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Performance of a smell identification test versus the Mini-Mental Status Exam for the detection of dementia and cognitive impairment among persons with cognitive concerns in primary care
Jose Alejandro Luchsinger, Jeanne A. Teresi, Lenfis Valdez, Dahiana Rosario, Maria de Miguel, Delphine Taylor, Jessica R. Singer, Nancy Chang et al.. Journal of Alzheimer s Disease, 2025-05-21
Topic: Risk, prevention and care in population studies
BackgroundOdor identification deficits predict Alzheimer's disease (AD) in epidemiological studies.ObjectiveTo compare the accuracy of a short odor identification test with a short cognitive screening test for the detection of dementia and cognitive impairment in elderly persons with cognitive concerns.MethodsThis was a cross-sectional study of 600 participants 65 years and older, without known mild cognitive impairment (MCI) or dementia, with cognitive concerns, attending primary care practices in New York City. The odor identification test was the Brief Smell Identification Test (BSIT). The comparator test was the Mini Mental Status Exam II (MMSE). Cognitive diagnoses were made using the National Alzheimer's Coordinating Center Uniform Data set (NACC-UDS) version 3 forms with slight modifications. Test performance was compared using Receiver Operating Characteristic analyses.ResultsThe mean age was 72.65 ± 6.31 years, 73.3% were female, 63.3% were Hispanic, 13.5% non-Hispanic Black, and 20.8% non-Hispanic White; 23.5% were classified as normal cognition, 27.7% as cognitive impairment-not mild cognitive impairment (MCI), 31.2% as amnestic MCI, 5.7% as non-amnestic MCI, and 12% as dementia. The MMSE was superior to the BSIT in detecting dementia and any cognitive impairment. Combining abnormal scores in the BSIT (≤8) to MMSE (≤24) improved the MMSE's specificity and positive predictive value (PPV) in detecting cognitive impairment.ConclusionsThe MMSE was superior to the BSIT in detecting dementia and cognitive impairment in primary care but using both tests improved specificity and PPV for identifying persons with subjective complaints needing further cognitive and biomarker evaluation.
Key findings
- The comparator test was the Mini Mental Status Exam II (MMSE).
- Cognitive diagnoses were made using the National Alzheimer's Coordinating Center Uniform Data set (NACC-UDS) version 3 forms with slight modifications.
- Test performance was compared using Receiver Operating Characteristic analyses.ResultsThe mean age was 72.65 ± 6.31 years, 73.3% were female, 63.3% were Hispanic, 13.5% non-Hispanic Black, and 20.8% non-Hispanic White; 23.5% were classified as normal cognition, 27.7% as cognitive impairment-not mild cognitive impairment (MCI), 31.2% as amnestic MCI, 5.7% as non-amnestic MCI, and 12% as dementia.
- The MMSE was superior to the BSIT in detecting dementia and any cognitive impairment.
- Combining abnormal scores in the BSIT (≤8) to MMSE (≤24) improved the MMSE's specificity and positive predictive value (PPV) in detecting cognitive impairment.ConclusionsThe MMSE was superior to the BSIT in detecting dementia and cognitive impairment in primary care but using both tests improved specificity and PPV for identifying persons with subjective complaints needing further cognitive and biomarker evaluation.
Why it matters
In 600 primary care patients aged 65 and older with cognitive concerns, the MMSE was better than a brief smell identification test at detecting dementia and cognitive impairment, though combining an abnormal smell score with the MMSE improved specificity. This compares screening tests and does not address treating, curing or preventing Alzheimer's disease.
Study details
- Study designcross-sectional
- Participants600
- Effect size73.3%; 63.3%; 13.5%
- Evidence strengthLow
How this study scored 48/100
Published in a peer-reviewed journal, and it is a snapshot of people at one point in time. Scored zero for randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of Alzheimer s Disease) |
| Journal's citation record | 2 / 4 | Journal of Alzheimer s Disease: journal h-index 218 (OpenAlex, 2026-10-29) |
| Study design | 4 / 12 | A snapshot of people at one point in time |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 2 / 4 | 600 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 1 / 7 | Cited 1 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.3 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 1 / 6 | Cited 0.6× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 1 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Davangere P. Devanand: h-index 59 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | Columbia University: institution h-index 1,824 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 4 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 40397401) |
| Free to read | 2 / 2 | Free to read |
| Total | 48 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
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APA 7th
Luchsinger, J. A., Teresi, J. A., Valdez, L., Rosario, D., de Miguel, M., Taylor, D., et al. (2025). Performance of a smell identification test versus the Mini-Mental Status Exam for the detection of dementia and cognitive impairment among persons with cognitive concerns in primary care. Journal of Alzheimer s Disease. https://doi.org/10.1177/13872877251345083
Vancouver
Luchsinger JA, Teresi JA, Valdez L, Rosario D, de Miguel M, Taylor D, et al. Performance of a smell identification test versus the Mini-Mental Status Exam for the detection of dementia and cognitive impairment among persons with cognitive concerns in primary care. Journal of Alzheimer s Disease. 2025. doi:10.1177/13872877251345083. PMID: 40397401.
BibTeX
@article{luchsinger2025-40397401,
author = {Luchsinger, Jose Alejandro and Teresi, Jeanne A. and Valdez, Lenfis and Rosario, Dahiana and de Miguel, Maria and Taylor, Delphine and Singer, Jessica R. and Chang, Nancy and others},
title = {{Performance of a smell identification test versus the Mini-Mental Status Exam for the detection of dementia and cognitive impairment among persons with cognitive concerns in primary care}},
journal = {Journal of Alzheimer s Disease},
year = {2025},
doi = {10.1177/13872877251345083},
pmid = {40397401},
url = {https://doi.org/10.1177/13872877251345083}
}
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