It is clear from this review that olfactory function is markedly altered in old age and in a number of age-related diseases. The deficits appear to be rather general and detectable by several types of olfactory tests. Considerable interindividual variability exists, however, and the physiologic bases of these changes are not clear. In many healthy elderly persons, smell loss appears to occur as a result of one or more causes, including viral insult, cumulated exposure to toxic fumes, head trauma, and calcification of the cribriform plate. Several reviews have appeared suggesting that the olfactory system may be a center of primary involvement in AD. Of particular interest is the hypothesis that environmental agents (related etiologically to the disease process) pass into the central nervous system via the highly active transport mechanisms of the olfactory receptors. This latter notion, although attractive, must be viewed conservatively, as it is possible that the olfactory pathways are simply selectively vulnerable to destruction by various disease processes. This may explain why Huntington's chorea and multiinfarct dementia, in addition to AD and PD, are associated with alterations in smell function. Although it is tempting to assume, as have authors such as Koss et al., that alterations in threshold function reflect peripheral olfactory dysfunction and that alterations in odor identification and other more demanding tasks reflect central olfactory dysfunction, there is little empirical support for such a simple dichotomy. Despite the fact that a peripheral/central distinction is useful in clinical audiology (where threshold loss is commonly associated with CN VIII pathology), an evaluation of the utility of this distinction in olfaction requires further research. The limited data suggest that both identification and detection deficits commonly arise from damage to the olfactory epithelium, even though identification deficits unassociated with detection deficits may occur in some central brain disorders. It is apparent from the studies reviewed in this chapter that considerable progress has been made during the last decade in elucidating the nature and prevalence of olfactory disturbances in elderly patients, as well as in patients with dementia-related diseases.(ABSTRACT TRUNCATED AT 400 WORDS)