Olfactory Dysfunction Reflects Disease Progression in Japanese Patients with Multiple Sclerosis.

Objective Olfactory dysfunction is an important clinical feature in patients with multiple sclerosis (MS). The incidence and extent of olfactory dysfunction are reportedly higher in secondary progressive (SP) MS than in relapsing and remitting (RR) MS. We investigated the use of olfactory dysfunction for evaluating the disease status of Japanese patients with MS. Methods Olfactory identification was evaluated using the Odor Stick Identification Test for the Japanese (OSIT-J) in patients with RRMS (n=40) and SPMS (n=11) and compared the findings with those of healthy controls (n=40). Patients with RRMS for more than 10 years (L-RRMS, n=10) were included in the RRMS group. The cognitive function was evaluated using the Japanese version of the Wechsler Adult Intelligence Scale, 3rd edition. The third ventricle width (3rd VW) was measured as a marker of central brain atrophy using magnetic resonance imaging. Results SPMS patients had significantly lower OSIT-J scores than RRMS and L-RRMS patients. More SPMS patients had OSIT-J scores below the lower limit of the normal score (LLN) than RRMS patients. The LLN effectively discriminated between RRMS and SPMS (sensitivity 70%, specificity 91.5%, area under the curve 0.933, 95% confidence interval 0.874-1.000). Patients with SPMS had a significantly lower processing speed and larger 3rd VW than those with RRMS or L-RRMS. Conclusion The olfactory dysfunction was worse, along with cognitive impairment and brain atrophy, in SPMS patients than in RRMS patients, independent of disease duration, in our Japanese population. This directly reflected the disease progression and may have been able to distinguish SPMS from RRMS, independent of ethnic and cultural background.