Identification of the needs of individuals affected by COVID-19.

BACKGROUND: The optimal management of COVID-19 symptoms and their sequelae remains an important area of clinical research. Policy makers have little scientific data regarding the effects on the daily life of affected individuals and the identification of their needs. Such data are needed to inform effective care policy. METHODS: We studied 639 people with COVID-19 resident in France via an online questionnaire. They reported their symptoms, effects on daily life, and resulting needs, with particular focus on olfaction. RESULTS: The results indicate that a majority of participants viewed their symptoms as disabling, with symptoms affecting their physical and mental health, social and professional lives. 60% of the individuals reported having unmet medical, psychological and socio-professional support needs. Finally, affected individuals were concerned about the risk and invasiveness of possible treatments as shown by a preference for non-invasive intervention over surgery to cure anosmia. CONCLUSIONS: It is important that policy makers take these needs into consideration in order to assist affected individuals to regain a normal quality of life.

The impact of COVID-19 has been substantial, both on individuals' health and on society. Information is needed to understand the biological mechanisms underlying the illness and to provide appropriate support for people affected. This study uses data from an online questionnaire of adults diagnosed with COVID-19 to characterize symptoms, understand their impact on peoples' everyday lives, and determine the support that people need. Our over-arching analysis of symptoms experienced reveals that heart- and skin-related symptoms are linked to chronic illness, and symptoms related to the sense of smell may have a different underlying disease mechanism. Most respondents had a mild initial illness, but their symptoms were long-lasting and had a severe impact. Our findings show that sufferers need different kinds of support in order to regain a normal quality of life.

African Gene Flow Reduces Beta-Ionone Anosmia/Hyposmia Prevalence in Admixed Malagasy Populations.

While recent advances in genetics make it possible to follow the genetic exchanges between populations and their phenotypic consequences, the impact of the genetic exchanges on the sensory perception of populations has yet to be explored. From this perspective, the present study investigated the consequences of African gene flow on odor perception in a Malagasy population with a predominantly East Asian genetic background. To this end, we combined psychophysical tests with genotype data of 235 individuals who were asked to smell the odorant molecule beta-ionone (ßI). Results showed that in this population the ancestry of the OR5A1 gene significantly influences the ability to detect ßI. At the individual level, African ancestry significantly protects against specific anosmia/hyposmia due to the higher frequency of the functional gene (OR ratios = 14, CI: 1.8-110, p-value = 0.012). At the population level, African introgression decreased the prevalence of specific anosmia/hyposmia to this odorous compound. Taken together, these findings validate the conjecture that in addition to cultural exchanges, genetic transfer may also influence the sensory perception of the population in contact.

Recovery From COVID-19-Related Olfactory Disorders and Quality of Life: Insights From an Observational Online Study.

Although olfactory disorders (OD) are among the most significant symptoms of COVID-19, recovery time from COVID-19-related OD and their consequences on the quality of life remain poorly documented. We investigated the characteristics and behavioral consequences of COVID-19-related OD using a large-scale study involving 3111 French respondents (78% women) to an online questionnaire over a period of 9 months covering different epidemic waves (from 8 April 2020 to 13 January 2021). In the patients who subjectively recovered from COVID-19-related OD (N = 609), recovery occurred on average after 16 days and most of the time within 1 month ("normal" recovery range); 49 subjectively recovered in 1-2.5 months, and several cases took up to 6.5 months. Among the patients with ongoing OD (N = 2502), 974 were outside the "normal" recovery range (persistent OD) and reported OD for 1-10 months. Developing a persistent OD was more likely with increasing age and in women and was more often associated with parosmia and phantosmia. The deleterious impact of COVID-19-related OD on the quality of life was significantly aggravated by OD duration and was more pronounced in women. Because persistent OD is not infrequent after COVID-19, has deleterious consequences on the quality of life, and receives few solutions from the health practitioners, it would be beneficial to implement screening and treatment programs to minimize the long-term behavioral consequences of COVID-19-related OD.

Expertise shapes domain-specific functional cerebral asymmetry during mental imagery: the case of culinary arts and music.

Mental imagery in experts has been documented in visual arts, music and dance. Here, we examined this issue in an understudied art domain, namely, culinary arts. Previous research investigating mental imagery in experts has reported either a stronger involvement of the right hemisphere or bilateral brain activation. The first aim of our study was to examine whether culinary arts also recruit such a hemispheric pattern specifically during odor mental imagery. In a second aim, we investigated whether expertise effects observed in a given sensory domain transfer to another modality. We combined psychophysics and neurophysiology to study mental imagery in cooks, musicians and controls. We collected response times and event-related potentials (ERP) while participants mentally compared the odor of fruits, the timbre of musical instruments and the size of fruits, musical instruments and manufactured objects. Cooks were faster in imagining fruit odors, and musicians were faster in imagining the timbre of musical instruments. These differences were not observed in control participants. This expertise effect was reflected in the ERP late positive complex (LPC): only experts showed symmetric bilateral activation, specifically when cooks imagined odors and when musicians imagined timbres. In contrast, the LPC was significantly greater in the left hemisphere than in the right hemisphere for non-expert participants in all conditions. These findings suggest that sensory expertise does not involve transfer of mental imagery ability across modalities and highlight for the first time that olfactory expertise in cooks induces a balance of activations between hemispheres as does musical expertise in musicians.

Altered Affective Evaluations of Smells in Alzheimer's Disease.

BACKGROUND: Studies of olfaction in Alzheimer's disease (AD) mainly focused on deficits in odor detection and identification, with very few investigations of olfactory emotional changes and their consequences for hedonics. OBJECTIVE: The aim of the present study was to characterize affective evaluations of odors in AD patients. METHODS: To this end, 20 AD patients and 20 matched controls were tested. Participants were screened for odor detection and identification ability and then asked to rate the intensity, pleasantness, and edibility of 20 odorants. RESULTS: Results showed that, overall, AD patients had lower detection ability and perceived all odors as weaker than controls. As expected, they had lower identification ability on both cued and non-cued tasks. In addition, when smelling pleasant odors, patients had significantly lower hedonic ratings than controls (p <  0.02), whereas no group difference was found for neutral or unpleasant odors (p >  0.05 in both cases). Moreover, an analysis combining both intensity and pleasantness ratings showed that whereas intensity increased as a function of pleasantness and unpleasantness in controls, this quadratic relationship was not observed in AD patients. CONCLUSIONS: The study suggests that the simplest categorization criteria of odors (intensity and hedonic valence) are impaired in AD patients (especially for pleasant odors).

Odor Perception in Children with Autism Spectrum Disorder and its Relationship to Food Neophobia.

Atypical sensory functioning in Autism Spectrum Disorder (ASD) has been well documented in the last decade for the visual, tactile and auditory systems, but olfaction in ASD is still understudied. The aim of the present study was to examine whether children with ASD and neuro-typically (NT) developed children differed in odor perception, at the cognitive (familiarity and identification ability), sensorimotor (olfactory exploration) and affective levels (hedonic evaluation). Because an important function of the sense of smell is its involvement in eating, from food selection to appreciation and recognition, a potential link between odor perception and food neophobia was also investigated. To these ends, 10 children between 6 and 13 years old diagnosed with ASD and 10 NT control children were tested. To compare performance, 16 stimuli were used and food neophobia was assessed by the parents on a short food neophobia scale. Results revealed that (i) significant hedonic discrimination between attractive and aversive odors was observed in NT (p = 0.005; d = 2.378) and ASD children (p = 0.042; d = 0.941), and (ii) hedonic discrimination level was negatively correlated with food neophobia scores in ASD (p = 0.007) but not NT children. In conclusion, this study offers new insights into odor perception in ASD children, highlighting a relationship between odor hedonic reactivity and eating behavior. This opens up new perspectives on both (i) the role of olfaction in the construction of eating behavior in ASD children, and (ii) the measurement and meaning of food neophobia in this population.

Repeated exposure to odors induces affective habituation of perception and sniffing.

Olfactory perception, and especially hedonic evaluation of odors, is highly flexible, but some mechanisms involved in this flexibility remain to be elucidated. In the present study we aimed at better understanding how repeated exposure to odors can affect their pleasantness. We tested the hypothesis of an affective habituation to the stimuli, namely a decrease of emotional intensity over repetitions. More specifically, we tested whether this effect is subject to inter-individual variability and whether it can also be observed at the olfactomotor level. Twenty-six participants took part in the experiment during which they had to smell two odorants, anise and chocolate, presented 20 times each. On each trial, sniff duration and volume were recorded and paired with ratings of odor pleasantness and intensity. For each smell, we distinguished between "likers" and "dislikers," namely individuals giving positive and negative initial hedonic evaluations. Results showed a significant decrease in pleasantness with time when the odor was initially pleasant ("likers"), while unpleasantness remained stable or slightly decreased when the odor was initially unpleasant ("dislikers"). This deviation toward neutrality was interpreted as affective habituation. This effect was all the more robust as it was observed for both odors and corroborated by sniffing, an objective measurement of odor pleasantness. Affective habituation to odors can be interpreted as an adaptive response to stimuli that prove over time to be devoid of positive or negative outcome on the organism. This study contributes to a better understanding of how olfactory preferences are shaped through exposure, depending on the individual's own initial perception of the odor.

A pleasant familiar odor influences perceived stress and peripheral nervous system activity during normal aging.

Effects of smells on stress have been demonstrated in animals and humans, suggesting that inhaling certain odorants may counteract the negative effects of stress. Because stress plays a key role in cerebral aging, the present study set out to examine whether positive odor effects on perceived stress can be achieved in elderly individuals. To this end, two groups of aged individuals (n = 36 women, aged from 55 to 65 years), were tested. The first group was exposed for 5 days to a pleasant and, by end of exposure, familiar odor ("exposure odor"), whereas the other was exposed to a non-scented control stimulus. Stress and mood states were assessed before and after the 5-day odor exposure period. Psychophysiological markers were also assessed at the end of exposure, in response to the "exposure odor" and to a "new odor." Results revealed that stress on this second exposure was decreased and zygomatic electromyogram activity was increased specifically in the group previously exposed to the odor (p < 0.05). Taken as a whole, these findings offer a new look at the relationship between perceived stress, olfaction and normal aging, opening up new research perspectives on the effect of olfaction on quality of life and well-being in aged individuals.

Hedonic appreciation and verbal description of pleasant and unpleasant odors in untrained, trainee cooks, flavorists, and perfumers.

Olfaction is characterized by a salient hedonic dimension. Previous studies have shown that these affective responses to odors are modulated by physicochemical, physiological, and cognitive factors. The present study examined expertise influenced processing of pleasant and unpleasant odors on both perceptual and verbal levels. For this, performance on two olfactory tasks was compared between novices, trainee cooks, and experts (perfumers and flavorists): Members of all groups rated the intensity and pleasantness of pleasant and unpleasant odors (perceptual tasks). They were also asked to describe each of the 20 odorants as precisely as possible (verbal description task). On a perceptual level, results revealed that there were no group-related differences in hedonic ratings for unpleasant and pleasant odors. On a verbal level, descriptions of smells were richer (e.g., chemical, olfactory qualities, and olfactory sources terms) and did not refer to pleasantness in experts compared to untrained subjects who used terms referring to odor sources (e.g., candy) accompanied by terms referring to odor hedonics. In conclusion, the present study suggests that as novices, experts are able to perceptually discriminate odors on the basis of their pleasantness. However, on a semantic level, they conceptualize odors differently, being inclined to avoid any reference to odor hedonics.

The effect of verbal context on olfactory neural responses.

Odor names refer usually to "source" object categories. For example, the smell of rose is often described with its source category (flower). However, linguistic studies suggest that odors can also be named with labels referring to categories of "practices". This is the case when rose odor is described with a verbal label referring to its use in fragrance practices ("body lotion," cosmetic for example). It remains unknown whether naming an odor by its practice category influences olfactory neural responses differently than that observed when named with its source category. The aim of this study was to investigate this question. To this end, functional MRI was used in a within-subjects design comparing brain responses to four different odors (peach, chocolate, linden blossom, and rose) under two conditions whereby smells were described either (1) with their source category label (food and flower) or (2) with a practice category label (body lotion). Both types of labels induced activations in secondary olfactory areas (orbitofrontal cortex), whereas only the source label condition induced activation in the cingulate cortex and the insula. In summary, our findings offer a new look at olfactory perception by indicating differential brain responses depending on whether odors are named according to their source or practice category.

Effect of aging on hedonic appreciation of pleasant and unpleasant odors.

Does hedonic appreciation evolve differently for pleasant odors and unpleasant odors during normal aging? To answer this question we combined psychophysics and electro-encephalographic recordings in young and old adults. A first study showed that pleasant odorants (but not unpleasant ones) were rated as less pleasant by old adults. A second study validated this decrease in hedonic appreciation for agreeable odors and further showed that smelling these odorants decreased beta event-related synchronization in aged participants. In conclusion, the study offers new insights into the evolution of odor hedonic perception during normal aging, highlighting for the first time a change in processing pleasant odors.

Cross-modal integration of emotions in the chemical senses.

Although the brain structures involved in integrating odorant and trigeminal stimuli are well-documented, there is still a need to clarify (1) how emotional response is represented in the human brain during cross-modal interaction between odors and trigeminal stimuli, and (2) whether the degree of congruency between the two types of stimuli influences these emotional responses and their neural processing. These questions were explored combining psychophysics, event-related potentials (ERP) and fMRI in the same group of 17 subjects under a "congruent condition" (intranasal carbon dioxide mixed with the smell of orange, a combination found in soda drinks, for example), and an "incongruent condition" (intranasal carbon dioxide mixed with the smell of rose, a combination not encountered in everyday life). Responses to the 3 constituent stimuli (carbon dioxide, orange, and rose) were also measured. Hedonic and intensity ratings were collected for all stimulations. The congruent bimodal stimulus was rated as more pleasant than the incongruent. This behavioral effect was associated with enhanced neural activity in the hippocampus and anterior cingulate gyrus, indicating that these brain areas mediate reactivation of pleasant and congruent olfactory-trigeminal associations.

Dissociated representations of pleasant and unpleasant olfacto-trigeminal mixtures: an FMRI study.

How the pleasantness of chemosensory stimuli such as odorants or intranasal trigeminal compounds is processed in the human brain has been the focus of considerable recent interest. Yet, so far, only the unimodal form of this hedonic processing has been explored, and not its bimodal form during crossmodal integration of olfactory and trigeminal stimuli. The main purpose of the present study was to investigate this question. To this end, functional magnetic resonance imaging (fMRI) was used in an experiment comparing brain activation related to a pleasant and a relatively unpleasant olfacto-trigeminal mixture, and to their individual components (CO(2) alone, Orange alone, Rose alone). Results revealed first common neural activity patterns in response to both mixtures in a number of regions: notably the superior temporal gyrus and the caudate nucleus. Common activations were also observed in the insula, although the pleasant mixture activated the right insula whereas the unpleasant mixture activated the left insula. However, specific activations were observed in anterior cingulate gyrus and the ventral tegmental area only during the perception of the pleasant mixture. These findings emphasized for the firs time the involvement of the latter structures in processing of pleasantness during crossmodal integration of chemosensory stimuli.

The lyon clinical olfactory test: validation and measurement of hyposmia and anosmia in healthy and diseased populations.

The LCOT is a self-administered test designed to assess olfactory deficits. Altogether, 525 subjects contributed to the validation. Elderly participants were well represented in this sample. In a validation study (study 1), 407 healthy and 17 anosmic volunteers between 15 and 91 years of age underwent threshold, supraliminal detection, and identification testing. Cutoff values for normosmia and hyposmia were calculated and applied in a second study in a group of patients with smell complaints and in a group of Alzheimer patients with age-matched controls. Incidence of smell deficit was estimated at 5.6% in the healthy population of study 1, and at 16% in the elderly control group of study 2. Assessment of the ability of each subtest to discriminate between groups showed that LCOT is relevant to differentiating between perception and identification deficits and between Alzheimer's and hyposmic patients.

Physicochemical influence on odor hedonics: Where does it occur first?

We recently reported data showing that, while human olfactory pleasantness is modulated by semantic knowledge of smells, the physicochemical aspects of odorant molecules are prominent determinants of odor hedonic valence, especially in children and seniors, two age groups characterized by either low level of (children) or weak access to (seniors) odor semantic knowledge.1 Here, we present additional data from a human and an animal study, confirming that odorant structure predicts odor pleasantness and suggesting that this influence may be already engraved at receptor level.

Ontogeny of odor liking during childhood and its relation to language development.

One important aspect of odor hedonics is its plasticity during human development. The present study set out to probe the modulators of such olfactory change during that period by testing the hypothesis that language and semantic representations of objects are strong organizers of odor liking. To this end, 15 three-year-old children were tested in a longitudinal study. Participants were exposed to exactly the same 12 odorants once a year over a 3-year period. At each experimental session, they were asked to answer 2 questions: 1) "Do you like or dislike this odor?" and 2) "Can you tell me what it is?" The level of language production was assessed on a standardized test. The 3-year-old children were found to categorize the same number of odorants as liked and as disliked. The follow-up study, in contrast, showed that at 5 years of age they categorized more of these odors as liked and that the shift was significant only in the children with higher language production skills. Taken as a whole, these findings suggest that the 3- to 5-year age range, when children begin to master language, is a turning point in the construction of olfactory hedonic categories during childhood.

Semantic knowledge influences prewired hedonic responses to odors.

BACKGROUND: Odor hedonic perception relies on decoding the physicochemical properties of odorant molecules and can be influenced in humans by semantic knowledge. The effect of semantic knowledge on such prewired hedonic processing over the life span has remained unclear. METHODOLOGY/PRINCIPAL FINDINGS: The present study measured hedonic response to odors in different age groups (children, teenagers, young adults, and seniors) and found that children and seniors, two age groups characterized by either low level of (children) or weak access to (seniors) odor semantic knowledge, processed odor hedonics more on the basis of their physicochemical properties. In contrast, in teenagers and young adults, who show better levels of semantic odor representation, the role of physicochemical properties was less marked. CONCLUSIONS/SIGNIFICANCE: These findings demonstrate for the first time that the biological determinants that make an odor pleasant or unpleasant are more powerful at either end of the life span.

The effect of early experience on odor perception in humans: psychological and physiological correlates.

The olfactory function in humans is characterized by wide variability between individuals. One of the prominent factors that contribute to this plasticity is early exposure. The present study examined how brain activity is modulated by such olfactory experience. To this end, two groups of people living in France but originating from different cultures ("European-French" (EF, 18 subjects) vs. "Algerian-French" (AF, 19 subjects)) were tested, and their perceptual and physiological responses to the smells of mint (presumed to be experienced earlier in life by "Algerian-French" subjects) and of rose (control odorant) were compared. Neurophysiological responses were obtained in the form of chemosensory event-related potentials (CSERP). The results confirmed that the AF group was exposed to Mint tea earlier than the EF group. On the perceptual level, when asked to associate the smell of mint with objects or events retrieved from memory, the discourse of AF subjects included more "experience-oriented" associations than that of EF subjects. This was associated with longer P2 latency in CSERPs in response to the smell of mint in the AF group. These findings highlight the plasticity of behavioral and neural olfactory processes as a result of differential lifetime exposure.

Perceptual and sensorimotor differences between "good" and "poor" olfactory mental imagers.

Like odor perception, odor imagery is characterized by wide variability between individuals. The present two-part study sought to assess whether this inter-individual variability is underlain by behavioral differences in actual odor perception. In study 1, subjects judged the intensity, pleasantness, familiarity and edibility of 3 odorants. Participants were split into two olfactory imagery groups ("good" versus "poor" olfactory imagers) according to their scores on an imagery questionnaire. Results showed that good olfactory imagers judged all odors as more familiar and more edible than did poor olfactory imagers. Study 2 sought to determine whether these effects derived from a particular strategy of reenacting olfactomotor responses to smells on the part of good olfactory imagers, by recording their sniffs during odor perception. Results revealed that good olfactory imagers sniffed all odors longer and, again, judged these same odors as more edible and familiar. This supports the hypothesis of more complete odor processing and better access to odor semantics in good olfactory imagers.

Which format for odor images?

Olfactory mental images are defined as short-term memory representations of olfactory events that give rise to the experience of "smelling with the mind's nose." The present paper reviewed converging evidences that support the view that as visual mental images, odor mental images preserve some aspects of olfactory percepts. The role of olfactomotor mechanisms in recalling olfactory mental images from long-term memory to short-term memory is also discussed.