Covid-19 affects taste independent of taste-smell confusions: results from a combined chemosensory home test and online survey from a large global cohort.

People often confuse smell loss with taste loss, so it is unclear how much gustatory function is reduced in patients self-reporting taste loss. Our pre-registered cross-sectional study design included an online survey in 12 languages with instructions for self-administering chemosensory tests with 10 household items. Between June 2020 and March 2021, 10,953 individuals participated. Of these, 5,225 self-reported a respiratory illness and were grouped based on their reported COVID test results: COVID-positive (COVID+, N = 3,356), COVID-negative (COVID-, N = 602), and COVID unknown for those waiting for a test result (COVID?, N = 1,267). The participants who reported no respiratory illness were grouped by symptoms: sudden smell/taste changes (STC, N = 4,445), other symptoms excluding smell or taste changes (OthS, N = 832), and no symptoms (NoS, N = 416). Taste, smell, and oral irritation intensities and self-assessed abilities were rated on visual analog scales. Compared to the NoS group, COVID+ was associated with a 21% reduction in taste (95% confidence interval (CI): 15-28%), 47% in smell (95% CI: 37-56%), and 17% in oral irritation (95% CI: 10-25%) intensity. There were medium to strong correlations between perceived intensities and self-reported abilities (r = 0.84 for smell, r = 0.68 for taste, and r = 0.37 for oral irritation). Our study demonstrates that COVID-19-positive individuals report taste dysfunction when self-tested with stimuli that have little to none olfactory components. Assessing the smell and taste intensity of household items is a promising, cost-effective screening tool that complements self-reports and may help to disentangle taste loss from smell loss. However, it does not replace standardized validated psychophysical tests.

Recent Smell Loss Is the Best Predictor of COVID-19 Among Individuals With Recent Respiratory Symptoms.

In a preregistered, cross-sectional study, we investigated whether olfactory loss is a reliable predictor of COVID-19 using a crowdsourced questionnaire in 23 languages to assess symptoms in individuals self-reporting recent respiratory illness. We quantified changes in chemosensory abilities during the course of the respiratory illness using 0-100 visual analog scales (VAS) for participants reporting a positive (C19+; n = 4148) or negative (C19-; n = 546) COVID-19 laboratory test outcome. Logistic regression models identified univariate and multivariate predictors of COVID-19 status and post-COVID-19 olfactory recovery. Both C19+ and C19- groups exhibited smell loss, but it was significantly larger in C19+ participants (mean ± SD, C19+: -82.5 ± 27.2 points; C19-: -59.8 ± 37.7). Smell loss during illness was the best predictor of COVID-19 in both univariate and multivariate models (ROC AUC = 0.72). Additional variables provide negligible model improvement. VAS ratings of smell loss were more predictive than binary chemosensory yes/no-questions or other cardinal symptoms (e.g., fever). Olfactory recovery within 40 days of respiratory symptom onset was reported for ~50% of participants and was best predicted by time since respiratory symptom onset. We find that quantified smell loss is the best predictor of COVID-19 amongst those with symptoms of respiratory illness. To aid clinicians and contact tracers in identifying individuals with a high likelihood of having COVID-19, we propose a novel 0-10 scale to screen for recent olfactory loss, the ODoR-19. We find that numeric ratings ≤2 indicate high odds of symptomatic COVID-19 (4 < OR < 10). Once independently validated, this tool could be deployed when viral lab tests are impractical or unavailable.

Olfactory influences on reach-to-press movements in a stop-signal task.

Response inhibition is sensitive to unexpected changes in the environment triggered by emotional stimuli. Whereas the impact of visual material on inhibition has been widely documented, the attention on the influence of olfactory stimuli has been neglected. Here, we examined the effect of pleasant (orange), unpleasant (trimethyloxazole), and control (clean air) odour primes in a stop-signal task. Twenty-five participants had to elicit or inhibit reach-to-press actions which allowed to examine the olfactory influences on both the planning (release phase) and the on-line control (reaching phase) of responses. Additionally, we manipulated the distance between the initial hand position and the target to be pressed (10 vs. 20 vs. 30 cm). The pleasant (vs. control) odour impaired inhibition, as reflected in slower stop-signal reaction times and higher release errors, indicating greater mobilisation of inhibitory resources by pleasant stimuli. Further, faster release responses were triggered by pleasant and unpleasant primes, supporting the idea of perceptual prioritisation of emotional (vs. non-emotional) stimuli. The olfactory manipulation did not affect the reaching phase of the responses. Instead, the distance manipulation modulated the reaching but not the release phase. These results extend the sparse literature on the influences of odour stimuli on response inhibition.

More Than Smell-COVID-19 Is Associated With Severe Impairment of Smell, Taste, and Chemesthesis.

Recent anecdotal and scientific reports have provided evidence of a link between COVID-19 and chemosensory impairments, such as anosmia. However, these reports have downplayed or failed to distinguish potential effects on taste, ignored chemesthesis, and generally lacked quantitative measurements. Here, we report the development, implementation, and initial results of a multilingual, international questionnaire to assess self-reported quantity and quality of perception in 3 distinct chemosensory modalities (smell, taste, and chemesthesis) before and during COVID-19. In the first 11 days after questionnaire launch, 4039 participants (2913 women, 1118 men, and 8 others, aged 19-79) reported a COVID-19 diagnosis either via laboratory tests or clinical assessment. Importantly, smell, taste, and chemesthetic function were each significantly reduced compared to their status before the disease. Difference scores (maximum possible change ±100) revealed a mean reduction of smell (-79.7 ± 28.7, mean ± standard deviation), taste (-69.0 ± 32.6), and chemesthetic (-37.3 ± 36.2) function during COVID-19. Qualitative changes in olfactory ability (parosmia and phantosmia) were relatively rare and correlated with smell loss. Importantly, perceived nasal obstruction did not account for smell loss. Furthermore, chemosensory impairments were similar between participants in the laboratory test and clinical assessment groups. These results show that COVID-19-associated chemosensory impairment is not limited to smell but also affects taste and chemesthesis. The multimodal impact of COVID-19 and the lack of perceived nasal obstruction suggest that severe acute respiratory syndrome coronavirus strain 2 (SARS-CoV-2) infection may disrupt sensory-neural mechanisms.

Psychometric properties of the Spanish version of the Edinburgh Handedness Inventory in a sample of Chilean undergraduates.

An individual's nervous and cognitive systems are lateralized, and handedness represents a behavioral manifestation of such organization. Therefore, accurately and reliably measuring handedness has repercussion on our understanding of both the human brain and cognition. The Edinburgh Handedness Inventory (EHI) is the most frequently used instrument to measure handedness both in clinical practice and research. We assessed the psychometric properties of the Spanish version of the EHI in a sample of 348 Chilean university students by confirmatory factor analysis. Cronbach's alpha and composite reliability were calculated to evaluate the internal consistency and reliability of the EHI, while the average variance extracted was estimated to evaluate its convergent validity. A 10-item unifactorial structure was confirmed, with factor loadings ≥0.50, showing excellent goodness-of-fit indicators, very high internal consistency and adequate composite reliability and convergent validity. Socio-demographic variables (sex, area of residence and belonging to an indigenous people or community) did not significantly modulate the EHI scores. Overall, by using this validated version of the EHI to accurately and reliably measure handedness in the greater Spanish population, researchers will be able to produce robust data to tackle the still open questions of lateralization in human cognitive and neural architecture.

Facial infrared thermography as an index of social anxiety.

Previous research on physiological indices of social anxiety has offered unclear results. In this study, participants with low and high social anxiety performed five social interaction tasks while being recorded with a thermal camera. Each task was associated with a dimension assessed by the Social Anxiety Questionnaire for Adults (1 = Interactions with strangers. 2 = Speaking in public/Talking with people in authority, 3 = Criticism and embarrassment, 4 = Assertive expression of annoyance, disgust or displeasure, 5 = Interactions with the opposite sex). Mixed-effects models revealed that the temperature of the tip of the nose decreased significantly in participants with low (vs. high) social anxiety (p < 0.001), while no significant differences were found in other facial regions of interest: forehead (p = 0.999) and cheeks (p = 0.999). Furthermore, task 1 was the most effective at discriminating between the thermal change of the nose tip and social anxiety, with a trend for a higher nose temperature in participants with high social anxiety and a lower nose temperature for the low social anxiety group. We emphasize the importance of corroborating thermography with specific tasks as an ecological method, and tip of the nose thermal change as a psychophysiological index associated with social anxiety.

Olfactory habituation to food and nonfood odours.

Olfactory perception can be modulated by the repeated exposure to odours. Olfactory habituation is a reduced behavioural response to repetitive stimulation. Edibility is considered an important top-down feature that can affect olfactory perception, but whether it could modulate olfactory habituation when food or nonfood odours are repeatedly smelled remains unclear. Indeed, due to their ecological salience, food odours attract attention automatically which might slow down habituation. This registered report aimed to determine whether olfactory habituation shows a different pattern when participants are presented with food or nonfood odours. In a within-subject design, 50 participants were tested under satiated and fasted states in separated experimental sessions. In each session, participants were exposed to the same food and nonfood odour in different blocks of 20 trials each. Participants rated the perceived odour intensity and pleasantness after each trial. We used an intermittent odour presentation to reduce olfactory fatigue while capitalising on the effect of cognitive states on habituation. Linear mixed-effects models showed that the perceived odour intensity decreased over time only for nonfood odours. Conversely, the perceived odour pleasantness decreased significantly more across trials for food odours. These effects were retrieved regardless of the participant's hunger state. Our results are in line with the olfactory-specific satiety theory which posits a specific decrease in the perceived pleasantness of food odours, without changes in the perceived odour intensity. In short, our findings indicate that perceived odour edibility modulates olfactory habituation, extending the previous literature on the impact of top-down factors on olfactory perception.

The use of transcutaneous Vagal Nerve Stimulation as an effective countermeasure for Simulator Adaptation Syndrome.

This research focused on investigating the effectiveness of Transcutaneous Vagal Nerve Stimulation (tVNS) as compared to Galvanic Cutaneous Stimulation (GCS) at mitigating Simulator Adaptation Syndrome (SAS). Fifty drivers (mean age = 23.04 ± 17.71 years old, twenty-two men) participated in a driving simulation experiment. The total scores of the Simulator Sickness Questionnaire, head movements (body balance index), and driving performance variables were measured under five stimulation conditions: i) baseline (no stimulation delivered), ii) sham GCS, iii) sham tVNS, iv) active GCS, and v) active tNVS. The results showed that tVNS alleviated SAS and improved driving performance variables more effectively than GCS. We conclude that GCS and tVNS have similar neurological mechanisms to reduce SAS, providing possible explanations for the greater effectiveness of tVNS. We encourage the use of tVNS to decrease SAS.

Covid-19 affects taste independently of smell: results from a combined chemosensory home test and online survey from a global cohort (N=10,953).

People often confuse smell loss with taste loss, so it is unclear how much gustatory function is reduced in patients self-reporting taste loss. Our pre-registered cross-sectional study design included an online survey in 12 languages with instructions for self-administering chemosensory tests with ten household items. Between June 2020 and March 2021, 10,953 individuals participated. Of these, 3,356 self-reported a positive and 602 a negative COVID-19 diagnosis (COVID+ and COVID-, respectively); 1,267 were awaiting test results (COVID?). The rest reported no respiratory illness and were grouped by symptoms: sudden smell/taste changes (STC, N=4,445), other symptoms excluding smell or taste loss (OthS, N=832), and no symptoms (NoS, N=416). Taste, smell, and oral irritation intensities and self-assessed abilities were rated on visual analog scales. Compared to the NoS group, COVID+ was associated with a 21% reduction in taste (95% Confidence Interval (CI): 15-28%), 47% in smell (95%-CI: 37-56%), and 17% in oral irritation (95%-CI: 10-25%) intensity. In all groups, perceived intensity of smell (r=0.84), taste (r=0.68), and oral irritation (r=0.37) was correlated. Our findings suggest most reports of taste dysfunction with COVID-19 were genuine and not due to misinterpreting smell loss as taste loss (i.e., a classical taste-flavor confusion). Assessing smell and taste intensity of household items is a promising, cost-effective screening tool that complements self-reports and helps to disentangle taste loss from smell loss. However, it does not replace standardized validated psychophysical tests.

Chemosensory Dysfunction in Long-Term COVID-19 Assessed by Self-Reported and Direct Psychophysical Methods.

Chemosensory dysfunction is a frequent postacute sequela of COVID-19. Depending on the type of test used to measure it (self-report vs. direct test), the degree of chemosensory dysfunction in long-term COVID-19 has been found to be highly variable. In this manuscript, we report the cross-sectional data (first assessment) of a longitudinal study (6-month follow-up) examining smell, taste, and chemesthesis in participants affected by long-term COVID-19 (COVID+) and participants without COVID-19 (COVID-) by means of both self-reported and direct psychophysical methods. In total, 208 Italian participants (COVID+ n = 133; COVID- n = 75) completed the Smell and Taste Check developed by the Global Consortium for Chemosensory Research (GCCR), which includes self-reports on smell, taste, and chemesthetic abilities as well as direct intensity ratings of unstandardized smell, taste, and chemesthetic household items. Furthermore, all participants completed SCENTinel, a validated direct smell test. We found a positive association between the self-reported, unstandardized direct test and the validated direct test for smell, indicating moderate to large agreement across measures. Furthermore, the performance on SCENTinel was significantly associated with self-reported smell loss. A positive association between the self-reports and the intensity of household items was also retrieved for taste and chemesthesis. The time relative to COVID-19 onset (267.3 ± 113.9 days) did not modulate the chemosensory performance of self-reported abilities, intensity ratings, and SCENTinel. All in all, we confirm the impairment of three chemical senses (smell, taste, and chemesthesis) in an independent sample of Italian participants affected by long-term COVID-19 by using and comparing self-reported and direct psychophysical methods. We contribute to the discussion on best practices to monitor chemosensory dysfunction in individuals affected by long-term COVID-19.

Psychometric Properties of the PCS and the PCS-4 in Individuals With Musculoskeletal Pain.

BACKGROUND: The factor structure of the Pain Catastrophizing Scale (PCS) has rarely been adequately analyzed (e.g., performing principal component analyses rather than factorial approximations). We aimed to evaluate the psychometric properties of the PCS through a variety of exploratory and confirmatory factorial approaches. METHOD: Three hundred ninety-four Chilean patients with musculoskeletal pain were included (age, M = 49.61, SD = 18.00; 71.57% women). Eight factorial models were proposed to analyze the structure of the data. In addition, validity evidence of the PCS based on relationships with other variables were analyzed considering pain intensity and kinesiophobia. RESULTS: The results suggest a unidimensional structure. Models with more than one dimension exhibited undesirable factor loadings or inadequate indices of fit. Based on these results, a short version of the scale composed of 4 items is proposed (PCS-4). The PCS-4 scores demonstrated high levels of invariance between sex, chronicity, and education groups and also were associated with pain and kinesiophobia. CONCLUSIONS: The results of the PCS-4 Spanish version showed evidence of reliability and validity for adequately measuring pain catastrophizing in Chileans who suffer from musculoskeletal pain. The PCS-4 is a short form that should be explored in future studies (e.g., in other Spanish-speaking populations).

The Effect of Sleep Quality on Pain in Chilean Individuals with Musculoskeletal Disorders.

Poor sleep quality (SQ) negatively affects pain associated with musculoskeletal disorders (MSD). As the level of economic development of a country determines its sanitary conditions, these can influence the sleep-pain relationship; therefore, it is relevant to generate evidence in the population with MSD in developing countries. This cross-sectional study sought to determine the effect of poor SQ on pain in Chilean individuals with MSD, controlling for sex and duration of pain (in months). METHOD: A total of 228 individuals were included. SQ was measured with the Pittsburg Sleep Quality Index (PSQI), pain (intensity, interference and distress relative to pain) was measured with visual analog scales. Structural equation modeling (SEM) was performed to analyze the effect of SQ on pain. RESULTS: A high frequency of poor SQ was present in the studied group, and was more prevalent in women. The SEM model evidenced that poor SQ predicts greater pain. Sex influences sleep quality and pain, but not pain duration. CONCLUSIONS: These findings indicate that poor SQ predicts higher pain in MSD and that women exhibit worse SQ and more significant pain than men. Our findings support that SQ should be considered in the comprehensive approach to pain in individuals with MSD.

Joint and individual effectiveness of galvanic cutaneous stimulation and tactile stimulation at decreasing Simulator Adaptation Syndrome.

This research was focused on investigating the effectiveness of galvanic cutaneous stimulation and tactile stimulation jointly and individually at mitigating Simulator Adaptation Syndrome. Forty drivers (mean age = 23.1 ± 3.4 years old, twenty women) participated in a driving simulation experiment. Total scores of the Simulator Sickness Questionnaire, head movements (an index of body balance), and driving performance variables were compared across four different stimulation conditions: i) baseline (where no stimulation was presented), ii) galvanic cutaneous stimulation and iii) tactile stimulation deployed individually, and iv) both techniques deployed jointly. The results showed that both techniques presented in conjunction alleviate Simulator Adaptation Syndrome and improve driving performance more effectively than when they are presented in isolation. Importantly, reduced head movements were only revealed when galvanic cutaneous stimulation was applied. We concluded that the reduction of this syndrome is due to an improvement of body balance (elicited by galvanic cutaneous stimulation), and a distraction from the symptoms (elicited by tactile stimulation). We encourage the use of both techniques simultaneously to decrease Simulator Adaptation Syndrome.

The best COVID-19 predictor is recent smell loss: a cross-sectional study.

BACKGROUND: COVID-19 has heterogeneous manifestations, though one of the most common symptoms is a sudden loss of smell (anosmia or hyposmia). We investigated whether olfactory loss is a reliable predictor of COVID-19. METHODS: This preregistered, cross-sectional study used a crowdsourced questionnaire in 23 languages to assess symptoms in individuals self-reporting recent respiratory illness. We quantified changes in chemosensory abilities during the course of the respiratory illness using 0-100 visual analog scales (VAS) for participants reporting a positive (C19+; n=4148) or negative (C19-; n=546) COVID-19 laboratory test outcome. Logistic regression models identified singular and cumulative predictors of COVID-19 status and post-COVID-19 olfactory recovery. RESULTS: Both C19+ and C19- groups exhibited smell loss, but it was significantly larger in C19+ participants (mean±SD, C19+: -82.5±27.2 points; C19-: -59.8±37.7). Smell loss during illness was the best predictor of COVID-19 in both single and cumulative feature models (ROC AUC=0.72), with additional features providing no significant model improvement. VAS ratings of smell loss were more predictive than binary chemosensory yes/no-questions or other cardinal symptoms, such as fever or cough. Olfactory recovery within 40 days was reported for ~50% of participants and was best predicted by time since illness onset. CONCLUSIONS: As smell loss is the best predictor of COVID-19, we developed the ODoR-19 tool, a 0-10 scale to screen for recent olfactory loss. Numeric ratings ≤2 indicate high odds of symptomatic COVID-19 (10

Task-irrelevant odours affect both response inhibition and response readiness in fast-paced Go/No-Go task: the case of valence.

Whether emotional stimuli influence both response readiness and inhibition is highly controversial. Visual emotional stimuli appear to interfere with both under certain conditions (e.g., task relevance). Whether the effect is generalisable to salient yet task-irrelevant stimuli, such as odours, remains elusive. We tested the effect of orthonasally-presented pleasant (orange) and unpleasant odours (trimethyloxazole and hexenol) and clean air as a control on response inhibition. In emotional Go/No-Go paradigms, we manipulated the intertrial interval and ratios of Go/No-Go trials to account for motor (Experiment 1, N = 31) and cognitive (Experiment 2, N = 29) response inhibition processes. In Experiment 1, participants had greater difficulty in withholding and produced more accurate and faster Go responses under the pleasant vs. the control condition. Faster Go responses were also evident in the unpleasant vs. the control condition. In Experiment 2, neither pleasant nor unpleasant odours modulated action withholding, but both elicited more accurate and faster Go responses as compared to the control condition. Pleasant odours significantly impair action withholding (as compared to the control condition), indicating that more inhibitory resources are required to elicit successful inhibition in the presence of positive emotional information. This modulation was revealed for the motor aspect of response inhibition (fast-paced design with lower Go/No-Go trial ratio) rather than for attentional interference processes. Response readiness is critically impacted by the emotional nature of the odour (but not by its valence). Our findings highlight that the valence of task-irrelevant odour stimuli is a factor significantly influencing response inhibition.

Hand Switching Costs are not Uniform Across Response Components.

We investigated the extent to which a complex finger sequence impacts on hand switching costs in a sequential action. Response component latencies (premotor, motor, and movement) were compared in no-switch (same finger performed the action of pressing and reaching) and switch conditions (pressing with one finger and completing the reaching action with the homologous finger from the other hand). Results showed that the switch condition presented longer latency for premotor and movement components. For the motor component, however, switch condition was faster. This expands the previous literature investigating switching costs using simple finger movements in more complex tasks. A mechanical explanation of the interplay between response subcomponents is provided to explain the inversion of response pattern for the motor component.

Response Inhibition as a Function of Movement Complexity and Movement Type Selection.

This study aims to determine whether response inhibition shows the same degree of effectiveness for two sources of motor complexity: (1) Movement complexity, which is measured through two actions with different motor requirements (simple lifting action vs. complex reaching action), and (2) Movement type selection, which is measured in movements performed separately (no active-movement type selection) vs. selectively (active-movement type selection). Activation-suppression model was tested in three experiments to measure activation of the preponderant responses and subsequent suppression in a Simon task. More errors and higher magnitude of congruence effect (which reflects greater effectiveness of response suppression) were expected for more difficult motor conditions. Reaction time, movement time, kinematic errors, and movement errors were recorded. Results of Experiment 1, in which movement type selection was not active, showed that both movements did not differ in their activation and suppression, as they presented similar kinematic error rates and Simon effects. Experiment 2, in which movement type selection was active, resulted in a higher kinematic error rate and higher magnitude of Simon effect in lifting. These results were confirmed in Experiment 3, in which participants performed all experimental motor complexity conditions. Finally, Experiment 4 showed that responses with similar movement complexity did not differ in their activation and suppression, even when movement type selection was active. Thus, the present study provides evidence on the varying effectiveness of response inhibition as a function of movement complexity, but only in demanding situations in which movement type selection is active. These results can be attributed to a top-down strategy to minimize error for actions most prone to develop kinematic error.

Mitigating Simulator Adaptation Syndrome by means of tactile stimulation.

Some drivers experience Simulator Adaptation Syndrome (SAS), a condition in which nausea, disorientation, dizziness, headache, and difficulty focusing, are exhibited when driving in a simulator. To reduce this syndrome, we investigated the efficacy of tactile stimulation (TS) on mitigating Simulator Adaptation Syndrome (SAS) in a driving simulation. Fifteen drivers (eight women; mean age = 24.07 years) participated in this experiment. We compared the total scores of the Simulator Sickness Questionnaire (SSQ) across two stimulation conditions (TS condition and no stimulation condition as a baseline measure). The experimental outcomes revealed that TS seemed to decrease SAS due to attentional distraction from the symptoms and not because of an improvement in balance ability.