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Olfactory discrimination in disorders of consciousness: A new sniff protocol.

ABSTRACT: BACKGROUND:The identification of salient stimuli useful for rehabilitation purposes is important in patients with disorders of consciousness (DOC): among these, olfactory stimuli might play an important role due to the functional coupling between olfactory and emotional processing. However, a high percentage of post brain injury patients present anosmia. AIMS OF THE STUDY:The aim of this pilot research is to present an innovative approach to test olfactory functions at the bedside using four selected odors in patients with DOC. METHODS:Sixteen patients with DOC were tested with two assessment techniques the new olfactory discrimination protocol (ODP) and a functional magnetic resonance imaging paradigm to evaluate olfactory neural process. The Frequentist and Bayesian methods were used to analyze reliability properties of the new tool. RESULTS:Analysis showed a good agreement between assessment techniques and a substantial test-retest reliability of the ODP. Cohen's Ks were equal to 0.814 (95% CI = 0.471, 1) and 0.607 (0.118; 1) respectively, using the Frequentist approach, while they were 0.762 (95% HPD = 0.470; 0.966) and 0.650 (0.320; 0.913) with the Bayesian approach in the 11 patients analyzed. CONCLUSIONS:Despite the limits of this preliminary research, the ODP can be useful for clinicians for the preliminary assessment of the olfactory discrimination in patients with DOC.

SUBMITTER: Sattin D

PROVIDER: S-EPMC6710199 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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Olfactory discrimination in disorders of consciousness: A new sniff protocol.

Sattin Davide D Bruzzone Maria Grazia MG Ferraro Stefania S Nigri Anna A Leonardi Matilde M Guido Davide D

Brain and behavior 20190628 8

<h4>Background</h4>The identification of salient stimuli useful for rehabilitation purposes is important in patients with disorders of consciousness (DOC): among these, olfactory stimuli might play an important role due to the functional coupling between olfactory and emotional processing. However, a high percentage of post brain injury patients present anosmia.<h4>Aims of the study</h4>The aim of this pilot research is to present an innovative approach to test olfactory functions at the bedside ...[more]

PMID: 31251479

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Project description:ObjectivesThe aim of this study was to determine whether behavioral responses elicited by olfactory stimulation are a predictor of conscious behavioral response and prognosis of patients with disorders of consciousness (DOC).MethodsTwenty-three DOC patients (8 unresponsive wakefulness syndrome [UWS]; 15 minimally conscious state [MCS]) were recruited for this study in which 1-Octen-3-ol (familiar neutral odor) and pyridine were used to test odor behavioral responses, and water was used as an odorless stimulus. One rater presented the three odors in front of each patient's nose randomly, and another one videotaped all behavioral responses (e.g., pouting, wrinkling nose, slightly shaking head, frowning, etc.). Two independent raters, blind to the stimuli and the patient's diagnosis, gave the behavioral results according to the recorded videos. One-, 3-, and 6-month follow-up evaluations were conducted to obtain a good prognostic value.ResultsAll MCS patients showed behavioral responses to the 1-Octen-3-ol stimulus; nine MCS and one UWS showed olfactory emotional responses to the pyridine, and two MCS showed olfactory emotional responses to the water stimulus. The incidence of behavioral response was significantly higher using 1-Octen-3-ol than it was for water by McNemar test (p < 0.001), significantly higher using pyridine than it was for water (p < 0.01). The χ2 test results indicated that there were significant differences between MCS and UWS to 1-Octen-3-ol (p < 0.001). For MCS patients, the incidence of behavioral response was no different between using 1-Octen-3-ol and pyridine (p > 0.05). There was no significant relationship between the olfactory behavioral response and the improvement of consciousness based on the χ2 test analysis (p > 0.05).ConclusionOlfactory stimuli, especially for the familiar neutral odor, might be effective for eliciting a conscious behavioral response and estimating the clinical diagnosis of DOC patients.Clinical trial registration[https://clinicaltrials.gov/ct2/show/NCT03732092], [identifier NCT03732092].

Project description:In this study, we examine race/ethnic consciousness and its associations with experiences of racial discrimination and health in New Zealand. Racism is an important determinant of health and cause of ethnic inequities. However, conceptualising the mechanisms by which racism impacts on health requires racism to be contextualised within the broader social environment. Race/ethnic consciousness (how often people think about their race or ethnicity) is understood as part of a broader assessment of the 'racial climate'. Higher race/ethnic consciousness has been demonstrated among non-dominant racial/ethnic groups and linked to adverse health outcomes in a limited number of studies. We analysed data from the 2006/07 New Zealand Health Survey, a national population-based survey of New Zealand adults, to examine the distribution of ethnic consciousness by ethnicity, and its association with individual experiences of racial discrimination and self-rated health. Findings showed that European respondents were least likely to report thinking about their ethnicity, with people from non-European ethnic groupings all reporting relatively higher ethnic consciousness. Higher ethnic consciousness was associated with an increased likelihood of reporting experience of racial discrimination for all ethnic groupings and was also associated with fair/poor self-rated health after adjusting for age, sex and ethnicity. However, this difference in health was no longer evident after further adjustment for socioeconomic position and individual experience of racial discrimination. Our study suggests different experiences of racialised social environments by ethnicity in New Zealand and that, at an individual level, ethnic consciousness is related to experiences of racial discrimination. However, the relationship with health is less clear and needs further investigation with research to better understand the racialised social relations that create and maintain ethnic inequities in health in attempts to better address the impacts of racism on health.

Project description:BackgroundTranscutaneous auricular vagus nerve stimulation (taVNS) has recently been explored for the treatment of Disorders of consciousness (DoC) caused by traumatic brain injury. The evidence of taVNS during the consciousness recovery has been recently reported. However, the mechanism of taVNS in the recovery of consciousness is not clear. This study attempts to investigate the effectiveness of taVNS in DoC by means of Coma Recovery Scale-Revised (CRS-R), Magnetic resonance imaging (MRI), Electrophysiology (EEG), and Single-molecular array (Simoa).Methods/designNighty patients with DoC acquired brain injury are randomized into one of three groups receiving sham taVNS or active taVNS (just left and left or right), respectively. Each of the three groups will experience a 40 days cycle (every 10 days for a small period, baseline 2 weeks, intervention 2 weeks, 40 min per day, 5 days per week, then no intervention for 2 weeks, intervention 2 weeks, 40 min per day, and 5 days per week). Primary outcomes (CRS-R) will be recorded five times during every period. Secondary outcomes will be recorded at the first and at the last period [MRI, EEG, Phosphorylated tau (P-tau), and Neurofilament light chain (NFL)]. We will take notes the adverse events and untoward effects during all cycles.DiscussionTranscutaneous auricular vagus nerve stimulation as a painless, non-invasive, easily applied, and effective therapy was applied for treatment of patients with depression and epilepsy several decades ago. Recent progress showed that taVNS has behavioral effects in the consciousness recovery. However, there is no clinical evidence to support the effects of taVNS on brain activity. Therefore, we will design a randomized controlled trial to evaluate the effectiveness and safety of taVNS therapy for DoC, and explore neural anatomy correlated to taVNS during the consciousness recovery. Finally, this protocol also tests some biomarkers along with the recovery of consciousness.Clinical trial registrationChinese Clinical Trial Registry, ChiCTR2100045161. Registered on 9 April 2021.

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Olfactory discrimination in disorders of consciousness: A new sniff protocol.

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Olfactory discrimination in disorders of consciousness: A new sniff protocol.

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