The Use of Smell Identification Tests in the Diagnosis of Parkinson’s Disease in Brazil Laura Silveira-Moriyama, MD, 1 Margarete de Jesus Carvalho, MD, 2 Regina Katzenschlager, MD, 3 Aviva Petrie, MSc, CStat, 4 Ronald Ranvaud, PhD, 5 Egberto Reis Barbosa, MD 2 , and Andrew J. Lees, MD 1 * 1 Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, United Kingdom 2 Neurology Department, Sa˜o Paulo School of Medicine, University of Sa˜o Paulo, Sa˜o Paulo, Brazil 3 Department of Neurology, Donauspital/Sozialmedizinisches Zentrum Ost, Vienna, Austria 4 Biostatistics Unit, UCL Eastman Dental Institute, London, United Kingdom 5 Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of Sa˜o Paulo, Sa˜o Paulo, Brazil Abstract: Smell identification tests may be of routine clinical value in the differential diagnosis of PD but are subject to cultural variation and have not been systematically evaluated in the Brazilian population. We have applied culturally adapted translations of the University of Pennsylvania 40- item smell identification test (UPSIT-40) and the 16-item identification test from Sniffin’ Sticks (SS-16) to nonde- mented Brazilian PD patients and controls. Pearson’s correla- tion coefficient between the test scores was 0.76 (95% CI 0.70–0.81, n 5 204, P < 0.001). To calculate reliability measures for each test we used the diagnosis (either PD or control) as outcome variable for separate logistic regression analyses using the score in the UPSIT-40 or the SS-16 as a covariate. The SS-16 specificity was 89.0% with a sensitivity of 81.1% (106 PD and 118 controls). The UPSIT-40 specific- ity was 83.5% and its sensitivity 82.1% (95 PD and 109 con- trols). Regression curves were used to associate an individu- al’s smell test score with the probability of belonging to the PD, as opposed to the control group. Our data provide sup- port for the use of the UPSIT-40 and SS-16 to help distin- guish early PD from controls. Ó 2008 Movement Disorder Society Key words: Parkinson’s disease; UPSIT; smell; Sniffin sticks; olfaction Hyposmia is very common in Parkinson’s disease (PD) and the potential use of smell tests as diagnostic tools is of considerable contemporary interest. 1 Self- reporting of smell dysfunction is regarded as too unreliable as up to 70% 2,3 of PD patients with smell deficits on formal testing have failed to notice it. A significant difference in olfactory evoked potentials between PD and control subjects has been reported 1,4,5 but the interpretation of the findings is not straightforward and the technique is only available in a very small number of dedicated research centers. Standardized, bedside olfaction tests offer a reliable and convenient way to evaluate olfaction. In threshold tests the patient is asked to indicate whether an odor is detected from a given stimulus (a bottle, pen or piece of paper). In discrimination tests the patient is pre- sented with two or more stimuli and is asked whether they emit the same or different smells. In identification tests the patient is asked to name the stimulus, usually from a list of choices. Identification tests are the easi- est to perform and interpret, and have been most widely used in Parkinson’s disease. A shortcoming of odor identification tests, however, is that they are more likely to be affected by cross-cultural differences and as a consequence research results cannot be general- ized. Currently there is no commercially available Potential conflict of interest: None reported Additional Supporting Information may be found in the online ver- sion of this article. *Correspondence to: Prof. Andrew Lees, Reta Lila Weston Insti- tute of Neurological Studies, UCL Institute of Neurology, 1 Wake- field St., London WC1N 1PJ, United Kingdom. E-mail: alees@ion. ucl.ac.uk Received 2 May 2008; Revised 9 June 2008; Accepted 30 June 2008 Published online 10 September 2008 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/mds.22241 2328 Movement Disorders Vol. 23, No. 16, 2008, pp. 2328–2334 Ó 2008 Movement Disorder Society