Abstract Details

Title A Quantative Test for Olfaction Is the Most Sensitive Physical Examination Biomarker for Residual Neurological Dysfunction Due to Mild Traumatic Brain Injury (mTBI) That Can Be Performed in the Setting of a Clinical Examination Room

Topic Neural Repair/Rehabilitation

Presentation(s) P04 - (-)

Poster/Presentation
Number 022

Objective

Background BACKGROUND: TBI is an extremely important civilian and military health issue. Concussion (mTBI) is the most frequent form of TBI. Identifying residual neurological injury following mTBI (complex mTBI) in a clinic setting may be useful for directing post-mTBI care.

Design/Methods DESIGN/METHODS: We studied 6 Veteran groups: Combat-acquired mTBI (Iraq or Afghanistan) with loss of consciousness (LOC, 126), without LOC (21), without mTBI (52), civilian mTBI with LOC (21), without LOC (21) and without TBI (21). We examined frequencies of NDs on a 50 element examination including quantitative olfaction (Sensonics, Haddon Heights NJ). Montreal Cognitive Assessment Test (MOCA) assessed cognition. ANOVA analyzed ND frequencies. Kendall's rank and Pearson's product-moment tests determined correlations.

Results RESULTS: The frequencies of NDs were: combat mTBI with LOC - 52%, combat mTBI without LOC 9.5%, combat without TBI - 0%, civilian mTBI with LOC - 9.5%, civilian mTBI without LOC - 0% and civilian without TBI - 0%. Only 5/50 elements of the neurological examination revealed NDs. NDs for combat veterans with mTBI and LOC were: reduced olfaction - 65, impaired balance - 14, abnormal eye movements - 13, motor asymmetry - 2 and sensory change - 2. Both combat veterans without LOC who had a ND had only impaired olfaction. The 2 civilains with NDs had impaired olfaction - 2 and impaired balance -1. Among the 69 with NDs, 37 (54%) had only impaired olfaction. Impaired olfaction was not explained by smoking, sinus disease or inhalation of irritants. Impaired olfaction correlated with impaired cognitive function, but the extent of cognitive impairment did not correlate with olfaction scores.

Conclusions CONCLUSIONS: Olfaction was the most sensitive neurological examination biomarker for neurological injury following mTBI with LOC. However, the severity of impaired olfaction did not correlate with extent of impaired cognition.

Authors/Disclosures
Robert L. Ruff, MD, PhD, FAAN PRESENTER	No disclosure on file
Ronald G. Riechers II, MD (Cleveland VAMC)	No disclosure on file
	No disclosure on file
Frederik Barkhof, MD, PhD (Image Analysis Center)	Frederik Barkhof has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Frederik Barkhof has received personal compensation in the range of $0-$499 for serving as a Consultant for Biogen. Frederik Barkhof has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Combinostics. Frederik Barkhof has received personal compensation in the range of $500-$4,999 for serving as a Consultant for IXICO. Frederik Barkhof has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Janssen. Frederik Barkhof has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EISAI.

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