P2‐329: NONSTANDARDIZED OLFACTORY IDENTIFICATION TESTING IN NEUROCOGNITIVE DISORDERS

Clinicians struggle to accurately predict which patients with neurocognitive disorders (NCDs) will cognitively decline. Deficient olfactory identification (OI) is common in Alzheimer's dementia (AD), but is rarely assessed in the clinical evaluation of NCDs. Clinical research predominantly uses manufactured, standardized odor identification kits (SOITs). While promising, the expense and need to continually restock these kits limits practical use. Nonstandardized odor identification tests (NSOITs), however, are inexpensive, readily available, and reusable. The objective of this study was to assess the diagnostic utility of NSOITs in the assessment of patients with NCDs. We hypothesized that the ability to identify a small and variable amount of ground coffee by smell would: a) Differ between Alzheimer's and nondegenerative NCDs; b) Correlate with different rates of cognitive decline; c) Provide a sensitive more than specific prediction of a patient's decline. We tested the ability of memory clinic patients (n=95) to identify a small and variable amount of ground coffee by smell. Patients who could both smell and name the coffee were considered to have passed (OI+). Montreal Cognitive Assessment (MoCA) scores from the first visit were compared. We also evaluated longitudinal MoCA scores on a smaller subgroup on whom those measures were available. Regression demonstrated different MoCA scores between the OI+ and OI- groups across all patients before and after adjusting for age (β=3.57, p=0.002, CI[1.31;5.83]). Patients with AD (n=18) were more likely to be OI- than those with nondegenerative NCDs (n=37) (p<0.001). Longitudinal mixed-effects analysis with an interaction between time and MoCA score performed on a smaller subsample (n=38) showed faster decline in OI- than OI+ patients (β=4.60, p<0.001, CI [2.77; 6.48]) before and after adjusting for age. Logistical and χ2 testing suggested a trend between OI and more than 2 points MoCA decline (p = 0.08), with a sensitivity of 0.85 and specificity of 0.44. Accurately identifying the smell of ground coffee correlates with MoCA scores and likely distinguishes non-neurodegenerative NCDs from AD. OI- patients tend to decline at a faster rate than OI+ patients. We demonstrate a possible trend towards efficacy of NSOITs as a screening tool for cognitive decline.