Anosmia, by any other name…

The loss of the sense of smell (anosmia) is these days well-associated with COVID and Long-COVID, but also can simply come with age:

National Institute of Aging | How Smell & Taste Change With Age

…although it can also be something else entirely:

❝Another possibility is a problem with part of the nervous system responsible for smell.

Some studies have suggested that loss of smell could be an early sign of a neurodegenerative disease, such as Alzheimer’s or Parkinson’s disease.

However, a recent study of 1,430 people (average age about 80) showed that 76% of people with anosmia had normal cognitive function at the study’s end.❞

Read more: Harvard Health | Is it normal to lose my sense of smell as I age?

We’d love to look at and cite the paper that they cite, but they didn’t actually provide a source. We did find some others, though:

❝Olfactory capacity declines with aging, but increasing evidence shows that smell dysfunction is one of the early signs of prodromal neurodegenerative diseases such as Alzheimer’s and Parkinson’s disease.

The loss of smell is considered a clinical sign of early-stage disease and a marker of the disease’s progression and cognitive impairment.❞

~ Dr. Irene Fatuzzo et al.

Read more: Neurons, Nose, and Neurodegenerative Diseases: Olfactory Function and Cognitive Impairment

What’s clear is the association; what’s not clear is whether one worsens the other, and what causal role each might play. However, the researchers conclude that both ways are possible, including when there is another, third, underlying potential causal factor:

❝Ongoing studies on COVID-19 anosmia could reveal new molecular aspects unexplored in olfactory impairments due to neurodegenerative diseases, shedding a light on the validity of smell test predictivity of cognitive dementia.

The neuroepithelium might become a new translational research target (Neurons, Nose, and Neurodegenerative diseases) to investigate alternative approaches for intranasal therapy and the treatment of brain disorders. ❞

~ Ibid.

Another study explored the possible mechanisms of action, and found…

❝Olfactory impairment was significantly associated with increased likelihoods of MCI, amnestic MCI, and non-amnestic MCI.

In the subsamples, anosmia was significantly associated with higher plasma total tau and NfL concentrations, smaller hippocampal and entorhinal cortex volumes, and greater WMH volume, and marginally with lower AD-signature cortical thickness.

These results suggest that cerebral neurodegenerative and microvascular lesions are common neuropathologies linking anosmia with MCI in older adults❞

~ Dr. Yi Dong et al.

• MCI = Mild Cognitive Impairment
• NfL = Neurofilament Light [Chain]
• WMH = White Matter Hyperintensity
• AD =Alzheimer’s Disease

Read more: Anosmia, mild cognitive impairment, and biomarkers of brain aging in older adults

How to act on this information

You may be wondering, “this is fascinating and maybe even a little bit frightening, but how is this Saturday’s Life Hacks?”

We wanted to set up the “why” before getting to the “how”, because with a big enough “why”, it’s much easier to find the motivation to act on the “how”.

Test yourself

Or more conveniently, you and a partner/friend/relative can test each other.

Simply do like a “blind taste testing”, but for smell. Ideally these will be a range of simple and complex odors, and commercially available smell test kits will provide these, if you don’t want to make do with random items from your kitchen.

If you’d like to use a clinical diagnostic tool, you can check out:

Clinical assessment of patients with smell and taste disorders

…and especially, this really handy diagnostic flowchart:

Algorithm of evaluation of a patient who has olfactory loss

Train yourself

“Olfactory training” has been the got-to for helping people to regain their sense of smell after losing it due to COVID.

In simple terms, this means simply trying to smell things that “should” have a distinctive odor, and gradually working up one’s repertoire of what one can smell.

You can get some great tips here:

AbScent | Useful Insights Into Smell Training

Hack your training

An extra trick was researched deeply in a recent study which found that multisensory integration helped a) initially regain the ability to smell things and b) maintain that ability later without the cross-sensory input.

What that means: you will more likely be able to smell lemon while viewing the color yellow, and most likely of all to be able to smell lemon while actually holding and looking at a slice of lemon. Having done this, you’re more likely to be able to smell (and distinguish) the odor of lemon later in a blind smell test.

In other words: with this method, you may be able to cut out many months of frustration of trying and failing to smell something, and skip straight to the “re-adding specific smells to my brain’s olfactory database” bit.

Read the study: Olfactory training: effects of multisensory integration, attention towards odors and physical activity

Or if you prefer, here’s a pop-science article based on that:

One in twenty people has no sense of smell—here’s how they might get it back

Take care!

Avoiding/Managing Rheumatoid Arthritis

Arthritis is the umbrella term for a cluster of joint diseases involving inflammation of the joints, hence “arthr-” (joint) “-itis” (suffix used to denote inflammation). These are mostly, but not all, autoimmune diseases, in which the body’s immune system mistakenly attacks our own joints.

Inflammatory vs Non-Inflammatory Arthritis

Arthritis is broadly divided into inflammatory arthritis and non-inflammatory arthritis.

You may be wondering: how does one get non-inflammatory inflammation of the joints?

The answer is, in “non-inflammatory” arthritis, such as osteoarthritis, the damage comes first (by general wear-and-tear) and inflammation generally follows as part of the symptoms, rather than the cause. So the name can be a little confusing. In the case of osteo- and other “non-inflammatory” forms of arthritis, you definitely still want to keep your inflammation at bay as best you can, but it’s not as absolutely critical a deal as it is for “inflammatory” forms of arthritis.

We’ll tackle the beast that is osteoarthritis another day, however.

Today we’re going to focus on…

Rheumatoid Arthritis

This is the most common of the autoimmune forms of arthritis. Some quick facts:

• It affects a little under 1% of the global population, but the older we get, the more likely it becomes
• Early onset of rheumatoid arthritis is most likely to show up around the age of 50 (but it can show up at any age)
• However, incidence (not onset) of rheumatoid arthritis peaks in the 70s age bracket
• It is 2–4 times more common in women than in men
• Approximately one third of people stop work within two years of its onset, and this increases thereafter.

Well, that sounds gloomy.

Indeed it’s not fun. There’s a lot of stiffness and aching of joints (often with swelling too), loss of joint function can be common, and then there are knock-on effects like fatigue, weakness, and loss of appetite.

Beyond that it’s an autoimmune disorder, its cause is not known, and there is no known cure.

Is there any good news?

If you don’t have rheumatoid arthritis at the present time, you can reduce your risk factors in several ways:

• Having an anti-inflammatory diet. Get plenty of fiber, greens, and berries. Fatty fish is great too, as are oily nuts. On the other side of things, high consumption of salt, sugar, alcohol, and red meat are associated with a greater risk of developing rheumatoid arthritis.
• Not smoking. Smoking is bad for pretty much everything, including your chances of developing rheumatoid arthritis.
• Not being obese. This one may be more a matter of correlation than causation, because of the dietary factors (if one eats an anti-inflammatory diet, obesity is less likely), but the association is there.

There are other risk factors that are harder to control, such as genetics, age, sex, and having a mother who smoked.

See: Genetic and environmental risk factors for rheumatoid arthritis

What if I already have rheumatoid arthritis?

If you already have rheumatoid arthritis, it becomes a matter of symptom management.

First, reduce inflammation any (reasonable) way you can. We did a main feature on this before, so we’ll just drop that again here:

Keep Inflammation At Bay

Next, consider the available medications. Your doctor may or may not have discussed all of the options with you, so be aware that there are more things available than just pain relief. To talk about them all would require a whole main feature, so instead, here’s a really well-compiled list, along with explanations about each of them, up to date as of this year:

Rheumatoid Arthritis Medication List (And What They Do, And How)

Finally, consider other lifestyle adjustments to manage your symptoms. These include:

• Exercise—gently, though! You do not want to provoke a flare-up, but you do want to maintain your mobility as best you can. There’s a use-it-or-lose-it factor here. Swimming and yoga are great options, as is tai chi. You may want to avoid exercises that involve repetitive impacts to your joints, like running.
• Rest—while keeping mobility going. Get good sleep at night (this is important), but don’t make your bed your new home, or your mobility will quickly deteriorate.
• Hot & cold—both can help, and alternating them can reduce inflammation and stiffness by improving your body’s ability to respond appropriately to these stimuli rather than getting stuck in an inappropriate-response state of inflammation.
• Mobility aids—if it helps, it helps. Maybe you only need something during a flare-up, but when that’s the case, you want to be as gentle on your body as possible while keeping moving, so if crutches, handrails etc help, then by all means get them and use them.
• Go easy on the use of braces, splints, etc—these can offer short-term relief, but at a long term cost of loss of mobility. Only you can decide where to draw the line when it comes to that trade-off.

You can also check out our previous article:

Managing Chronic Pain (Realistically!)

Take good care of yourself!