Odor identification in aging and dementia Influences of cognition and the ApoE gene

Sammanfattning: Olfactory function is impaired in aging and dementia. The general aim of this thesis was to identify variables that predict olfactory function and dysfunction (assessed with an odor identification test) in middle-aged and elderly adults. The thesis investigated whether odor identification performance was associated with demographic variables, cognitive function, the ApoE gene, dementia, and other health-related variables. The ApoE-?4 allele is associated with cognitive impairment and Alzheimer’s disease, the most common form of dementia. The studies included in this thesis used data from the Betula study, a large-scale, population-based prospective study on aging, memory, and health. Study 1 investigated demographic and cognitive predictors of odor identification ability in non-demented participants. The results showed that younger age, female sex, and high education contributed to better odor identification ability. Cognitive speed and vocabulary had a small additional influence. Study 2 included information about ApoE genotypes, dementia and other health-related variables. The results indicated that the ApoE-?4 allele was associated with odor identification impairment among the elderly, but not middle-aged adults. Participants who were demented at the time of testing or became demented within five years after testing exhibited olfactory impairments. Interestingly, the age-related olfactory impairment in ?4-carriers was independent of clinical dementia within five years. In Study 3, decline in global cognitive status over a five-year test-retest interval was predicted in a sample of elderly participants. The major result was a three-way interaction reflecting that odor identification impairment, old age, in combination with the ?4 allele predicted a larger cognitive decline. However, odor identification impairment did not predict cognitive change in elderly who were non-carriers of the ?4 allele. Overall, the results indicate that odor identification impairment in elderly is related to ApoE-?4, cognitive decline, and clinical and pre-clinical stages of dementia. Theoretical and practical implications of the results are discussed. Furthermore, it is proposed that in order to effectively predict clinical dementia or cognitive decline from olfactory assessment in the elderly, variables that mediate (e.g. neuropathology) or moderate (e.g. age) the associations between olfactory function, the ?4 allele, and dementia need to be further evaluated, preferably in studies using longitudinal assessment.