Awareness of Olfactory Dysfunction in Subjective Cognitive Decline, Mild Cognitive Decline, and Alzheimer’s Disease

Hyposmia and metacognitive errors are related to aging, depression, male gender, and cognitive decline. The current study investigated the awareness of olfactory dysfunction in subjective cognitive decline (SCD), mild cognitive impairment (MCI), and Alzheimer’s disease (AD), as well as the influence of additional factors.

A sample of 641 patients, including controls, SCD, non-amnestic MCI (naMCI), amnestic MCI (aMCI), and AD patients, was assessed with the Sniffin’ Sticks odor identification test (OIT) and the subjective olfactory capability (SOC) scale, in addition to measures of depressive symptoms, verbal memory, and executive functioning. Olfactory awareness groups were formed by means of the cutoffs of the OIT and the SOC.

Moderate and small, although significant, correlations between the OIT and the SOC were found among the study groups, with a significant discrimination of measured olfactory function via subjective assessment existing among controls but not among patients with AD. Of all AD patients, 34% overrated their sense of smell while 21% correctly identified themselves as being hyposmic, as opposed to corresponding 6% and 1% of healthy elderly. Overraters and correct hyposmic participants showed higher age and worse verbal memory and executive functions.

Reduced odor identification might underlie the same pathological changes within the brain as cognitive impairment and could serve as an additional marker for the development of AD.

Although people with AD are aware of hyposmia to some extent, the majority is affected by overestimation of the ability to smell, making the combination of subjective ratings and measures of olfactory function an interesting topic for further research.