Metacognitive knowledge of olfactory dysfunction in Parkinson's disease.

It is well known that patients with Parkinson's Disease (PD) suffer from olfactory impairments, but it is not clear whether patients are aware of their level of deficit in olfactory functioning. Since PD is a neurodegenerative disorder and its progression may be correlated with olfactory loss (Ansari & Johnson, 1975; but see also Doty, Deems, & Stellar, 1988), it is possible that these patients would be subject to metacognitive errors of over-estimation of olfactory ability (White & Kurtz, 2003). Nineteen non-demented PD patients and 19 age-matched controls were each given an objective measure of olfactory identification (the UPSIT, Doty, Shaman, Kimmelman, & Dann, 1984) and a subjective measure involving a questionnaire that asked them to self-rate both their olfactory function generally and their ability to smell each of 20 odors, 12 of which were assessed on the UPSIT. All of the PD patients showed impaired olfactory ability, as did 7 of the controls, according to the UPSIT norms. Self-rated and performance-based olfactory ability scores were significantly correlated in controls (r=.49, p=.03) but not in patients with PD (r=.20, p=.39). When the 12 odors common to both the self-rated questionnaire and UPSIT were compared, PD patients were less accurate than controls (t(36)=-4.96, p<.01) at estimating their own ability and the number of over-estimation errors was significantly higher (tone-tailed(29)=1.80, p=.04) in PD patients than in the control group, showing less metacognitive awareness of their ability than controls. These results support the idea that olfactory metacognition is often impaired in PD, as well as in controls recruited for normosmic ability (Wehling, Nordin, Espeseth, Reinvang, & Lundervold, 2011), and indicate that people with PD generally exhibit over-estimation of their olfactory ability at a rate that is higher than controls. These findings imply that PD patients, unaware of their olfactory deficit, are at greater risk of harm normally detected through olfaction, such as smoke or spoiled foods.

Is That "Mr." or "Ms." Lemon? An Investigation of Grammatical and Semantic Gender on the Perception of Household Odorants.

Linguistic relativism is the idea that the structure of language influences thought. The present study investigates linguistic relativism by asking whether people who speak a gendered language think of objects in a way that is consistent with the grammatical gender (more masculine or feminine) more than people who speak a language without that linguistic feature. Odorants are unique stimuli for examining this question, because they carry a semantic gender without a biological one, yet gender is thought to be a central dimension of their perception. Canadian participants in the present study (native French or native English speakers) described a set of labeled odorants that varied systematically in grammatical and semantic gender to produce an implicit gender measure and also explicitly rated them for gender. Analysis of the implicit femininity contained in participants' descriptions showed a tendency for both native French and native English speakers to produce descriptions that were consistent with semantic gender; moreover, there were no effects of grammatical gender on implicit or explicit ratings. These results suggest that in a bilingual culture, French speakers may have been influenced by the anthropomorphism associated with odorants rather than grammatical gender.

Scent of a Woman-Or Man: Odors Influence Person Knowledge.

First impressions of social traits are regularly, rapidly, and readily determined from limited information about another individual. Relatively little is known about the way that olfactory information, particularly from scents that are not body odors, alters a first impression. Can the attributes of an odorant be conferred onto a person associated with that scent? To explore this, 101 participants were asked to form an impression of a hypothetical person based on the following stimuli: A gender-neutral silhouette, a list of six personal characteristics, and one of five odorants. Participants then rated the likelihood that the hypothetical person possessed each of 51 personality traits that were determined a priori as falling into six attribute categories. Participants also directly rated all odorants for the six categories and intensity. A T-test showed that ratings of the hypothetical person were less disparate from the odor that was presented during impression formation than from other odors. ANOVA revealed that the effects were heterogeneous, with odorants varying in their effectiveness in associating the hypothetical person with categories. The present data suggest that a hypothetical person can be imbued with the specific attributes of an odor and that some odors are better at contributing to impressions than others.

Tracking smell loss to identify healthcare workers with SARS-CoV-2 infection.

INTRODUCTION: Healthcare workers (HCW) treating COVID-19 patients are at high risk for infection and may also spread infection through their contact with vulnerable patients. Smell loss has been associated with SARS-CoV-2 infection, but it is unknown whether monitoring for smell loss can be used to identify asymptomatic infection among high risk individuals. In this study we sought to determine if tracking smell sensitivity and loss using an at-home assessment could identify SARS-CoV-2 infection in HCW. METHODS AND FINDINGS: We performed a prospective cohort study tracking 473 HCW across three months to determine if smell loss could predict SARS-CoV-2 infection in this high-risk group. HCW subjects completed a longitudinal, behavioral at-home assessment of olfaction with household items, as well as detailed symptom surveys that included a parosmia screening questionnaire, and real-time quantitative polymerase chain reaction testing to identify SARS-CoV-2 infection. Our main measures were the prevalence of smell loss in SARS-CoV-2-positive HCW versus SARS-CoV-2-negative HCW, and timing of smell loss relative to SARS-CoV-2 test positivity. SARS-CoV-2 was identified in 17 (3.6%) of 473 HCW. HCW with SARS-CoV-2 infection were more likely to report smell loss than SARS-CoV-2-negative HCW on both the at-home assessment and the screening questionnaire (9/17, 53% vs 105/456, 23%, P < .01). 6/9 (67%) of SARS-CoV-2-positive HCW reporting smell loss reported smell loss prior to having a positive SARS-CoV-2 test, and smell loss was reported a median of two days before testing positive. Neurological symptoms were reported more frequently among SARS-CoV-2-positive HCW who reported smell loss compared to those without smell loss (9/9, 100% vs 3/8, 38%, P < .01). CONCLUSIONS: In this prospective study of HCW, self-reported changes in smell using two different measures were predictive of SARS-CoV-2 infection. Smell loss frequently preceded a positive test and was associated with neurological symptoms.

Adding cocoa to sucrose: the effect on cold pain tolerance.

The sweet taste of sucrose acts as an analgesic, whereas the taste of a bitter substance decreases pain tolerance. The present experiment explores the analgesic effect of a complex taste and asks how adding cocoa, a substance often associated with sweet foods but that has a bitter taste, to a sucrose solution affects cold pain tolerance. The 24 male participants were exposed to Cold Pressor Tests (CPTs) while holding 1 of 3 tastants in their mouths: water, sucrose, or sucrose with cocoa added. After each CPT, participants rated pain intensity and tastant qualities. Intraoral sucrose increased the amount of time that men were able to leave their hands in cold water, whereas the cocoa solution did not. Solutions did not differ in pleasantness or sweetness, but the cocoa solution was rated as more bitter. Bitterness ratings of cocoa exceeded the ratings of sucrose (corrected for water) by an average of 16.9% (P = 0.02), which, in turn, produced a 30% reduction in the duration of pain tolerance (P = 0.002). These results suggest that the addition of a bitter substance reduces cues to the nutritive value of sucrose that may drive its analgesic effect.

Tracking Smell Loss to Identify Healthcare Workers with SARS-CoV-2 Infection.

BACKGROUND: Healthcare workers (HCW) treating COVID-19 patients are at high risk for infection and may also spread infection through their contact with vulnerable patients. Smell loss has been associated with SARS-CoV-2 infection, but it is unknown whether monitoring for smell loss can be used to identify asymptomatic infection among high risk individuals, like HCW. METHODS: We performed a prospective cohort study, tracking 473 HCW across three months to determine if smell loss could predict SARS-CoV-2 infection in this high-risk group. HCW subjects completed a longitudinal, novel behavioral at-home assessment of smell function with household items, as well as detailed symptom surveys that included a parosmia screening questionnaire, and RT-qPCR testing to identify SARS-CoV-2 infection. RESULTS: SARS-CoV-2 was identified in 17 (3.6%) of 473 HCW. Among the 17 infected HCW, 53% reported smell loss, and were more likely to report smell loss than COVID-negative HCW on both the at-home assessment and the screening questionnaire (P < .01). 67% reported smell loss prior to having a positive SARS-CoV-2 test, and smell loss was reported a median of two days before testing positive. Neurological symptoms were reported more frequently among COVID-positive HCW who reported smell loss (P < .01). CONCLUSIONS: In this prospective study of HCW, self-reported changes in smell using two different measures were predictive of COVID-19 infection. Smell loss frequently preceded a positive test and was associated with neurological symptoms.

The effect of NMDA-NR2B receptor subunit over-expression on olfactory memory task performance in the mouse.

The N-methyl-D-aspartate (NMDA) receptor in the forebrain is thought to modulate some forms of memory formation, with the NR2B subunit being particularly relevant to this process. Relative to wild-type mice, transgenic animals in which the NR2B subunit was over-expressed demonstrate superior memory in a number of behavioral tasks, including object recognition [Nature 401 (1999) 63]. The purpose of the present study was to explore the generality of such phenomena, interpreted as the effect of increasing NR2B expression on the retention of other types of sensory-related information. To accomplish this, we focused our evaluation on the highly salient sensory modality of olfaction. In the first experiment, mice performed both a novel-object-recognition task identical to that performed by Tang et al. [Nature 401 (1999) 63] and a novel-odor-recognition task analogously constructed. Although the results of the object recognition task were consistent with the previous literature, there was no evidence of an effect of NR2B over-expression on the retention of odor recognition memory in the specific task performed. As it was possible that, unlike object recognition memory, novel odor recognition is not NMDA-receptor-dependent, a second task was designed using the social transmission of food preference paradigm. In contrast to the foregoing olfactory task, there is evidence that the latter procedure is, indeed, NMDA-dependent. The results of the second study demonstrated that transgenic mice with NR2B over-expression had a clear memory advantage in this alternative odor memory paradigm. Taken together, these results suggest the NR2B subunit is an important component in some but not all forms of olfactory memory organization. Moreover, for those functions that are NMDA-receptor-dependent, these data support the growing literature demonstrating the importance of the NR2B subunit.

Effectiveness of gabapentin for treatment of burning mouth syndrome.

Burning mouth syndrome is a debilitating disorder involving oral pain that may have at least 4 underlying causes. Although several treatments have been proposed, none seems to be universally effective. We report the case of a 67-year-old woman with unremitting oral burning that is increased with the application of anesthetic agents. Initial treatments with nortriptyline hydrochloride and sertraline hydrochloride were contraindicated because of adverse effects, but the administration of gabapentin significantly reduced oral burning. The present case illustrates the effectiveness of gabapentin as a treatment of burning mouth syndrome.

The relationship between metacognitive awareness of olfactory ability and age in people reporting chemosensory disturbances.

When determining how much to rely on olfactory information, accurate estimates of olfactory ability are important. Nevertheless, metacognitive errors regarding olfactory ability are common in the normal population. Are older adults less accurate at estimating olfactory ability, or do they simply tend to make a particular type of estimation error? We examined data from 203 patients, all of whom self-rated olfactory ability and then were tested with the Odorant Confusion Matrix. The patients' self-reports did not match the objective measure of olfactory ability in 42% of the cases, thus demonstrating a high level of impairment in metacognitive knowledge. Neither the cause of loss nor the patient's age was related to the inability to accurately estimate olfactory loss, but both contributed to the type of metacognitive errors patients made. Younger patients tended to underestimate their olfactory ability, thus behaving similarly to patients with "blindsight" who demonstrate residual visual function in the absence of awareness. Older patients tended to overestimate their olfactory ability, thus making the metacognitive error of deficit unawareness that is observed in a number of other clinical syndromes. These findings indicate that older patients are not necessarily more likely to make errors in estimating their olfactory ability; rather, they are more prone to a particular type of metacognitive error than are younger patients.

A second look at the structure of human olfactory memory.

How do we remember olfactory information? Is the architecture of human olfactory memory unique compared with that of memory for other types of stimuli? Ten years ago, a review article evaluated these questions, as well as the distinction between long- and short-term olfactory memory, with three lines of evidence: capacity differences, coding differences, and neuropsychological evidence, though serial position effects were also considered. From the data available at the time, the article preliminarily suggested that olfactory memory was a two-component system that was not qualitatively different from memory systems for other types of stimuli. The decade that has elapsed since then has ushered in considerable changes in theories of memory structure and provided huge advances in neuroscience capabilities. Not only have many studies exploring various aspects of olfactory memory been published, but a model of olfactory perception that includes an integral unitary memory system also has been presented. Consequently, the structure of olfactory memory is reevaluated in the light of further information currently available with the same theoretical lines of evidence previously considered. This evaluation finds that the preponderance of evidence suggests that, as in memory for other types of sensory stimuli, the short-term-long-term distinction remains a valuable dissociation for conceptualizing olfactory memory, though perhaps not as architecturally separate systems.

Chemosensory cross-modal stroop effects: congruent odors facilitate taste identification.

In order to explore the cross-modal cognitive associations between smell and taste, a chemosensory analogue of the Stroop task (Stroop 1935) was developed. Fourteen participants were presented with an odorant and a tastant and asked to identify the tastant as "sweet" or "sour" by pressing 1 of 2 buttons as quickly as possible. Participants were faster to name the taste when it was presented with an odor that was congruent (e.g., strawberry/sweet) than with an incongruent odor (e.g., strawberry/sour). These results support the concept of a high level of cognitive integration between the senses of smell and taste and illustrates occasions of interference between information arising from different sensory systems.

The relationship between PROP and ethanol preferences: an evaluation of 4 inbred mouse strains.

Ethanol's taste attributes undoubtedly contribute to the development of drug preference. Ethanol's taste is both sweet and bitter. Taster status for bitter 6-n-propylthiouracil (PROP) has been proposed as a genetic marker for alcoholism; however, human results are conflicting. We collected preference scores for both tastants in 4 mouse strains selected on the basis of previously reported taste preference, with the generally accepted idea that inbred mice show minimal within-strain variation. Eighty-eight male mice (22 per strain) participated. The strains were as follows: C57BL/6J, ethanol preferring; BALB/cJ, ethanol avoiding; SWR/J, PROP avoiding; and C3HeB/FeJ, PROP neutral. Using a brief-access (1-min trials) 2-bottle preference test, we assessed the taste response of each strain to PROP and ethanol on separate days. Although PROP avoiding versus neutral mice could be segregated into significantly different populations, this was not the case for ethanol avoiding versus preferring mice, and all strains showed high variability. On average, only BALB/cJ, SWR/J, and C3HeB/FeJ mice conformed to their literature-reported preferences; nonetheless, there were a substantial number of discordant animals. C57BL/6J did not conform to previous results, indicating that they are ethanol preferring. Finally, we did not observe a significant relationship between PROP and ethanol preferences across strains. The high variability per strain and the number of animals in disagreement with their respective literature-reported preference raise concerns regarding their utility for investigations underlying mechanisms of taste-mediated ingestive responses. Absent postingestive consequences, the brief-access results suggest a possible degree of previously masked polymorphisms in taste preferences or a more recent drift in underlying genetic factors. The absence of a relationship between PROP and ethanol indicates that the bitter quality in ethanol may be more highly related to other bitter compounds that are mediated by different genetic influences.