Olfactory Deficits and Donepezil Treatment in Cognitively Impaired Elderly
Status:
Completed
Trial end date:
2019-05-01
Target enrollment:
Participant gender:
Summary
Olfactory identification deficits occur in patients with Alzheimer's disease (AD), are
associated with disease severity, predict conversion from mild cognitive impairment (MCI) to
AD and are associated with healthy elderly subjects developing MCI. Odor (olfactory)
identification deficits may reflect degeneration of cholinergic inputs to the olfactory bulb
and other olfactory brain regions. Acetylcholinesterase inhibitors (ACheI) like donepezil
show modest effects in improving cognition but can be associated with adverse effects and
increased burden and costs because of the need for prolonged, often lifelong, treatment.
Converging findings on odor identification test performance (UPSIT, scratch and sniff 40-item
test) from four pilot studies, including two of our own, suggest that acute change in the
UPSIT in response to an anticholinergic challenge (atropine nasal spray), incremental change
over 8 weeks, and even the baseline UPSIT score by itself, may predict cognitive improvement
with ACheI treatment in MCI and AD. If change in odor identification deficits can help to
identify which patients should receive ACheI treatment, this simple inexpensive approach will
advance the goal of improving personalized treatment, improve selection and monitoring of
patients for ACheI treatment, reduce needless ACheI exposure with risk of side effects, and
decrease health care costs.
Phase:
Phase 4
Details
Lead Sponsor:
New York State Psychiatric Institute
Collaborators:
National Institute on Aging (NIA) National Institutes of Health (NIH)