In the United States, more than 6.9 million individuals are affected with Alzheimer’s disease (AD) and studies predict the cases will double by 2060. Early identification techniques should be considered since pathological alterations in the brain start appearing 15 to 20 years prior to the onset of symptoms. Research on olfactory impairment holds promise, as it is based on the earliest activation of smell-related brain areas.
Laboratory testing with the University of Pennsylvania Smell Identification Test (UPSIT) and Sniffin’ Sticks shows a potential to predict cognitive decline. The AROMHA Brain Health Test (ABHT) was designed by researchers as a sophisticated electronic olfactory test that can be conducted remotely by patients. A research study explores the utility, scalability, and reliability of ABHT for detecting early stages of cognitive decline.
It is a web-based self-administered test that combines Odor Percept Identification (OPID), Percepts of Odor Episodic Memory (POEM), and Odor Discrimination (OD). The participants conducted an online survey involving consent as they obtained five single-use sniffable odor test cards at home.
The study recruited participants from 21 U.S. states and Puerto Rico through The Massachusetts Alzheimer’s Disease Research Center and clinical trials and online ads. A total of 180 participants were registered in the study divided into three groups: 127 cognitively normal (CN), 34 with subjective cognitive concerns (SCC), and 19 with mild cognitive impairment (MCI) combined with severe cognitive impairment.
Participants were required to identify ‘sniff the sniff task’ from formerly detected scents with the strength and recollection of past farmland spaces. Data were collected on HIPAA-compliant cloud systems allowing researchers to run statistical analyses using R software. As part of the overall data analysis framework t-tests and Wilcoxon rank sum tests and ANCOVAs were included.
Researchers found that test results of those observed through Zoom and in-person demonstrations matched those who provided tests without observation, confirming that implementing remote self-testing is effective. Results of the test indicated that performance was equivalent between participants speaking English and Spanish, showing its universal applicability across linguistic groups.
The performance metrics worse-oriented with age were well in accordance with previously reported reductions in test scores for olfactory detection performance, notably in OPID9, OPID18, OD10 and POEM metrics. People with anosmia scored significantly lower than healthy controls on all subtested olfactory tests, making this test more sensitive to those with full-blown anosmia than the other studies.
Compared to CN and SCC status participants, MCI participants had statistically lower OPID and OD10 scores. With adjustment for participant demographics the power to distinguish between cognitive impairment and normal function through ABHT remained significant.
The study demonstrates that ABHT is a suitable technique for the assessment of olfactory capacities in studies of cognitive health. The research results suggest an association between impaired olfactory performance and brain function decline whereas they confirm previous findings of relationships between lack of olfaction and neurodegenerative brain diseases.
Since ABHT testing can be delivered remotely, it enables wide access to older adults even in the long term with limited access to testing facilities. Laboratory studies show that self-screening digital tools are feasible for older users because participants aged 95 years and older successfully completed the test.
This test marks a critical discovery for the identification of Alzheimer’s disease at the preclinical stage. This unsupervised, remote, self-administrated olfactory test enables users to identify someone undergoing cognitive decline in a convenient manner. Researchers proved the feasibility of stand-alone odor tests in residences which facilitates initiating early treatment strategies to improve outcomes of Alzheimer’s disease. More research will also allow for better prediction and broad application of ABHT within new diagnostic frameworks.
References:
Jobin B, Magdamo C, Delphus D, et al. The AROMHA brain health test is a remote olfactory assessment to screen for cognitive impairment. Sci Rep. 2025;15:9290. The AROMHA brain health test is a remote olfactory assessment to screen for cognitive impairment | Scientific Reports
