Smell and Alzheimer’s

Smell, the Most Powerful Memory Trigger

Of our five senses, I believe the sense of smell is underrated and underappreciated. It has the power to evoke memories, imagination, old sentiments, and associations, some good, some not so good. Odors can cause our hearts to beat joyously, or contract with remembered grief and pain.

Relaxing in a lavender patch

Relaxing in a lavender patch

The sense of smell diminishes as we age. Persons in the early stages of Alzheimer’s disease may have subtle problems identifying odors. In fact, as I reported in an earlier blog article, a deteriorating sense of smell may even precede the onset of memory problems, and be a predictor of changes in the brain. We often think of Alzheimer’s as a disease of “memory for words and pictures.” However, it may also be a disease of “memory for sensory information” as well.

The focus of this article is to provide an opportunity to reflect, as family caregivers, on our amazing sense of smell. My mentor and friend, Merle Stern, composed the meditation below. As we pause to appreciate this powerful sense, we will come to a deeper awareness and better understanding of the need for compassion when our loved ones lose this unique sense. Hopefully, it will also help you feel more centered, particularly if it has been a tough day as a caregiver.

Merle shared with me that she remembers her mother telling her that when she went off to university, she was greatly missed. To soothe the void, her mother refrained from laundering Merle’s bed linen so that she could crawl occasionally into Merle’s bed and absorb the smell. Her mother found it soothing and comforting. Years later, when handed a crying baby, Merle took a page from her “mother’s book.”  She took a coat or sweater of the baby’s mother, placed it in her arms, and then took the baby who snuggled up, contented and happy, comforted by the smell of its mother.

With these thoughts in mind, please take a few minutes to find a quiet place and a comfortable position so that you can enter into this meditation without distraction.

Let yourself drift in time and space to a scent that ignites memories you wish to recall. The scent might be that of a person or a place (like a kitchen with a wood burning stove where everyone congregated around the table to share stories.) The scent might be from an object, such as a cup of freshly brewed morning coffee, your favorite perfume that you received as a gift from a loved one, or a special flower that grew in your family’s garden.

Breathe deeply with your eyes open. Imagine fusing yourself with the smell so that it is an extension of you and you are an extension of it. With each breath you inhale as you absorb the scent, you become an extension of it. When you exhale, the scent becomes an extension of you. You become the scent; the scent is your breath. You are recognized by this scent. It is in your pores, your body cells, in your blood, in your being.

Now gently close your eyes. Visualize in your mind’s eye the form your scent has taken. How do you see it? What is the color? Is there a luminous quality? What is the shape? Reach out and touch it, making contact with its shape and texture. It exudes an odor different from the one you chose. As you absorb its color, its luminous quality, its shape, texture, and smell, visualize this new form it now takes within you.

october-22-cup-of-coffee-photo-montage-488177_1280It emerges like a symphony and you can hear music playing, created from all the smells you love such as: chocolate, freshly baked homemade bread, lilacs, lavender, apples, coffee. This symphony of smells breathes new life into you. You revel in the radiance of the smell. You feel your body nourished by it. You wake up in the morning to this smell and fall asleep surrounded by this smell. You begin to feel renewed and ready to evaluate your life as a caregiver.

Take a few moments in quiet reflection. When you feel ready, open your eyes and come back to your surroundings, feeling revived and refreshed.

Spend a few minutes journaling about this experience. At times, we as caregivers might feel like we’re caught up in a whirlwind of emotions and thoughts. Ask yourself the following questions and write down your answers. That way you can come back from time to time and read what you’ve written to re-charge yourself:

  • What is missing in my life at this time? Is it solitude, communion with others, socialization, etc.?
  • How can I be more sensitive to the changing senses that my loved one may be experiencing because of the disease?
  • What can I do to enhance the quality of my life and that of my loved one?
  • What concrete plans will I make to incorporate these finding in my life?
  • Envisage your life emerging from this vantage point. What will it look like?

Our sense of smell is ten thousand times more sensitive than any of our other senses. May we come to appreciate this marvelous wonder of the human body! Helen Keller puts it so beautifully: “Smell is a potent wizard that transports you across thousands of miles and all the years you have lived.”

I wish you peace, patience, and joy in your caregiving today and every day!

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Please feel free to pass on this reflection to family and friends, but please give credit to Merle Stern and this website. I’d love to get your reactions and feedback about the meditation. Just jot me a note in the comments section below.

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If you’d like information about “smell training,” I’d recommend you watch this ten-minute video by Chris Kelly who is affiliated with the Monell Chemical Senses Center: https://youtu.be/wtAkWHN2xhc.

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For an inside look at how a person with dementia experiences the sense of smell, please check out this blog, “Welcome to Dementialand:” https://welcometodementialand.wordpress.com/2016/09/19/what-you-smell-in-dementialand/.

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Alzheimer’s and the Senses Part Three: Smell

Freshly baked cherry pie. Roast turkey. Warm mulled cider. Do the thoughts of these smells have you salivating? Old Spice men’s aftershave lotion (my Dad’s favorite). Skunk spray. Lilacs in bloom. Ammonia. Sweaty clothes. What memories do these odorants arouse? october8-nose-smelling-flower-adult-19033_640

Our incredible sense of smell serves many functions. It is a “portal” to our emotions. It is one of the drivers of what we eat and drink. Our ability to smell alerts us to possible dangers, and is critical to our good health and quality of life.

How Our Sense of Smell Works

The average human being, it is said, can recognize up to 10,000 separate odors. Our human olfactory (smell) system has approximately four hundred different receptors. These enable us to detect and identify thousands of odorants. Odorants are microscopic molecules released by substances around us that become airborne. When we breathe or sniff the air, these odorants are drawn into our nose, entering a complex system of nasal passages.

Lining a portion of these nasal passages is the olfactory epithelium, a thin sheet of mucus-coated sensory tissue located high inside the nose. The odorant molecules we breathe in settle into the mucus, making contact with and stimulating the specialized olfactory sensory cells, called sensory neurons. Each of these forty million different olfactory neurons has one odor receptor. These nerve cells connect directly to the brain.

october-8-nose-chartEach nerve cell has thin threadlike projections called olfactory cilia which float in the mucus. Olfactory cilia contain the molecular wherewithal for detecting and starting the process to recognize the odors, and for generating an electrical signal to be sent to the brain.

Electrical signals are sent to the brain along a thin nerve fiber known as an axon. Axons from the millions of olfactory receptor cells bundle together to form the olfactory nerve. Olfactory receptor cells send electrical messages via the olfactory nerve to the olfactory bulb.

Odor information eventually travels to the limbic system, the part of the brain involved in emotion and memory. Other odor information goes to the olfactory cortex where thought processes take place. Cross-connections between the limbic system and the cortex may be essential in forming our emotionally-laden and lifelong olfactory memories. The odor memories we make as children last many years.

Odorants reach the olfactory sensory cells in two ways: 1) by inhaling through the nose; 2) by chewing our food aromas are released through the channel that connects the roof of the throat to the nose.nose-and-mouth-are-connected This is one reason why, when we are congested due to a sinus infection, flu, or a head cold, this channel is blocked, affecting our ability to smell and taste our food.

Our sense of smell is also influenced by what is called the common chemical sense. This sense involves thousands of nerve endings, especially on the moist surfaces of our eyes, nose, mouth and throat. These nerve endings help us sense irritating substances – like the tear-inducing power of an onion, or the coolness of menthol.

Types of Smell Disorders

According to the National Institutes of Health, Senior Health, there are several types of smell disorders depending on how the sense of smell is affected.

  • Hyposmia occurs when a person’s ability to detect certain odors is reduced.
  • Anosmia is the complete inability to detect odors.
  • Parosmia is a change in the normal perception of odors, such as when the smell of  something familiar is distorted, or when something that normally smells pleasant now smells foul.
  • Phantosmia is the sensation of an odor that isn’t there.

The Importance of Smell  

Our sense of smell can serve as a first warning signal, alerting us to spoiled food, the odor of a natural gas leak or dangerous fumes, the smoke of a fire. When smell is impaired, it can also lead to a change of eating habits. Some people may eat too little and lose weight, or eat too much and gain weight. In severe cases, loss of smell can lead to depression.

Assessments for Loss of Smell

Serious smell loss can be caused by nasal obstruction that requires corrective surgery or by chronic viral infections with swelling that require special medications. Otolaryngologists are physicians who specialize in diseases of the ear, nose, and throat, including problems affecting taste and smell. An accurate assessment of smell loss includes:

  • Physical examination of the ears, nose, and throat.
  • Personal history including exposure to toxic chemicals or trauma.
  • Smell tests.
  • Discussion of treatment options, such as surgery, antibiotics, or steroids.

Alzheimer’s, Dementia and Olfactory Testing

An impaired sense of smell is normal as we age. Older people become less adept at identifying smells. Researchers estimate that more than one-third of adults over age seventy have olfactory deficits.

Losing our sense of smell could be a sign of brain damage. The sense of smell is often the first sense to go in cognitive decline, even before memory loss. It’s not the nose’s sensitivity that diminishes, but the brain’s capability of identifying what the odors are.  However, not all individuals with smell loss will develop a brain-related disorder.

Olfactory testing is gaining attention as researchers are discovering that changes in odor identification and loss of ability to smell may be an early biomarker in identifying Alzheimer’s, Parkinson’s, and other neurodegenerative disorders. Multiple studies have demonstrated a high correlation between Alzheimer’s disease and the presence and build up of beta amyloid protein and tau pathology in the areas of the brain that help us detect and perceive odors.

In one study, researchers at the University of Florida asked over ninety participants to smell a spoonful of peanut butter at a short distance from their nose. Participants included persons with a confirmed early stage Alzheimer’s diagnosis, persons with other forms of dementia, and those who had no cognitive or neurological problems. Only those with a confirmed diagnosis of early stage Alzheimer’s had trouble smelling the peanut butter, with their left nostril. The difference in smell between left and right nostril is unique to the disease. Currently, a smell test is not used as a diagnostic tool, but only to confirm an Alzheimer’s diagnosis. The theory is that, as dementia begins and progresses, the parts of the brain, particularly on the left side, that distinguish odors start to deteriorate. The brain is less capable of identifying smells.

At the 2016 Alzheimer’s Association International Conference in Toronto, researchers at Columbia University Medical Center, New York, reported on a study of 397 participants with an average age of 80. The study tested the predictability of dementia transition and cognitive decline using the 40-item University of Pennsylvania Smell Identification Test (UPSIT). october-8-smell-testThe test involved a scratch-and-sniff test of familiar scents like turpentine, lemon, licorice, and bubble gum. Participants were followed for four years. Their conclusions were that odor identification impairments were predictors of the transition to dementia.

How You Can Help

Smell ensures we maintain our personal hygiene and offers us an essential interaction with the world around us. Smell is essential for giving us pleasure from simple things such as flowers and food. For many people smell also helps to re-create memories.

Declines in the sense of smell are not obvious to detect. Although smell is not directly life threatening, it can still impact one’s quality of life. Nutrition and safety concerns are heavily linked to smell. People who have total or partial loss of the sense of smell are almost twice as likely to have some kinds of accidents than people who have normal smell function: cooking-related accidents; exposure to an undetected fire or gas leak; eating or drinking spoiled foods or toxic substances.

1) A Medical Checkup

Since changes in a person’s smell can occur for numerous reasons, schedule a medical checkup to ensure that there is no tumor, polyps, physical blockage or condition that might require treatment.

2) Preventing a Fire or Gas Leak

Your loved one may not be able to tell or smell that he or she left something burning on the stove or that gas is leaking and causing danger. Place sensors in their houses that can detect and warn of gas or smoke, and ones that can pick up the odor of dangerous airborne chemicals. Make sure smoke detectors are still working and change batteries on a regular basis. There are also items such as the “Fire Avert” detector. This invention detects a stove fire by smoke rather than heat. When triggered by the sound of a smoke detector, it shuts off power to the stove. (See below for description details.)

3) Labels on Bleach and Other Chemicals

Make sure that bottles of bleach, ammonia, and other chemicals are clearly marked in large letters, or kept locked away so they are not mistaken for liquids to drink.

4) Ensuring a Healthy Appetite

About 95% of what we think is taste is actually smell. With loss of smell, foods may taste different or have little or no taste. Plan meals that contain foods with different flavors, spices, and textures (e.g. creamy, crispy, crunchy). october-smell-herbs-restaurant-939436_640Try experimenting with a variety of spices and fresh herbs. To prevent malnutrition, ensure that the food your loved one consumes has appropriate levels of vitamins and nutrients.

5) Marinate Meat and Fish

One way to add a lot of flavor to meats and fish is to soak them in a marinade for a few hours or even overnight. Grocery stores carry a variety of prepared marinades, or you can make your own with simple pantry ingredients. Keep any foods in the refrigerator when they’re being marinated so that they remain safe to eat. Once the food is done marinating, cook it as you usually would and have your loved one try it. It just may be that what they previously couldn’t taste well now tastes great.

6) Preventing Food Spoilage

When shopping for food, try to buy in small portion sizes rather than bulk. If you do buy in bulk, then divide food into one-portion size individually sealed packages to store and cook.  Check the pantry shelves, refrigerator and freezer at least once a week for outdated, moldy and spoiled food.

7) Daily Hygiene

Many persons with smell loss have no idea that they have body or clothing odor, even if they do the “sniff” test. If they realized this, most would be embarrassed. If just the thought of bathing or showering your loved one makes you cringe, take a look below at the California Central Chapter’s recommendations and tips.

Avoid pointing out that clothes they are wearing are dirty or smelly. This puts your loved one on the defensive and could set up an argument. Instead, remove the soiled clothing from their room at night once your loved one is sound asleep. They’ll forget about it the next morning if there’s something else handy to put on. You might also purchase identical outfits, so that one can be washed while the other is worn.

8) Mold and Mildew

When you walk into the home, is there a musty smell? Your loved one may not be able to notice this smell. It is due to mold or mildew which are both fungi spores and could become a health problem. There are cleaning solutions available on the market. Air movement is also important for removing moisture and odors.  

Understanding the loss of one’s sense of smell and its associated problems will surely maximize your loved one’s quality of life, help them retain their independence longer, and even avert a dangerous accident.

I wish you peace, patience, and joy in your caregiving today and every day!

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( Sources used in preparing this article: 1. National Institutes of Health/Senior Health; 2. National Institute on Deafness and Other Communication Disorders; 3. The Monell Chemical Senses Center; 4. Alzheimer’s Association/AAIC.)

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Watch this four-minute TED-Ed animated explanation of our remarkable sense of smell: http://ed.ted.com/lessons/how-do-we-smell-rose-eveleth.

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To read more about the Fire Avert product, go to: http://www.firerescuemagazine.com/articles/print/volume-8/issue-1/professional-development/firefighter-s-invention-stops-kitchen-fires.html. This product is available through the Alzheimer Store. You can get a 10% discount by placing your order through my website: http://caregiverfamilies.com/products/.

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Find good tips on bathing with this newsletter from the California Central Chapter of the Alzheimer’s Association: http://www.alz.org/cacentral/documents/Dementia_Care_32-_The_Battle_of_the_Bathing.pdf.

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Dementia care advocate and trainer, Teepa Snow, has a short video that describes the loss of smell:  https://youtu.be/j9FFLaymycg.

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This four-minute video on problems with smell is by the National Institutes of Health: http://nihseniorhealth.gov/problemswithsmell/aboutproblemswithsmell/video/smell1_na.html?intro=yes.

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