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Associations between olfactory dysfunction and cognition: a scoping review

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Abstract

Introduction

Strong evidence suggests that olfactory dysfunction (OD) can predict additional neurocognitive decline in neurodegenerative conditions such as Alzheimer’s and Parkinson’s diseases. However, research exploring olfaction and cognition in younger populations is limited. The aim of this review is to evaluate cognitive changes among non-elderly adults with non-COVID-19-related OD.

Methods

We performed a structured comprehensive literature search of PubMed, Ovid Embase, Web of Science, and Cochrane Library in developing this scoping review. The primary outcome of interest was the association between OD and cognitive functioning in adults less than 60 years of age.

Results

We identified 2878 studies for title and abstract review, with 167 undergoing full text review, and 54 selected for data extraction. Of these, 34 studies reported on populations of individuals restricted to the ages of 18–60, whereas the remaining 20 studies included a more heterogeneous population with the majority of individuals in this target age range in addition to some above the age of 60. The etiologies for smell loss among the included studies were neuropsychiatric disorders (37%), idiopathic cause (25%), type 2 diabetes (7%), trauma (5%), infection (4%), intellectual disability (4%), and other (18%). Some studies reported numerous associations and at times mixed, resulting in a total number of associations greater than the included number of 54 studies. Overall, 21/54 studies demonstrated a positive association between olfaction and cognition, 7/54 demonstrated no association, 25/54 reported mixed results, and only 1/54 demonstrated a negative association.

Conclusion

Most studies demonstrate a positive correlation between OD and cognition, but the data are mixed with associations less robust in this young adult population compared to elderly adults. Despite the heterogeneity in study populations and outcomes, this scoping review serves as a starting point for further investigation on this topic. Notably, as many studies in this review involved disorders that may have confounding effects on both olfaction and cognition, future research should control for these confounders and incorporate non-elderly individuals with non-psychiatric causes of smell loss.

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Data availability

The data that support the findings of this study are openly available within the references listed, which were accessed through the databases listed in the methods section.

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Acknowledgements

The authors would like to acknowledge Informationist Marian LaForest, MPH at CUIMC Health Sciences Library and Evidence Synthesis Librarian and Information Methodologist Michelle R. Demetres, MLIS at Weill Cornell Medicine for their guidance in the development and revision of the ideal search strategy to comprehensively identify relevant studies.

Funding

This work was supported by Grant K23DC019678 from the National Institute on Deafness and Other Communication Disorders (https://www.nih.gov/about-nih/what-we-do/nih-almanac/national-institute-deafness-other-communication-disorders-nidcd) and the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The funders did not play any role in study design, data collection/analysis, decision to publish, or manuscript preparation.

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Author notes

  1. Patricia T. Jacobson and Brandon J. Vilarello have contributed equally to this work and share first authorship.

Authors and Affiliations

  1. Department of Otolaryngology-Head and Neck Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA

    Patricia T. Jacobson, David A. Gudis & Jonathan B. Overdevest

  2. Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA

    Brandon J. Vilarello, Jeremy P. Tervo, Nicholas A. Waring, David A. Gudis, D. P. Devanand & Jonathan B. Overdevest

  3. Department of Psychiatry, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA

    Terry E. Goldberg & D. P. Devanand

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Contributions

JO, DG, TG, and DPD conceptualized the work. PJ, BV, and JO developed and revised the search terms alongside the librarian team, with subsequent execution of the literature search. PJ, BV, JT, and NW performed article screening and data extraction. PJ and BV drafted the manuscript. All authors critically revised the work.

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Correspondence to Jonathan B. Overdevest.

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Jacobson, P.T., Vilarello, B.J., Tervo, J.P. et al. Associations between olfactory dysfunction and cognition: a scoping review. J Neurol 271, 1170–1203 (2024). https://doi.org/10.1007/s00415-023-12057-7

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