OLFACTION IN MULTIPLE SCLEROSIS

描述(改编自《调查者摘要》)：多个 硬化症(MS)可导致瘫痪和死亡，并影响数百万人 美国人，通常是在他们的生命的黄金时期。虽然它有很好的记录 多发性硬化症改变了视觉、听力、言语和平衡，它对 嗅觉--一种对确定食物风味和 防止变质的食物、泄漏的天然气、火灾等 环境危害--一直备受争议。事实上，有一些 医学教科书上写道，多发性硬化症患者没有嗅觉， 错误地认为嗅觉系统是无髓鞘的。1984年， 首席调查员发现，31名多发性硬化症患者中有23% 宾夕法尼亚大学气味鉴定得分低于正常 测试(UPSIT)。去年，他报告了一系列案例研究 表明嗅觉功能障碍可能是 在一项针对14名多发性硬化症患者的初步研究中，首席研究员 在UPSIT分数和数量之间显示显著关系 与嗅觉功能相关的大脑区域内的斑块(即 眶前叶皮质和颞叶下部)。没有这样的关系 在与嗅觉无关的脑区观察到。这些小说 研究结果表明，嗅觉障碍与多发性硬化症有关 直接反映了中枢神经病理受累的程度 嗅觉结构。在拟议的研究中，首席调查员 将决定一些经过充分验证的嗅觉的程度 在大量多发性硬化症患者中，测试发生了变化，包括 气味检测、识别、辨别和记忆。他会(1) 描述多发性硬化症鼻两侧的嗅觉功能障碍 同时使用心理物理和电生理方法，(2) 使用高分辨率核磁共振确定测试措施是否 与嗅觉相关斑块的数量/体积相关 结构，(3)确定嗅觉措施是否与 MS症状的加重或缓解(包括出现或 斑块消失)，(4)确定女性是否 比男性更容易受到MS相关嗅觉丧失的影响，以及(5)建立 嗅觉测试措施是否与神经心理学有关 认知功能的测量，重点是测量 眶前叶和下颞叶的神经处理。给定 嗅觉功能与睡眠质量密切相关的初步研究结果 嗅觉相关结构内与MS相关的斑块数量， 首席研究员预计，这项研究将阐明，对于 第一次，与嗅觉障碍相关的嗅觉障碍的发病机制 常见的神经性疾病。重要的是，这项研究将提供 洞察不同的嗅觉功能指标如何与 特定中枢神经系统内的病理改变 结构，以及为临床医生提供合理建议的信息 患有多发性硬化症相关初级感觉缺陷的患者 情态。

DESCRIPTION (Adapted from the Investigator's Abstract): Multiple sclerosis (MS) can lead to paralysis and death and affects millions of Americans, often in the prime of their lives. While it is well documented that MS alters vision, hearing, speech and balance, its influence on olfaction - a sense critical for determination of food flavor and protection from spoiled food, leaking natural gas, fire, and other environmental hazards - has been controversial. Indeed, a number of medical textbooks state that the sense of smell is spared in MS, erroneously assuming that the olfactory system is unmyelinated. In 1984, the principal investigator discovered that 23 percent of 31 MS patients scored below normal on the University of Pennsylvania Smell Identification Test (UPSIT). Last year, he reported a series of case studies demonstrating that olfactory dysfunction can be the presenting symptom of MS. In a pilot study of 14 MS patients, the principal investigator has shown a significant relationship between UPSIT scores and the number of plaques within brain regions related to olfactory function (i.e., the orbitofrontal cortex and inferior temporal lobe). No such relationship was observed within non-olfactory related brain regions. These novel findings suggest that the olfactory dysfunction associated with MS directly reflects the degree of neuropathological involvement of central olfactory structures. In the proposed study, the principal investigator will determine the degree to which a number of well-validated olfactory tests are altered in a large cohort of MS patients, including tests of odor detection, identification, discrimination, and memory. He will (1) characterize the olfactory dysfunction of MS on each side of the nose using both psychophysical and electrophysiological measures, (2) determine, using high resolution MRI, whether the test measures are correlated with the number/volume of plaques in olfactory-related structures, (3) establish if olfactory measures are related to the exacerbation or remission of the MS symptoms (including appearance or disappearance of plaques), (4) ascertain whether women are more susceptible than men to MS-related olfactory loss, and (5) establish whether the olfactory test measures are related to neuropsychological measures of cognitive function, with an emphasis on tests which measure orbitofrontal and inferior temporal lobe neural processing. Given the pilot findings of a close relationship between olfactory function and the number of MS-related plaques within olfactory-related structures, the principal investigator expects that this research will explicate, for the first time, the pathogenesis of an olfactory dysfunction associated with a common neurological disorder. Importantly, this study will provide insight as to how different measures of olfactory function are related to pathological alterations within specific central nervous system structures, as well as information for the clinician to rationally counsel patients with MS-related deficits in this underappreciated primary sensory modality.