liposarcomas very rarely affect the oral cavity; in such cases the cheek is typically involved. Differential diagnosis between lipoma and other sarcomas is sometimes challenging because the macroscopic and histological features may be difficult to distinguish. Neoplasms with the morphology of lipoma should always receive a careful postoperative histopathologic evaluation. Complete surgical excision is the most effective treatment. We present a case of myxoid liposarcoma of the cheek, together with a literature review of intraoral liposarcomas reported during the last 60 years.

Isolated oropharyngeal Kaposi’s sarcoma in non AIDS patient: differences and similarities with spindle-cell haemangioendothelioma

Vascular tumours rarely affect the oropharynx and overall they can represent a diagnostic challenge since their clinico-histopathological patterns are not always clear. This case report, of an isolated pharyngeal vascular proliferation, allowed the authors to analyse the similarities and differences between Kaposis sarcoma and spindle-cell haemangioendothelioma. Moreover, it emphasizes the importance of diagnostic tools, such as the human herpesvirus 8 (HHV8) marker, that sometimes may represent the only reliable test for clearly establishing the diagnosis.

The Predictive Role of Hyposmia in Alzheimer's Disease

Loss of olfactory function starts at 60 years and become significantly worse after 70. In many cases olfactory disorders may be a consequence of a disease. Different types of olfactory deficit may be revealed by smell evaluation. Anosmia is defined as inability to perceive all odors (total) or some odors (partial). Hyposmia or microsmia is a decreased sensitivity to odors. Dysosmia is a distorted smell percpeption. Olfactory agnosia is defined as failure to identify odors in presence of normal detection and discrimination. Olfactory allucinations are named phantosmias. Many common diseases may compromise the sense of smell, permanently or temporaneally. The range of diseases causing olfactory disorders varies from the common cold to neurodegenerative diseases. Most common causes of olfactory loss are local nasal diseases (allergic rhinitis, nasal polyposis, sinus disease), head trauma, viral and bacterial infections of upper airways. Some neurodegenerative diseases like Alzheimers disease (AD) and various forms of Parkinson’s disease (PD) are accompanied, even from their earliest stages, by olfactory disorders. Dementia is defined by the American Academy of Neurology as a progressive and permanent decline in cognitive function and affects nearly 15% of people who live up to 65 years and 35% of those who reach the age of 85. The Alzheimers Disease International (ADI) in Alzheimer World Report published in 2010 provides that an aging population with dementia the most common form is AD which is currently estimated to affect 35,6 million of people will nearly double in 20 years to reach 66 million in 2030 with a higher concentration in poor countries leading to enormous social costs. The research on AD is now oriented to an early diagnosis which is essential before the development of the irreversible and typical changes due to AD. In AD patients, a reduced capacity for olfactory detection, discrimination and identification is usually found and confirmed by several studies (Mesholam et al., 1998; Hawkes, 2003; Kovacs, 2004; Albers et al., 2006; Westervelt et al., 2007). In this chapter we present a review on the predictive role of hyposmia in the early diagnosis of AD patients.

Olfactory Deficit and Hippocampal Volume Loss for Early Diagnosis of Alzheimer’s Disease

amygdala atrophy plays a role in smell identification failure in AD and its potential prodromal stage amnestic mild cognitive impairment (aMCI). Methods: 18 AD patients, 30 aMCI patients and 11 healthy controls were included in the study. All subjects underwent smell identification assessment using a smell identification test developed at our memory clinic the Motol Hospital Smell Test (MHST). As formerly approved, MHST results correlate with the UPSIT results (r 1⁄4 0,68, p < 0,0005). Volume of the left amygdala (LA) and right amygdala (RA) was measured using MRI manual tracing. Results: Smell identification was impaired in the AD group (p < 0,001) compared to the control group, the difference between the aMCI and the control group approached statistical significance (p 1⁄4 0,08). Volume of the LA was reduced in the AD group (p 1⁄4 0,026), whereas the aMCI group did not differ from the control group (p 1⁄4 0,102). Volume of the RAwas reduced in both AD (p < 0,001) and aMCI groups (p 1⁄4 0,013) when compared to the control group. There was a medium-strong correlation between smell identification and the LA volume (r 1⁄4 0,443, p < 0,001) and a weak correlation between smell identification and the RAvolume (r 1⁄4 0,348, p 1⁄4 0,007). Conclusions: The smell identification impairment and the reduction of the amygdala volumes in AD patients correspond with previous studies. The results obtained in the aMCI group probably reflect the heterogeneity of aMCI patients who are at higher risk for developing AD but not all of them represent a prodromal stage of AD. Our results suggest that amygdala plays a role in smell identification failure in AD patients.