Evidence map›Paper›PMID 41467596›Full record

SynthesisEuropean journal of neurology2026

The Utility of Olfactory Testing to Discriminate Parkinson's Disease From Diagnostic Mimics: A Systematic Review and Meta-Analysis.

Christoph Theyer, Johannes Kirchmair, Frank Jagusch, Simon Leiter, Atbin Djamshidian, Beatrice Heim, Corinne Horlings, Alessandra Fanciulli, Werner Poewe, Klaus Seppi and 2 more

Abstract readSystematic ReviewMeta-Analysis
In one paragraph

Synthesis in European journal of neurology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Christoph TheyerDepartment of Neurology, Innsbruck Medical University, Innsbruck, Austria.ORCID 0009-0001-3499-6163
Johannes KirchmairDepartment of Neurology, Innsbruck Medical University, Innsbruck, Austria.
Frank JaguschDepartment of Neurology, Innsbruck Medical University, Innsbruck, Austria.ORCID 0009-0005-3996-0871
Simon LeiterDepartment of Neurology, Innsbruck Medical University, Innsbruck, Austria.ORCID 0009-0006-5852-6824
Atbin DjamshidianDepartment of Neurology, Innsbruck Medical University, Innsbruck, Austria.ORCID 0000-0001-7174-6000
Beatrice HeimDepartment of Neurology, Innsbruck Medical University, Innsbruck, Austria.ORCID 0000-0002-6749-3044
Corinne HorlingsDepartment of Neurology, Innsbruck Medical University, Innsbruck, Austria.ORCID 0000-0002-2440-9180
Alessandra FanciulliDepartment of Neurology, Innsbruck Medical University, Innsbruck, Austria.ORCID 0000-0002-2854-4179
Werner PoeweDepartment of Neurology, Innsbruck Medical University, Innsbruck, Austria.ORCID 0000-0003-4367-0971
Klaus SeppiDepartment of Neurology, Innsbruck Medical University, Innsbruck, Austria.ORCID 0000-0001-6503-1455
Philipp MahlknechtDepartment of Neurology, Innsbruck Medical University, Innsbruck, Austria.ORCID 0000-0003-0671-0516
Florian KrismerDepartment of Neurology, Innsbruck Medical University, Innsbruck, Austria.ORCID 0000-0002-4493-5073

Funding

Austrian Science Fund FG 2700Michael J. Fox Foundation for Parkinson's Research MJFF-009277Michael J. Fox Foundation for Parkinson's Research MJFF-022057
6 · The paper itself

Abstract

backgroundHyposmia is present in most patients with Parkinson's disease (PD), whereas olfaction is usually preserved in its diagnostic mimics. To address the limited evidence from smaller studies, we conducted a meta-analysis on the diagnostic accuracy of olfactory testing in differentiating PD from clinical look-alikes.

methodsA systematic search was performed in PubMed and Web of Science according to the PRISMA guidelines. Studies describing results of validated smell tests in PD patients and at least one differential diagnosis were included. The risk of bias and applicability was assessed with the QUADAS-2 tool. For data synthesis, a hierarchical regression model was employed.

resultsOf 787 publications, 23 studies describing 1957 PD patients, 462 patients with atypical parkinsonian disorders, 239 patients with essential tremor, and 43 patients with secondary parkinsonism were included. The meta-analysis demonstrated a sensitivity of 79% (95% confidence interval [CI]: 72%-84%) and a specificity of 81% (95% CI: 73%-86%) for olfactory dysfunction to differentiate PD from all other disorders combined. Additional analyses showed consistent sensitivities across sub-analyses, with lowest specificities for the distinction from progressive supranuclear palsy, 64% (95% CI: 55%-72%), and highest from essential tremor, 92% (95% CI: 84%-96%).

conclusionOur findings indicate that olfactory testing shows moderate to good diagnostic accuracy in differentiating PD from its main differential diagnoses. While results of olfactory testing alone are insufficient for a definite distinction of PD from non-PD parkinsonism, it represents an easy-to-use and inexpensive test that may be used in combination with other diagnostic tools.

Indexed as

Olfaction DisordersParkinson DiseaseSmellDiagnosis, DifferentialEssential TremorHumansessential tremormultiple system atrophyolfactionParkinson diseaseprogressive Supranuclear palsy

Identifiers

PMID41467596
PMCPMC12750508

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.