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Introduction Basic studies suggest that olfactory dysfunction and functional near-infrared spectroscopy (fNIRS) can be used as tools for the diagnosis of mild cognitive impairment (MCI); however, real-world evidence is lacking. We investigated the potential diagnostic efficacy of olfactory-stimulated fNIRS for early detection of MCI and/or Alzheimer disease (AD). Methods We conducted a patient-level, single-group, diagnostic interventional trial involving elderly volunteers (age &gt;60 years) suspected of declining cognitive function. Patients received open-label olfactory-stimulated fNIRS for measurement of oxygenation difference in the orbitofrontal cortex. All participants underwent amyloid PET, MRI, Mini-Mental State Examination (MMSE), and Seoul Neuropsychological Screening Battery (SNSB). Results Of 97 subjects, 28 (28.9%) were cognitively normal, 32 (33.0%) had preclinical AD, 21 (21.6%) had MCI, and 16 (16.5%) had AD. Olfactory-stimulated oxygenation differences in the orbitofrontal cortex were associated with cognitive impairment; the association was more pronounced with cognitive severity. Olfactory-stimulated oxygenation difference was associated with MMSE (adjusted  β  [ aβ ] 1.001; 95%  CI  0.540−1.463), SNSB language and related function ( aβ , 1.218; 95%  CI , 0.020−2.417), SNSB memory ( aβ , 1.963; 95%  CI , 0.841−3.084), SNSB frontal/executive function ( aβ , 1.715; 95%  CI , 0.401−3.029) scores, standard uptake value ratio from amyloid PET ( aβ , −10.083; 95%  CI , −19.063 to −1.103), and hippocampal volume from MRI ( aβ , 0.002; 95%  CI , 0.001−0.004). Olfactory-stimulated oxygenation difference in the orbitofrontal cortex was superior in diagnosing MCI and AD (AUC, 0.909; 95%  CI , 0.848−0.971), compared to amyloid PET (AUC, 0.793; 95%  CI , 0.694−0.893) or MRI (AUC, 0.758; 95%  CI , 0.644−0.871). Discussion Our trial showed that olfactory-stimulated oxygenation differences in the orbitofrontal cortex detected by fNIRS were associated with cognitive impairment and cognitive-related objectives. This novel approach may be a potential diagnostic tool for patients with MCI and/or AD. Trial registration CRIS number,  KCT0006197 .

alzheimer's research and therapy

Novel diagnostic tools for identifying cognitive impairment using olfactory-stimulated functional near-infrared spectroscopy: patient-level, single-group, diagnostic trial