Clinicoradiological features in amyotrophic lateral sclerosis patients with olfactory dysfunction
Clinicoradiological features in amyotrophic lateral sclerosis patients with olfactory dysfunction
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DOI：
10.1080/21678421.2020.1859544
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发表时间：
2021-04
影响因子：
2.8
通讯作者：
M. Masuda;Hirohisa Watanabe;A. Ogura;R. Ohdake;Toshiyasu Kato;K. Kawabata;K. Hara;R. Nakamura;N. Atsuta;B. Epifanio;M. Katsuno;G. Sobue
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作者：
M. Masuda;Hirohisa Watanabe;A. Ogura;R. Ohdake;Toshiyasu Kato;K. Kawabata;K. Hara;R. Nakamura;N. Atsuta;B. Epifanio;M. Katsuno;G. Sobue
摘要目的：肌萎缩侧索硬化症(ALS)是一种以运动神经元受累为特征的成人型神经退行性疾病。尽管嗅觉功能障碍已在肌萎缩侧索硬化症中被描述，但与嗅觉功能障碍相关的临床放射学特征仍然知之甚少。方法：我们招募了30名ALS患者和53名年龄和性别匹配的健康对照(HCS)。所有参与者都接受了日语气味棒识别测试(OSIT-J)和临床评估，包括病程、ALSFRS-R、发病地点、用力肺活量以及反映一般、执行、记忆和语言功能的认知检查。我们调查了OSIT-J评分与临床特征的关系，并通过基于体素的形态计量学(VBM)分析MRI来检测萎缩性改变。结果：肌萎缩侧索硬化症患者的OSIT-J评分(6.9±3.2vs.9.8±1.9p<；0.001)显著低于肥胖症患者(P<0.0 5)。在ALS患者中，OSIT-J评分与考试时年龄、正面评估组合、单词流畅性、向前数字广度和ADAS-Jcog再认显著相关，而与教育程度、疾病类型、病程、ALSFRS-R和%VC无关。多元逐步回归分析显示，仅ADAS-Jcog识别对OSIT-J评分有显著预测作用。以年龄、性别、颅内总体积和ADAS-Jcog识别为协变量的VBM分析显示，OSIT-J评分与ALS患者左侧眶皮质(包括直回、眶内侧回和右侧海马区)的萎缩程度显著相关。结论：ALS患者可表现出明显的嗅觉障碍，并伴有眶皮质和海马区受累。嗅觉检查可作为筛查ALS额颞部改变的有用指标。
Abstract Objective: Amyotrophic lateral sclerosis (ALS) is an adult-onset neurodegenerative disorder characterized by motor neuron involvement. Although olfactory dysfunction has been described in ALS, clinicoradiological features associated with the olfactory dysfunction remain poorly understood. Methods: We enrolled 30 patients with ALS and age- and sex-matched 53 healthy controls (HCs). All participants underwent the odor stick identification test for Japanese (OSIT-J) and clinical assessments, including disease duration, ALSFRS-R, site of onset, forced vital capacity, and cognitive examinations that reflected the general, executive, memory and language function. We investigated the associations between OSIT-J score and clinical features and examined atrophic changes by voxel-based morphometry (VBM) analysis to MRI. Results: The OSIT-J score was significantly lower in ALS patients than HCs (6.9 ± 3.2 vs. 9.8 ± 1.9, p < 0.001). In ALS, there were significant relationships between OSIT-J score and age at examination, frontal assessment battery, word fluencies, digit span forward, and ADAS-Jcog recognition, but not education, disease type, duration, ALSFRS-R and, %VC. Multiple regression analysis with stepwise method showed the only ADAS-Jcog recognition substantially predicted OSIT-J score. VBM analysis with age, sex, total intracranial volume, and ADAS-Jcog recognition as covariates showed OSIT-J scores were substantially correlated with atrophic changes of left orbital cortex consisting of gyrus rectus and medial orbital gyrus and right hippocampus in ALS. Conclusion: ALS patients could show substantial olfactory dysfunction in association with orbital cortex and hippocampus involvements. The olfactory examination could be a useful marker for screening of frontotemporal alteration in ALS.