Parkinson's disease may reduce enjoyment of pleasant smells

People with Parkinson’s disease seem less able to enjoy pleasant smells, such as lemon. The discovery has led scientists to conclude that “the world smells different” with the condition. Utilising this could help doctors cheaply and non-invasively diagnose Parkinson’s disease, a process that usually takes several years and involves a raft of assessments.

Loss of the sense of smell is a core symptom of Parkinson’s, affecting 75 to 90 per cent of cases and often preceding the tremors commonly associated with the condition by years or even decades. There have been many efforts to use the loss of smell as a diagnostic tool, but these have been complicated by the fact that this sense also declines with healthy ageing.

Now, Noam Sobel at the Weizmann Institute of Science in Rehovot, Israel, and his colleagues have tried a different approach: testing smell perception.

The team recruited 94 people, most of whom were in their late 50s to late 60s. Thirty-three of them had been diagnosed with Parkinson’s disease, while another 33 had no known medical conditions, and 28 had smell dysfunction unrelated to Parkinson’s. The researchers used standard tests and questionnaires to assess participants’ ability to detect and identify smells.

They also used their own tests to find what they call an olfactory perceptual fingerprint. These involved getting the participants to rate the intensity and pleasantness of smells emanating from three jars. One contained a high concentration of the odorant citral, which smells like lemon, the next had a mix of the aromatic ingredients asafoetida and skatole that was so concentrated it smelt faecal, and the third was an empty jar.

All the tests detected when the participants had a decline in their ability to sense smells, but only the olfactory perceptual fingerprints could distinguish between people with smell loss who did or didn’t have Parkinson’s disease, telling the two groups apart with 88 per cent accuracy. This rose to 94 per cent when the age and sex of the participants were matched.

The researchers found that those with Parkinson’s perceived the citrus smell as being just as intense as the healthy group did, and more intense than the group with smell problems unrelated to the disease. Yet when it came to pleasantness, both groups with smell issues scored lower than the healthy one. The people with Parkinson’s also sniffed nearly 2 per cent longer in response to the unpleasant smell compared with the lemon one, whereas those in the other groups cut their sniff duration by 11 to 12 per cent.

Sobel and his colleagues speculate that smelling functions correctly in the nose of someone with Parkinson’s, but that their brain processes the signals differently, resulting in reduced enjoyment of pleasant odours and a sniffing response that no longer relates to how pleasant a scent is.

This is probably associated with changes in brain areas such as the anterior olfactory nucleus, which shrinks when deprived of smell signals, and is suspected to be one of the earliest sites of Parkinson’s brain pathology.

Differentiating between age-related smell loss and that linked to Parkinson’s disease would be very useful, says Michał Pieniak at the Smell & Taste Clinic at the Dresden University of Technology in Germany. Of every 10 people who come into the clinic saying they have lost their sense of smell and a reason can’t be pinpointed, approximately one will develop Parkinson’s, he says. “Anything that would bring us closer to helping identify their personal risk would be great.”

Charles Greer at Yale School of Medicine says the approach has promise, but tests on a larger group of people are needed. It might also take a long time to validate the approach, given that loss of smell can occur many years before the onset of other Parkinson’s symptoms, he says.

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