Olfactory Stimulation and the Diagnosis of Patients With Disorders of Consciousness: A Double-Blind, Randomized Clinical Trial

Jing Wang; Shaoming Zhang; Wenbin Liu; Yao Zhang; Zhouyao Hu; Ziwei Sun; Haibo Di

doi:10.3389/fnins.2022.712891

Olfactory Stimulation and the Diagnosis of Patients With Disorders of Consciousness: A Double-Blind, Randomized Clinical Trial

Front Neurosci. 2022 Feb 17:16:712891. doi: 10.3389/fnins.2022.712891. eCollection 2022.

Authors

Jing Wang^{1

2}, Shaoming Zhang², Wenbin Liu², Yao Zhang², Zhouyao Hu¹, Ziwei Sun¹, Haibo Di¹

Affiliations

¹ International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China.
² Shanghai Yongci Rehabilitation Hospital, Shanghai, China.

Abstract

Objectives: The aim of this study was to determine whether behavioral responses elicited by olfactory stimulation are a predictor of conscious behavioral response and prognosis of patients with disorders of consciousness (DOC).

Methods: Twenty-three DOC patients (8 unresponsive wakefulness syndrome [UWS]; 15 minimally conscious state [MCS]) were recruited for this study in which 1-Octen-3-ol (familiar neutral odor) and pyridine were used to test odor behavioral responses, and water was used as an odorless stimulus. One rater presented the three odors in front of each patient's nose randomly, and another one videotaped all behavioral responses (e.g., pouting, wrinkling nose, slightly shaking head, frowning, etc.). Two independent raters, blind to the stimuli and the patient's diagnosis, gave the behavioral results according to the recorded videos. One-, 3-, and 6-month follow-up evaluations were conducted to obtain a good prognostic value.

Results: All MCS patients showed behavioral responses to the 1-Octen-3-ol stimulus; nine MCS and one UWS showed olfactory emotional responses to the pyridine, and two MCS showed olfactory emotional responses to the water stimulus. The incidence of behavioral response was significantly higher using 1-Octen-3-ol than it was for water by McNemar test (p < 0.001), significantly higher using pyridine than it was for water (p < 0.01). The χ² test results indicated that there were significant differences between MCS and UWS to 1-Octen-3-ol (p < 0.001). For MCS patients, the incidence of behavioral response was no different between using 1-Octen-3-ol and pyridine (p > 0.05). There was no significant relationship between the olfactory behavioral response and the improvement of consciousness based on the χ² test analysis (p > 0.05).

Conclusion: Olfactory stimuli, especially for the familiar neutral odor, might be effective for eliciting a conscious behavioral response and estimating the clinical diagnosis of DOC patients.

Clinical trial registration: [https://clinicaltrials.gov/ct2/show/NCT03732092], [identifier NCT03732092].

Keywords: diagnosis; disorders of consciousness; minimally conscious state; olfactory stimulation; prognosis.

Associated data

ClinicalTrials.gov/NCT03732092