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Open Access Highly Accessed Research article

An olfactory ‘stress test’ may detect preclinical Alzheimer’s disease

Peter W Schofield1*, Houman Ebrahimi2, Alison L Jones3, Grant A Bateman4 and Sonya R Murray5

Author Affiliations

1 Neuropsychiatry service, Hunter New England Area Health, Newcastle, Australia & Centre for Translational Neuroscience and Mental Health, University of Newcastle, PO Box 833, Newcastle, NSW, 2300, Australia

2 Department of Radiology, John Hunter Hospital, Newcastle, Australia

3 Dean of Graduate Medicine, University of Wollongong, Newcastle, Australia

4 Department of Radiology, John Hunter Hospital, Newcastle, Australia

5 Neuropsychiatry service, Hunter New England Area Health, Newcastle, Australia

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BMC Neurology 2012, 12:24  doi:10.1186/1471-2377-12-24

Published: 2 May 2012



The olfactory bulb (OB) receives extensive cholinergic input from the basal forebrain and is affected very early in Alzheimer’s disease (AD). We speculated that an olfactory ‘stress test’ (OST), targeting the OB, might be used to unmask incipient AD. We investigated if change in olfactory performance following intranasal atropine was associated with several known antecedents or biomarkers of AD.


We measured change in performance on the University of Pennsylvania Smell Identification Test (UPSIT) in the left nostril before (20-items) and after (remaining 20-items) intranasal administration of 1 mg of atropine. We administered cognitive tests, measured hippocampal volume from MRI scans and recorded Apolipoprotein E genotype as indices relevant to underlying AD.


In a convenience sample of 56 elderly individuals (14 probable AD, 13 cognitive impairment no dementia, 29 cognitively intact) the change in UPSIT score after atropine (‘atropine effect’ = AE) correlated significantly with demographically scaled episodic memory score (r = 0.57, p < 0.001) and left hippocampal volume (LHCV) (r = 0.53, p < 0.001). Among non-demented individuals (n = 42), AE correlated with episodic memory (r = 0.52, p < 0.001) and LHCV (r = 0.49, p < 0.001) and hierarchical linear regression models adjusted for age, gender, education, and baseline UPSIT showed that the AE explained more variance in memory performance (24%) than did LHCV (15%). The presence of any APOE ϵ4 allele was associated with a more negative AE (p = 0.014).


The OST using atropine as an olfactory probe holds promise as a simple, inexpensive screen for early and preclinical AD and further work, including longitudinal studies, is needed to explore this possibility.