Association between Sour Taste SNP KCNJ2-rs236514, Diet Quality and Mild Cognitive Impairment in an Elderly Cohort.

Differences in sour-taste thresholds have been identified in cognition-related diseases. Diet is a modulator of cognitive health, and taste perception influences dietary preferences and habits. Heritable genetics and polymorphisms in the KCNJ2 gene involved in the transduction of sour taste have been linked to variations in sour taste and non-gustatory functions. However, relationships between sour taste genetics, mild cognitive impairment, and diet quality are yet to be elucidated. This study investigated the associations between the presence of the KCNJ2-rs236514 variant (A) allele, diet quality indices, and mild cognitive impairment evaluated by the Mini-Mental State Examination (MMSE), in a secondary cross-sectional analysis of data from the Retirement Health & Lifestyle Study. Data from 524 elderly Australians (≥65y) were analyzed, using standard least squares regression and nominal logistic regression modeling, with demographic adjustments applied. Results showed that the presence of the KCNJ2-A allele is associated with increased proportions of participants scoring in the range indicative of mild or more severe cognitive impairment (MMSE score of ≤26) in the total cohort, and males. These associations remained statistically significant after adjusting for age, sex, and diet quality indices. The absence of association between the KCNJ2-A allele and cognitive impairment in women may be related to their higher diet quality scores in all indices. The potential link between sour taste genotype and cognitive impairment scores may be due to both oral and extra-oral functions of sour taste receptors. Further studies are required on the role and relationship of neurotransmitters, sour taste genotypes and sour taste receptors in the brain, and dietary implications, to identify potential risk groups or avenues for therapeutic or prophylactic interventions.

The experience of dysgeusia in allogeneic haematopoietic cell transplantation survivors: a qualitative study.

BACKGROUND: Taste disorders are one of the most common side effects of treatment in oncology patients and often occur after allogeneic haematopoietic cell transplantation (allo-HCT). Dysgeusia does not receive close medical attention, and information about this disorder is largely based on the clinician's own experience. However, taste disorders can have an impact on the quality of life and nutritional status of survivors of allo-HCT. The number of performed annual transplantations is growing, as the number of older long-term survivors increases, but only few research studies examine survivors of allo-HCT with taste disorders. We conducted a qualitative descriptive study to explore experiences of dysgeusia in patients undergoing allo-HCT and to examine what strategies they used to mitigate it. METHODS: Using purposeful sampling, survivors of allo-HCT were recruited. Audiotape interviews were conducted until data saturation was achieved. Each interview was transcribed verbatim, and content analyses were performed to extract significant themes and subthemes. RESULTS: Three major themes embracing various aspects of allo-HCT survivors' experiences were identified: (1) the shape of taste; (2) everything is irritating and it is arduous to eat; (3) finding new strategies to overcome the problems. Together, they highlight the experiences of survivors showing how the taste disorders can affect the physical, psychological and social dimensions of a person. CONCLUSION: A cumulative burden is the result of dysgeusia and its clinical course reinforced also by related symptoms. Healthcare professionals must focus their attention on the management of these symptoms and offer interventions to safeguard the patient's social, physical and psychological well-being.

Awareness of dysgeusia and gustatory tests in patients undergoing chemotherapy for breast cancer.

PURPOSE: We analyzed the prevalence of gustatory test abnormalities in breast cancer (BC) patients undergoing chemotherapy. METHODS: We enrolled 43 BC patients undergoing chemotherapy and 38 BC patients who had never undergone chemotherapy (control group). Two gustatory tests were conducted: an instillation method examining the threshold for four basic taste stimuli and an electrogustometry method measuring the threshold for perception with electric stimulation at the front two-thirds of the tongue (cranial nerve VII) and at the back third of the tongue (cranial nerve IX). The results of the two gustatory tests and clinicopathological factors were compared between the chemotherapy and control groups and between patients with and without awareness of dysgeusia in the chemotherapy group. RESULTS: In the chemotherapy group, 19 (44%) patients were aware of dysgeusia and 8 (19%) had hypogeusia using the instillation method. Although more patients had parageusia in the chemotherapy than control group, no significant differences in the results of the two gustatory tests were observed. Patients with dysgeusia awareness had a higher threshold at cranial nerve IX using the electrogustometry method than those without dysgeusia awareness; no significant differences in hypogeusia were observed using the instillation method. In fact, 74% (14/19) of patients with dysgeusia awareness could identify the four tastes accurately using the instillation method. Similar results were observed for the instillation and electrogustometry methods at cranial nerve VII. CONCLUSIONS: While approximately half of the chemotherapy patients were aware of dysgeusia, 81% (35/43) of them could accurately identify the four basic tastes using the instillation method.

Salty taste thresholds and preference in patients with chronic kidney disease according to disease stage: A cross-sectional study.

AIM: The present study was performed to evaluate the differences in salty taste thresholds among normal controls and non-dialysis chronic kidney disease (CKD) patients according to disease stage and to evaluate the relationship between salty taste thresholds or preferences and mean spot urine sodium concentrations. METHODS: This cross-sectional study enrolled 436 patients with non-dialysis CKD and 74 normal controls. We evaluated detection and recognition thresholds, salty taste preferences and salt usage behaviours (through a questionnaire) in CKD patients and normal controls. We averaged the three most recent spot urine sodium concentrations and used this 'mean spot urine sodium' value to estimate sodium intake in CKD patients. RESULTS: Detection thresholds of stages 3 and 5 and recognition thresholds of stage 3 CKD patients were higher than those of normal controls. Salty taste preferences of stage 5 and salt usage behaviour scores of stages 4 and 5 CKD patients were lower than those of normal controls. Univariate analysis showed that estimated glomerular filtration rate (eGFR), salt usage behaviour score, salty taste preference, smoking, gender and zinc level were significantly associated with mean spot urine sodium in CKD patients. Multiple regression analysis showed that the eGFR and salty taste preference were independently correlated with mean spot urine sodium. CONCLUSIONS: Education to change salty taste preferences and regular follow up are necessary to decrease salt intake in CKD patients.

Participants with pharmacologically impaired taste function seek out more intense, higher calorie stimuli.

OBJECTIVE: Research suggests a weaker sense of taste in people with obesity, with the assumption that a debilitated taste response increases the desire for more intensely tasting stimuli to compensate for decreased taste input. However, empirical testing of this supposition remains largely absent. METHOD: In a randomized, repeated measures design, 51 healthy subjects were treated with varying concentrations of a tea containing Gymnema sylvestre (GS), to temporarily and selectively diminish sweet taste perception, or a control tea. Following treatment in the four testing sessions, taste intensity ratings for various sweet stimuli were captured on the generalized Labeled Magnitude Scale (gLMS), liking for real foods assessed on the hedonic gLMS, and optimal level of sweetness quantified via an ad-libitum mixing task. Data were analyzed with mixed models assessing both treatment condition and each subject's resultant sweet response with various taste-related outcomes, controlling for covariates. RESULTS: GS treatment diminished sweet intensity perception (p < 0.001), reduced liking for sweet foods (p < 0.001), and increased the desired sucrose content of these foods (p < 0.001). Regression modeling revealed a 1% reduction in sweet taste response was associated with a 0.40 g/L increase in optimal concentration of sucrose (p < 0.001). DISCUSSION: Our results show that an attenuation in the perceived taste intensity of sweeteners correlates with shifted preference and altered hedonic response to select sweet foods. This suggests that those with a diminished sense of taste may desire more intense stimuli to attain a satisfactory level of reward, potentially influencing eating habits to compensate for a lower gustatory input.

Predictors of Dysgeusia in Patients With Oropharyngeal Cancer Treated With Chemotherapy and Intensity Modulated Radiation Therapy.

OBJECTIVE(S): Dysgeusia is a significant factor reducing quality of life and worsening dysphagia in patients receiving chemoradiation therapy for head and neck cancer. The factors affecting dysgeusia severity are uncertain. We investigated the effects on patient-reported dysgeusia of doses to the oral cavity, salivary output (required to dissolve food particles), and patient-reported xerostomia. METHODS AND MATERIALS: Seventy-three patients with stage III to IV oropharyngeal cancer (OPC) (N=73) receiving definitive intensity modulated radiation therapy concurrently with chemotherapy participated in a prospective, longitudinal study of quality of life (QOL), including assessment of patient-reported gustatory function by taste-related questions from the Head and Neck QOL instrument (HNQOL) and the University of Washington Head and Neck-related QOL instrument (UWQOL), before therapy and periodically after treatment. At these intervals, patients also completed a validated xerostomia-specific questionnaire (XQ) and underwent unstimulated and stimulated major salivary gland flow rate measurements. RESULTS: At 1, 3, 6, and 12 months after treatment, dysgeusia improved over time: severe dysgeusia was reported by 50%, 40%, 22%, and 23% of patients, respectively. Significant associations were found between patient-reported severe dysgeusia and radiation dose to the oral cavity (P=.005) and tongue (P=.019); normal tissue complication probability for severe dysgeusia at 3 months showed mean oral cavity D50 doses 53 Gy and 57 Gy in the HNQOL and WUQOL questionnaires, respectively, with curve slope (m) of 0.41. Measured salivary output was not statistically significantly correlated with severe taste dysfunction, whereas patient-reported XQ summary scores and xerostomia while eating scores were correlated with severe dysgeusia in the UWQOL tool (P=.04). CONCLUSIONS: Taste impairment is significantly correlated with mean radiation dose to the oral cavity. Patient-reported xerostomia, but not salivary output, was correlated with severe dysgeusia in 1 of the 2 QOL questionnaires. Reduction in oral cavity doses is likely to improve dysgeusia.

Taste alteration and impact on quality of life after head and neck radiotherapy.

BACKGROUND: Dysgeusia is a relatively common complication of head and neck radiotherapy. The aim of this study was to evaluate taste condition after head and neck radiotherapy and its impact on quality of life. METHODS: In this cohort study 22 patients with head and neck cancer in Tehran University of Medical Sciences Hospital, were interviewed and examined before and 3 weeks after radiotherapy. Patients were given three consecutive concentrations of sugar, salt, citric acid and quinine sulfate solutions to evaluate their taste sensation by Whole Mouth Technique. EORTC-QLQ-H&N35 questionnaire was used before and after radiotherapy to assess the quality of life. Statistical analysis was done using Wilcoxon Signed Rank Test, Spearman's Coefficient of Correlation, Paired t-test, Multiple Ordinary and Multiple Linear Regressions. RESULTS: Significant changes were observed in concentrations and intensities of different perceived tastes before and after radiotherapy. All patients had dysgeusia after radiotherapy and 72.2% had total taste loss. Impairment was observed mainly in salt and bitter tastes followed by sour and sweet. Subjective dysgeusia reported by 3/4 of the patients, which was correlated with objective taste disorder in terms of different tastes intensity. Age, sex, radiotherapy fractions, dosage and patients level of education had no significant effects on taste alteration. Quality of life was significantly deteriorated after the occurrence of dysgeusia in both total and partial taste losers. None of the aforementioned factors had significant effects on quality of life. CONCLUSION: Head and neck radiotherapy causes impairment in taste perception, and life quality is influenced by dysgeusia.

The influence of hypotensive drugs on the taste sensitivity in patients with primary hypertension.

Numerous hypotensive drugs result in decreasing the taste sensitivity or total loss of taste perception. The aim of this study was to evaluate the influence of selected groups of hypotensive drugs used in combined treatment of the taste sensitivity in patients suffering from primary arterial hypertension. The study was conducted in a group of 84 patients aged 30-60, including 43 women and 41 men. The patients were divided into four groups depending on the applied combined treatment including the following treatment regimes: diuretic + beta-blocker, diuretic + beta-blocker + ACE-I, ACE-I + diuretic, ACE-I + diuretic + calcium channel blocker. The study involved also control group of 20 healthy people (without medications) aged 30-60, including 10 women and 10 men. Taste sensitivity was evaluated by two methods: chemosensory and electrogustometric. Chemosensory method was used to asses the sensitivity to salt and sweet tastes with the use of increasing concentrations of saccharose water solutions (0.012-0.041 mmol/L) and water solutions of sodium chloride (0.008-0.068 mmol/L). Electrogustometric thresholds of taste sensitivity were established with electrogustometer. The minimal intensity of the current, which stimulates nerve endings of the taste stimuli-transmitting nerves was determined in two areas of the tongue: at the apex and at the sides. By two different methods of evaluation it was shown that the analyzed groups of hypotensive drugs affect the taste sensitivity of the patients. It was observed that healthy people had higher taste sensitivity than patients. Introducing ACE-I into combined therapy significantly reduced the electrogustometric sensitivity in patients.

Changes in the oral cavity might reflect psychological disorders in some patients.

AIM: The treatment of oral dysesthesias, such as burning mouth syndrome, can be challenging. Patient acceptance of the role of psychological etiological factors might be improved if there are clinical signs that patients could confirm themselves, which could be used as reinforcement of clinical discussions. Published associations between psychological disorder and various oral signs and symptoms are not suited to this purpose, as they are ambiguous in origin and implication. Others, used clinically in this situation, are not supported by published literature. Therefore, the purpose of this study was to determine if a demonstrable relationship could be established between psychological profile and the appearance and function of the oral cavity. METHODS: Seventy-nine participants underwent an oral examination and completed a Depression Anxiety Stress Scale-21 questionnaire. Correlations were calculated between clinical variables and the raw Depression Anxiety Stress Scale scores. Univariate analyses determined variables with significant differences between a high-risk and normal group, and multiple logistic regression models were calculated for these. RESULTS: Various oral signs and symptoms were found to correlate with depression, anxiety, and/or stress, with some predictive of psychological disturbance. CONCLUSIONS: These signs and symptoms might be used to reinforce the psychological aspects of an oral dysesthesia.

Salivary dehydroepiandrosterone (DHEA) levels in patients with the complaint of burning mouth: a case-control study.

OBJECTIVE: This study was conducted to evaluate salivary dehydroepiandrosterone (DHEA) levels, salivary flow rate (SFR), depression, and hopelessness in patients with the complaint of burning mouth (BM). STUDY DESIGN: Thirty female patients with BM and 30 age-matched control women without any complaint of burning mouth were enrolled. After anamnesis and oral examination, the salivary flow rate was determined. Depression and hopelessness were evaluated by the application of inventories. Two saliva samples were collected for DHEA analysis. RESULTS: Dysgeusia (P = .045) and xerostomia (P = .003) were significantly higher in the BM group. The BM patients showed significantly lower salivary flow rate, both under stimulation (P = .001) and at rest (P < .001). Significant differences between the groups were not found in the depression (P = .416) or hopelessness (P = .597) scores. The BM group revealed significantly lower salivary DHEA levels in the morning samples (P = .003). CONCLUSION: Patients with BM exhibit decreased morning salivary DHEA as well as dysgeusia and hyposalivation more frequently than control subjects. Additional investigations are needed to clarify this association.

Smell and taste dysfunction following minor stroke: a case report.

Smell (olfactory) and taste (gustatory) are key senses in the regulation of nourishment and individual safety. Olfactory and gustatory dysfunctions have been infrequently reported together in patients following stroke (Landis et al., 2006; Leopold et al., 2006). This case report details two patients who experienced smell and taste dysfunction following minor stroke events. Symptoms reported included hyposmia (diminished sense of smell) and anosmia (complete loss of smell), and dysgeusia (distorted taste). Patients' sense of smell and taste were assessed in an ambulatory care stroke prevention clinic eight months following their strokes. Patient A presented with minor stroke due to a lesion in the anterior circulation, patient B with a lesion in the posterior circulation. Both patients reported intense olfactory and gustatory dysfunction immediately following their strokes. Examination revealed a general inability to detect subtle odours and the ability to identify only 'sweet' tastes for both patients. In addition, both patients reported heavily salting or sweetening their food to mask the distorted and unpleasant taste, which also impacted comorbid conditions such as hypertension and diabetes. Patients and their spouses reported a decrease in their appreciation of family-related activities due to the patients' olfactory and gustatory dysfunction. Patients reported weight loss, lack of energy and strength, likely due to poor nutrition. Olfactory and gustatory dysfunctions are potentially deleterious outcomes following minor stroke and should be assessed by health care professionals prior to patient discharge. Assistance may be required to promote the health and well-being of patients and their carers if smell and taste are impacted by the stroke event.

Association between regional idiopathic neuropathy and salivary involvement as the possible mechanism for oral sensory complaints.

UNLABELLED: The idiopathic sensorial disturbances of burning mouth syndrome (BMS), taste disturbances (dysgeusia), and dry mouth (xerostomia) have recently been recognized as one entity and given the generic name of oral sensorial complaints (OSC). However, not all patients with OSC complain of all three disturbances, and the underlying mechanism of OSC has not yet been elucidated. This study sought to determine whether OSC was associated with the alteration of oral sensory perception, salivary profile and/or personality traits. It examined 35 patients with OSC and 19 controls. Sensory perception was assessed by Quantitative Sensory Testing (QST) applied to the tongue, including thresholds for thermal sensations and pain, and the magnitude estimation of tonic suprathreshold heat pain stimuli. The salivary profile included flow rate and compositional analysis. Personality traits were examined by both state and trait anxiety and somatization scoring. Results showed significantly elevated thermal sensory thresholds and decreased pain scores for tonic heat pain. In addition, there was an increased level of somatization in the OSC group as compared to the control group (15.1 +/- 1.5 vs. 6.6 +/- 2.1, respectively; P = .003). Concomitantly, altered salivary composition (elevated Na, K, Cl, Ca, IgA, and amylase concentrations)-but not salivary flow rate reduction-was observed in those patients despite their complaints of oral dryness. All parameters were similar among the patients with OSC regardless of their type of complaint. Linear regression analysis revealed that an elevated warm sensory threshold was associated with higher levels of salivary K and Cl concentrations in the patients with OSC. These findings may be attributed to a regional small fiber idiopathic neuropathy affecting oral sensation and salivary secretion in OSC. Alternatively, a primary idiopathic salivary dysfunction might cause sensory neural dysfunction at the receptor level by changing the oral cavity milieu. PERSPECTIVE: Based on the salivary, psychophysical, and personality traits analysis currently presented, as well as on the available literature, we hypothesize that a comprehensive mechanism for OSC is based on a regional neuropathy, which is expressed by complaints of BMS, taste disturbances, and/or xerostomia. All are clearly distinguishable from similar conditions with established organic/therapeutic-related etiologies.

Zinc gluconate in the treatment of dysgeusia--a randomized clinical trial.

In the treatment of dysgeusia, the use of zinc has been frequently tried, with equivocal results. The aim of the present randomized clinical trial, which involved a sufficiently large sample, was therefore to determine the efficacy of zinc treatment. Fifty patients with idiopathic dysgeusia were carefully selected. Zinc gluconate (140 mg/day; n=26) or placebo (lactose; n=24) was randomly assigned to the patients. The patients on zinc improved in terms of gustatory function (p <0.001) and rated the dysgeusia as being less severe (p <0.05). Similarly, signs of depression in the zinc group were less severe (Beck Depression Inventory, p <0.05; mood scale, p <0.05). With the exception of the salivary calcium level, which was higher in the zinc patients (p <0.05), no other significant group differences were found. In conclusion, zinc appears to improve general gustatory function and, consequently, general mood scores in dysgeusia patients.

Somatoform salivary complaints. Case reports.

Patients with salivary gland complaints are seen with a large array of signs and symptoms. Usually these patients have an underlying pathophysiological process that can account for their symptoms. However, in a significant number of patients, no known biological process can be found that would account for the patient's complaint. In such cases, somatization is a possible cause. Somatization is a frequently cited feature of patients with various forms of mental illness. In this paper, we will attempt to illustrate the classic signs of a somatoform disorder in three different patients whose diverse salivary complaints fulfill the criteria for a diagnosis of somatoform disease.

Developing a measure of patient perceptions of short-term outcomes of third molar surgery.

PURPOSE: The purpose of the study was to develop an instrument to measure patients' perceptions of their experiences after the removal of third molar teeth. METHODS: Nineteen patients (ages 18 to 25 years) who underwent surgical removal of four third molars after local treatment for mild symptoms of pericoronitis completed a newly developed 14-item instrument each evening for the 14-day period after surgery. A focus group was used to further examine the experiences of a subset of subjects. RESULTS: On the first day postsurgery, patients reported a median level of 81 on the 0 to 100 scale of "limitation of daily activity because of pain" (100 = total interference). This dropped to 21 by day 5, and all but two patients returned completely to normal activities by day 8. During the first 3 days, the median level of "average pain" ranged from 51 to 33 (100 = pain as bad as could be), and all but two patient were pain-free by day 10. Bad taste/breath persisted for between 2 to 4 days; food impaction was experienced by nearly all patients from days 3 through 14. Swelling was encountered by 10 of the patients for the first 2 days and was reported by only one patient after day 5. CONCLUSIONS: This study demonstrated that patients' perceptions of their experiences could be collected using a self-administered instrument, and it confirmed the changes in postsurgical morbidity that occur in healthy, young adults. This instrument and these data will be valuable to those striving to make informed decisions regarding third molar surgery.

[Oral symptoms in the climacteric. A prevalence study]. / Sintomi orali in climaterio. Studio di prevalenza.

The female climacteric is attributed to physiological ovarian failure with the consequent decrease in the secretions of oestrogen, progestones and androgens. Numerous metabolic, psychological and physical changes have been associated with this event. Oral discomfort, including the burning mouth syndrome and the dry mouth syndrome, has been described as a menopausal symptom. However, the relationship between the hormonal changes related to climacteric and the onset of oral discomfort is still controversial. The purpose of the present study was to evaluate the prevalence of oral symptoms, with particular regard to burning sensation, xerostomia, altered taste and recurrent oral ulcerations. The relationship between oral and climacteric symptoms and psychological status of the patients was also evaluated. A questionnaire was administered to 136 women (mean age: 51.2 years, range 40-62) being consecutively referred to the University Hospital Menopause Clinic from October 1991 to March 1992. The questionnaire included informations regarding menopausal state, oral symptoms, drug assumption, wearing of partial or total dentures, parafunctions (lip and cheek biting, bruxism, tongue thrusting). Climacteric symptoms including flushes/sweats, palpitations, headache, arthralgia/myalgia, vaginal dryness, decreased concentration, tiredness, decreased libido, insomnia, vertigo were evaluated. Visual analogue scale (VAS) was used where appropriate. Information regarding the alteration of the psychological status was collected by means of the Hospital Anxiety and Depression Scale Statistical analysis was performed by chi 2 test or Fisher's Exact Probability Test and Mann-Whitney U-test. The level of significance accepted was 5%. The subjects in this study were divided into two groups on the basis of their answers to the questionnaire: group I (no. 39), premenopausal women; group II (no. 97), menopausal women.(ABSTRACT TRUNCATED AT 250 WORDS)

Unpleasant taste--a neglected symptom in depression.

Of 47 depressed patients, 19 reported the symptom of unpleasant taste. This symptom appeared unrelated to previous drug treatment. Also, in this study, there was no significant association with prognosis, severity or type of depression, or with various historical factors. Despite this, it would seem to be an underreported symptom, worthy of further investigation.