1 00:00:06,392 --> 00:00:08,361 >> OKAY. SEE WE'RE AT ONE 2 00:00:08,361 --> 00:00:10,229 O'CLOCK. GOOD AFTERNOON, 3 00:00:10,229 --> 00:00:11,898 EVERYONE. HAPPY SUMMER TO ALL OF 4 00:00:11,898 --> 00:00:14,767 YOU. MY NAME IS MARK STEVE STEV. 5 00:00:14,767 --> 00:00:16,335 I'M EXECUTIVE OFFICER NATIONAL 6 00:00:16,335 --> 00:00:17,937 INSTITUTE ON DEAFNESS AND OTHER 7 00:00:17,937 --> 00:00:19,739 COMMUNICATION DISORDERS HERE AT 8 00:00:19,739 --> 00:00:20,973 THE NATIONAL INSTITUTES OF 9 00:00:20,973 --> 00:00:23,543 HEALTH. ON BEHALF OF NIDCD 10 00:00:23,543 --> 00:00:28,080 DIRECTOR DR. DEBRA TUCI WELCOME 11 00:00:28,080 --> 00:00:29,549 TO OUR NIDCD BEYOND THE LAB 12 00:00:29,549 --> 00:00:31,751 SERIES. TODAY'S TALK CAN YOU 13 00:00:31,751 --> 00:00:34,353 SMELL THAT? SMELL IS A BIOMARKER 14 00:00:34,353 --> 00:00:36,556 OF BRAIN HEALTH AND QUALITY OF 15 00:00:36,556 --> 00:00:39,025 LIFE, WILL GIVE US INSIGHT INTO 16 00:00:39,025 --> 00:00:41,027 THIS IMPACT OF SMELL ON GENERAL 17 00:00:41,027 --> 00:00:42,795 HEALTH AND QUALITY OF LIFE AND 18 00:00:42,795 --> 00:00:45,064 THE EMERGING RESEARCH THAT AIMS 19 00:00:45,064 --> 00:00:47,967 TO IMPROVE SYMPTOMS AND THOSE 20 00:00:47,967 --> 00:00:50,970 SUFFERING WITH AN OLFACTORY 21 00:00:50,970 --> 00:00:52,338 DYSFUNCTION. NIDCD'S MISSION IS 22 00:00:52,338 --> 00:00:54,040 TO SUPPORT RESEARCH AND RESEARCH 23 00:00:54,040 --> 00:00:55,908 TRAINING IN THE NORMAL AND 24 00:00:55,908 --> 00:00:58,511 DISORDER PROCESSES OF HEARING, 25 00:00:58,511 --> 00:01:02,481 BALANCE, TASTE, SMELL, VOICE, 26 00:01:02,481 --> 00:01:03,950 SPEECH AND LANGUAGE AND TO 27 00:01:03,950 --> 00:01:05,351 SUPPORT BIOMEDICAL AND 28 00:01:05,351 --> 00:01:06,886 BEHAVIORAL RESEARCH THAT WILL 29 00:01:06,886 --> 00:01:08,354 IMPROVE THE LIVES OF MILLIONS OF 30 00:01:08,354 --> 00:01:11,924 PEOPLE WITH THESE DISORDERS. NOW 31 00:01:11,924 --> 00:01:15,127 FOR TODAY'S SPEAKER SERIES. 32 00:01:15,127 --> 00:01:16,996 BEYOND LAB LECTURE SERIES IS 33 00:01:16,996 --> 00:01:18,030 OPPORTUNITY FOR EVERYONE INSIDE 34 00:01:18,030 --> 00:01:21,000 AND OUTSIDE THE NIH INCLUDING 35 00:01:21,000 --> 00:01:23,035 ADMINISTRATIVE STAFF, SUPPORT 36 00:01:23,035 --> 00:01:25,137 STAFF, SCIENTISTS AND THE PUBLIC 37 00:01:25,137 --> 00:01:28,241 TO LEARN ABOUT NIDCD'S RESEARCH 38 00:01:28,241 --> 00:01:29,675 PLEASE NOTE THAT WE EXPECT TO 39 00:01:29,675 --> 00:01:31,544 HAVE A FEW MINUTES AFTER THE 40 00:01:31,544 --> 00:01:32,979 PRESENTATION FOR OUR SPEAKER, 41 00:01:32,979 --> 00:01:34,447 DR. LEVY, TO ANSWER YOUR 42 00:01:34,447 --> 00:01:36,682 QUESTIONS FOR TODAY. NOW I 43 00:01:36,682 --> 00:01:40,453 WOULD LIKE TO INTRODUCE DR. LISA 44 00:01:40,453 --> 00:01:43,856 CUNNINGHAM NIDCD SCIENTIFIC 45 00:01:43,856 --> 00:01:45,324 DIRECTOR SHE LEADS THE DIVISION 46 00:01:45,324 --> 00:01:47,393 OF INTRAMURAL RESEARCH WHICH 47 00:01:47,393 --> 00:01:50,229 CONDUCTS BASIC AND CLINICAL 48 00:01:50,229 --> 00:01:50,896 RESEARCH AND HUMAN 49 00:01:50,896 --> 00:01:52,632 COMMUNICATION. SHE WILL 50 00:01:52,632 --> 00:01:54,400 INTRODUCE TODAY'S SPEAKER DR. 51 00:01:54,400 --> 00:01:55,901 JOSH LEVY, AND AT THIS MOMENT I 52 00:01:55,901 --> 00:01:57,336 WOULD LIKE TO ASK YOU TO PLEASE 53 00:01:57,336 --> 00:01:59,872 JOIN ME IN WELCOMING DR. 54 00:01:59,872 --> 00:02:01,941 CUNNINGHAM TO THE PODIUM. 55 00:02:01,941 --> 00:02:06,979 [APPLAUSE] 56 00:02:06,979 --> 00:02:09,048 >> THANK YOU, VERY MUCH MARK. 57 00:02:09,048 --> 00:02:10,549 THANK YOU TO EVERYONE FOR 58 00:02:10,549 --> 00:02:11,584 JOINING US TODAY. IT IS MY 59 00:02:11,584 --> 00:02:13,352 PLEASURE TO WELCOME YOU TO 60 00:02:13,352 --> 00:02:15,354 TODAY'S BEYOND THE LAB TALK, 61 00:02:15,354 --> 00:02:17,256 FROM DR. JOSH LEVY IMPACT OF 62 00:02:17,256 --> 00:02:18,624 SMELL ON OUR HEALTH AND OUR 63 00:02:18,624 --> 00:02:21,694 EVERY DAY QUALITY OF LIFE. AS 64 00:02:21,694 --> 00:02:23,629 MARK MENTIONED NIDCD DEVELOPED 65 00:02:23,629 --> 00:02:24,997 THIS SPEAKER SERIESES WITH THE 66 00:02:24,997 --> 00:02:26,299 GOAL OF TAKING WHAT WE ARE 67 00:02:26,299 --> 00:02:27,933 DISCOVERING IN THE LAB OR CLINIC 68 00:02:27,933 --> 00:02:30,336 AND SHARING THAT INFORMATION 69 00:02:30,336 --> 00:02:32,905 WITH BOTH SCIENTIFIC AND 70 00:02:32,905 --> 00:02:34,140 NON-SCIENTIFIC STAFF AT NIH 71 00:02:34,140 --> 00:02:35,274 INTERESTED COMMUNITY MEMBERS, 72 00:02:35,274 --> 00:02:37,043 PATIENTS AND THEIR FAMILIES, 73 00:02:37,043 --> 00:02:38,944 ADVOCATES AND HEALTH 74 00:02:38,944 --> 00:02:40,813 PROFESSIONALS. WE HOPE SHARING 75 00:02:40,813 --> 00:02:42,281 SCIENTIFIC ADVANCES IN OUR 76 00:02:42,281 --> 00:02:44,617 MISSION AREAS HELPS STAFF AND 77 00:02:44,617 --> 00:02:45,985 COMMUNITY COME AWAY WITH A 78 00:02:45,985 --> 00:02:47,620 GREATER UNDERSTANDING OF HOW WE 79 00:02:47,620 --> 00:02:49,655 ARE ADVANCING SCIENCE AND 80 00:02:49,655 --> 00:02:51,290 ULTIMATELY HELPING PEOPLE AND 81 00:02:51,290 --> 00:02:53,192 THEIR FAMILIES. WE ALL PLAY A 82 00:02:53,192 --> 00:02:55,828 ROLE IN PUBLIC HEALTH. NOW I GET 83 00:02:55,828 --> 00:02:57,396 TO TELL YOU ABOUT OUR SPEAKER 84 00:02:57,396 --> 00:03:00,566 TODAY. DR. JOSH LEVY. JOSH IS A 85 00:03:00,566 --> 00:03:02,368 BETHESDA NATIVE AND HIS FIRST 86 00:03:02,368 --> 00:03:03,836 RESEARCH EXPERIENCE WAS RIGHT 87 00:03:03,836 --> 00:03:06,372 HERE AT NIH. SO I WANT OUR 88 00:03:06,372 --> 00:03:08,708 TRAINEES TO NOTICE DR. LEVY'S 89 00:03:08,708 --> 00:03:09,942 FIRST RESEARCH EXPERIENCE AS 90 00:03:09,942 --> 00:03:12,478 SUMMER TRAINEE, HE SPENT THREE 91 00:03:12,478 --> 00:03:14,080 SUMMERS AT THE NIH I BELIEVE IT 92 00:03:14,080 --> 00:03:15,748 WAS TWO SUMMERS IN HIGH SCHOOL, 93 00:03:15,748 --> 00:03:20,019 AND ONE SUMMER AS UNDERGRAD. AND 94 00:03:20,019 --> 00:03:21,687 ADDITIONALLY HE WORKED 95 00:03:21,687 --> 00:03:22,621 AFTERNOONS THROUGHOUT HIS SENIOR 96 00:03:22,621 --> 00:03:23,956 YEAR IN HIGH SCHOOL AND JOSH 97 00:03:23,956 --> 00:03:25,858 TELLS ME HIS RESEARCH EXPERIENCE 98 00:03:25,858 --> 00:03:28,260 HERE AT NIH AND DR. (INAUDIBLE) 99 00:03:28,260 --> 00:03:29,929 LAB SHAPED HIS CAREER AS A 100 00:03:29,929 --> 00:03:33,032 PHYSICIAN SCIENTIST. DR. LEVY 101 00:03:33,032 --> 00:03:34,600 COMPLETED HIS MEDICAL AND PUBLIC 102 00:03:34,600 --> 00:03:36,702 HEALTH TRAINING AT TULANE 103 00:03:36,702 --> 00:03:38,170 UNIVERSITY NEW ORLEANS, WHERE HE 104 00:03:38,170 --> 00:03:42,341 ALSO COMPLETED HIS RESIDENCY IN 105 00:03:42,341 --> 00:03:45,644 OTO LAYER GONG. HE COMPLETED 106 00:03:45,644 --> 00:03:48,447 FELLOWSHIP IN SINUS AND SKULL 107 00:03:48,447 --> 00:03:50,282 BASED SURGERY IN PORTLAND. HE 108 00:03:50,282 --> 00:03:51,751 THEN SERVED ASSOCIATE PROFESSOR 109 00:03:51,751 --> 00:03:53,519 AND ASSOCIATE VICE CHAIR 110 00:03:53,519 --> 00:03:55,755 RESEARCH DEPARTMENT OF OTO 111 00:03:55,755 --> 00:03:57,323 LARYNGOLOGY, HEAD AND NECK 112 00:03:57,323 --> 00:03:58,491 SURGERY EMORY UNIVERSITY 113 00:03:58,491 --> 00:04:00,593 ATLANTA. HE JOINED THE NIDCD AS 114 00:04:00,593 --> 00:04:03,129 CLINICAL DIRECTOR IN APRIL 23 115 00:04:03,129 --> 00:04:05,231 AND HIS RESEARCH FOCUSES ON 116 00:04:05,231 --> 00:04:06,365 ESTABLISHING INNOVATIVE CLINICAL 117 00:04:06,365 --> 00:04:07,933 TRIALS RELATED TO HEARING SMELL 118 00:04:07,933 --> 00:04:09,402 AND OTHER COMMUNICATION 119 00:04:09,402 --> 00:04:11,404 DISORDERS. HE IS THE CO-FOUNDER 120 00:04:11,404 --> 00:04:13,072 ALONG WITH DR. POLY JOSEPH 121 00:04:13,072 --> 00:04:14,640 NATIONAL SMELL AND TASTE CENTER 122 00:04:14,640 --> 00:04:18,544 WHICH OPENED ONE YEAR AGO TODAY 123 00:04:18,544 --> 00:04:20,546 JULY 9. DR. LEVY WILL TELL ABOUT 124 00:04:20,546 --> 00:04:21,881 HIS RESEARCHING ON SMELL WHICH 125 00:04:21,881 --> 00:04:23,115 IS A FOUNDATIONAL SENSE THAT 126 00:04:23,115 --> 00:04:26,218 ALLOWS US TO INTERACT WITH THE 127 00:04:26,218 --> 00:04:27,787 OUTSIDE WORLD. HOWEVER OUR SENSE 128 00:04:27,787 --> 00:04:29,555 OF SMELL DECLINES WITH AGE AND 129 00:04:29,555 --> 00:04:31,223 LOSS OF SMELL IS ASSOCIATED WITH 130 00:04:31,223 --> 00:04:32,792 OVER A HUNDRED UNIQUE MEDICAL 131 00:04:32,792 --> 00:04:34,527 CONDITIONS. SO I LOOK FORWARD TO 132 00:04:34,527 --> 00:04:35,895 LEARNING MORE FROM JOSH ABOUT 133 00:04:35,895 --> 00:04:37,430 THAT TODAY. THANK YOU FOR 134 00:04:37,430 --> 00:04:39,732 JOINING US. I HOPE YOU ENJOY 135 00:04:39,732 --> 00:04:41,233 TODAY'S TALK AND LET'S WELCOME 136 00:04:41,233 --> 00:04:44,837 JOSH. 137 00:04:44,837 --> 00:04:49,074 [APPLAUSE] 138 00:04:49,074 --> 00:04:51,777 >> THANK YOU SO O MUCH, MARK, 139 00:04:51,777 --> 00:04:54,447 LISA. I'M ABSOLUTELY THRILLED TO 140 00:04:54,447 --> 00:04:56,682 BE HERE. A SMALL ANECDOTE IS I 141 00:04:56,682 --> 00:05:00,319 LEARNED EARLY ON AS A SCIENTIST 142 00:05:00,319 --> 00:05:03,289 OUR WORK OUR DISCOVER IS RISK 143 00:05:03,289 --> 00:05:06,826 BEING COMPLETELY USELESS UNLESS 144 00:05:06,826 --> 00:05:08,627 IF WE COMMUNICATE AND WE TEACH 145 00:05:08,627 --> 00:05:10,830 OTHERS NOT ONLY WHAT WE ARE 146 00:05:10,830 --> 00:05:12,731 DISCOVERING BUT WHY WE ARE 147 00:05:12,731 --> 00:05:15,034 DISCOVERING IT. THIS SEMINAR 148 00:05:15,034 --> 00:05:16,902 SERIES IS MY OPPORTUNITY, 149 00:05:16,902 --> 00:05:20,039 SEMINAR TODAY TO SHARE WITH YOU 150 00:05:20,039 --> 00:05:24,877 WHAT AND THE WHY WHY AM I HERE 151 00:05:24,877 --> 00:05:28,948 AND SO DARN PROUD TO BE PART OF 152 00:05:28,948 --> 00:05:29,815 THIS TEAM. TIMS CLOSURES ARE 153 00:05:29,815 --> 00:05:31,851 HERE. THE MOST RELEVANT PART TO 154 00:05:31,851 --> 00:05:35,387 KNOW IS I'M A TRAINED SINUS 155 00:05:35,387 --> 00:05:37,356 SURGEON THAT INFORMS THE CARTOON 156 00:05:37,356 --> 00:05:39,492 AND MY SENSE OF HUMOR. THIS 157 00:05:39,492 --> 00:05:40,593 SHOULD BE AS INTERACTIVE AS 158 00:05:40,593 --> 00:05:43,362 POSSIBLE. I'M HAPPY TO ANSWER 159 00:05:43,362 --> 00:05:45,931 ANY QUESTIONS ALONG THE WAY AT 160 00:05:45,931 --> 00:05:49,034 THE END, ET CETERA. SO I WOULD 161 00:05:49,034 --> 00:05:51,237 LIKE TO START WITH A FEW PATIENT 162 00:05:51,237 --> 00:05:53,339 EXAMPLES TO GIVE YOU SOME 163 00:05:53,339 --> 00:05:56,141 CONTEXT OF THE WHY. WHY DO WE 164 00:05:56,141 --> 00:05:57,910 STUDY SMELL. THIS IS FROM MY 165 00:05:57,910 --> 00:05:59,812 PRIOR PRACTICE IN ATLANTA AND 166 00:05:59,812 --> 00:06:02,348 YOU CAN SEE THE TIME FRAME IS 167 00:06:02,348 --> 00:06:06,118 QUITE MOMENT US FOR ALL OF US. 168 00:06:06,118 --> 00:06:07,920 MARCH 2020, THERE WERE RUMORS 169 00:06:07,920 --> 00:06:09,488 GOING AROUND THE HOSPITAL, GROUP 170 00:06:09,488 --> 00:06:11,924 OF PHYSICIANS JUST RETURNED FROM 171 00:06:11,924 --> 00:06:15,027 INTERNATIONAL WORK IN ASIA, ALL 172 00:06:15,027 --> 00:06:16,095 OF WHICH COMPLAINED OF A 173 00:06:16,095 --> 00:06:19,164 DISTURBANCE OF SMELL AN TASTE. 174 00:06:19,164 --> 00:06:21,166 NO OTHER TYPICAL VIRAL SYMPTOMS 175 00:06:21,166 --> 00:06:23,936 AS WE THOUGHT OF IT AT THE TIME 176 00:06:23,936 --> 00:06:25,704 JUST ONE MONTH LATER I WAS 177 00:06:25,704 --> 00:06:28,607 TAKING CALL FOR OUR EMERGENCY 178 00:06:28,607 --> 00:06:30,576 ROOM, AND THANKFULLY A FRIEND 179 00:06:30,576 --> 00:06:32,411 WORKING IN THE ER AND HE CALLS 180 00:06:32,411 --> 00:06:34,747 ME. SAYS I HAVE AN 18-YEAR-OLD 181 00:06:34,747 --> 00:06:37,082 SITTING OUR IN THE WAITING ROOM. 182 00:06:37,082 --> 00:06:40,953 NOT ISOLATED. SHE'S VERY 183 00:06:40,953 --> 00:06:42,454 HEALTHY, VERY SMART, SAYS SHE 184 00:06:42,454 --> 00:06:44,557 HAS INFECTIOUS LOSS OF SMELL. 185 00:06:44,557 --> 00:06:48,727 WOULD YOU LIKE TO COME SEE HER? 186 00:06:48,727 --> 00:06:49,995 I SAID ABSOLUTELY NO, I WOULD 187 00:06:49,995 --> 00:06:53,032 NOT. I THINK THERE'S SOMETHING 188 00:06:53,032 --> 00:06:55,501 GOING ON AND AS A FIELD WE 189 00:06:55,501 --> 00:06:56,769 HAVEN'T FUNDAMENTALLY CONNECTED 190 00:06:56,769 --> 00:06:59,405 THE DOTS. THE REST OF THAT STORY 191 00:06:59,405 --> 00:07:03,509 IS HISTORY. BUT THERE ARE OTHER 192 00:07:03,509 --> 00:07:05,311 VERY IMPORTANT EXAMPLES THAT 193 00:07:05,311 --> 00:07:07,479 EXTEND WELL BEYOND VIRAL 194 00:07:07,479 --> 00:07:10,115 ILLNESS. THIS WAS A PATIENT I 195 00:07:10,115 --> 00:07:13,819 SAW IN CLINIC. 70-YEAR-OLD MALE, 196 00:07:13,819 --> 00:07:17,289 OTHERWISE HEALTHY, WITH SLOWLY 197 00:07:17,289 --> 00:07:18,924 WORSENING SENSE OF SMELL. THIS 198 00:07:18,924 --> 00:07:23,596 WAS GOING FOR TWO YEARS. ONE OF 199 00:07:23,596 --> 00:07:24,730 THE THINGS TO KEEP IN MANY MIND 200 00:07:24,730 --> 00:07:26,732 WE WILL TALK ABOUT THIS A BIT, 201 00:07:26,732 --> 00:07:29,501 AS WE AGE IT IS EXPECTED THAT 202 00:07:29,501 --> 00:07:31,637 SMELL DECLINES TO A CERTAIN 203 00:07:31,637 --> 00:07:33,639 EXTENT. IT IS A CONFOUNDER THAT 204 00:07:33,639 --> 00:07:36,275 MAKES DIAGNOSIS REALLY 205 00:07:36,275 --> 00:07:38,777 DIFFICULT. HE HAD NO OTHER 206 00:07:38,777 --> 00:07:41,313 FINDINGS. IS THIS AN EARLY 207 00:07:41,313 --> 00:07:42,781 PRESENTATION OF MORE SEVERE 208 00:07:42,781 --> 00:07:45,784 DISEASE? OR IS THIS COMPLETELY 209 00:07:45,784 --> 00:07:47,620 NORMAL? WE DON'T HAVE THE 210 00:07:47,620 --> 00:07:50,589 ANSWERS RIGHT NOW. HOWEVER, I 211 00:07:50,589 --> 00:07:52,825 WAS FORTUNATE ENOUGH TO MAINTAIN 212 00:07:52,825 --> 00:07:55,294 RELATIONSHIP WITH THIS PATIENT 213 00:07:55,294 --> 00:07:58,297 AND FOUR YEARS LATER HE RETURNED 214 00:07:58,297 --> 00:08:01,133 WITH A NEW ONSET TREMOR AN 215 00:08:01,133 --> 00:08:02,935 DIFFICULTY SPEAKING. HIGHLY 216 00:08:02,935 --> 00:08:07,873 SUGGESTIVE OF MORE SEVERE 217 00:08:07,873 --> 00:08:09,575 DISEASE. ANYONE WANT TO TAKE A 218 00:08:09,575 --> 00:08:18,083 SHOT AS TO WHAT WAS GOING ON? SO 219 00:08:18,083 --> 00:08:20,486 THIS IS A SUMMARY, A GRAPHIC OF 220 00:08:20,486 --> 00:08:21,854 PARKINSON'S DISEASE, THE COMMON 221 00:08:21,854 --> 00:08:24,623 SYMPTOMS AND SIGNS. THIS IS NOT 222 00:08:24,623 --> 00:08:25,924 FROM THE MEDICAL LITERATURE, 223 00:08:25,924 --> 00:08:30,496 THIS IS ACTUALLY ADOBE STOCK 224 00:08:30,496 --> 00:08:36,135 IMAGE, SOMETHING USED TO TEAC T. 225 00:08:36,135 --> 00:08:38,337 SMELL ISN'T THERE, NOT LISTED 226 00:08:38,337 --> 00:08:40,539 WHATSOEVER, ALTHOUGH AMONG THE 227 00:08:40,539 --> 00:08:44,643 OVER HUNDRED AS LISA MENTIONED 228 00:08:44,643 --> 00:08:45,544 CONDITIONS, THE CONNECTION 229 00:08:45,544 --> 00:08:46,679 BETWEEN LOSS OF SMELL AND 230 00:08:46,679 --> 00:08:48,681 SUBSEQUENT DEVELOPMENT OF 231 00:08:48,681 --> 00:08:50,249 PARKINSON'S IS EXTREMELY WELL 232 00:08:50,249 --> 00:08:52,785 ESTABLISHED. THERE IS A BIG 233 00:08:52,785 --> 00:08:54,787 DISCONNECT HERE IN HOW WE ARE 234 00:08:54,787 --> 00:08:56,588 COMMUNICATING, HOW WE ARE 235 00:08:56,588 --> 00:08:59,124 TEACHING, BOTH EACH OTHER AS 236 00:08:59,124 --> 00:09:01,026 CLINICIANS AND SCIENTISTS, AND 237 00:09:01,026 --> 00:09:02,528 OUR PATIENTS. WE NEED TO DO 238 00:09:02,528 --> 00:09:09,301 BELTER. SO WHAT IS THE COMMON 239 00:09:09,301 --> 00:09:11,570 THREAD HERE? IN ALL THREE OF 240 00:09:11,570 --> 00:09:15,307 THOSE CASES, THESE ARE SMELL 241 00:09:15,307 --> 00:09:17,743 LOSS, PRESENTING PRIOR TO OTHER 242 00:09:17,743 --> 00:09:20,079 SYMPTOMS. SMELL LOSS IS AN EARLY 243 00:09:20,079 --> 00:09:22,514 INDICATOR OF OTHER DISEASE. THIS 244 00:09:22,514 --> 00:09:25,584 IS BOTHERSOME. THIS IS NOT 245 00:09:25,584 --> 00:09:28,020 SOMETHING MOST PATIENTS BRUSH 246 00:09:28,020 --> 00:09:30,355 OFF. IN ALL THREE OF THESE CASES 247 00:09:30,355 --> 00:09:31,990 THEY ARE PRESENTING TO THE 248 00:09:31,990 --> 00:09:33,859 DOCTOR. OUR PATIENTS ARE ASKING 249 00:09:33,859 --> 00:09:36,995 FOR HELP. THE PROBLEM IS THAT WE 250 00:09:36,995 --> 00:09:39,865 HAVE VERY POOR UNDERSTANDING OF 251 00:09:39,865 --> 00:09:40,833 THE SIGNIFICANCE OF THESE 252 00:09:40,833 --> 00:09:43,702 SYMPTOMS. WE DON'T HAVE 253 00:09:43,702 --> 00:09:46,705 DIAGNOSTIC TOOLS TO SAY THE 254 00:09:46,705 --> 00:09:49,274 SMELL LOSS IS EXPECTED WITH 255 00:09:49,274 --> 00:09:51,577 AGING VERSUS ONE OF THESE OTHER 256 00:09:51,577 --> 00:09:55,948 HUNDRED PLUS CONDITIONS. SO 257 00:09:55,948 --> 00:09:58,484 WHAT IS THE CLINICAL RELEVANCE? 258 00:09:58,484 --> 00:10:04,656 WHY? WHY DO WE CARE? IT IS MORE 259 00:10:04,656 --> 00:10:05,758 THAN A HUNDRED CONDITIONS. 260 00:10:05,758 --> 00:10:08,827 THESE A RECENT REVIEW THAT 261 00:10:08,827 --> 00:10:12,131 DESCRIBED AN ASSOCIATION OF 262 00:10:12,131 --> 00:10:15,334 SMELL LOSS WITH 139 OTHER 263 00:10:15,334 --> 00:10:16,769 DISEASES AND DISORDERS OF THE 264 00:10:16,769 --> 00:10:20,305 HUMAN BODY. I RECOGNIZE THIS 265 00:10:20,305 --> 00:10:21,540 CLIP SHOT ON THE RIGHT IS WAY 266 00:10:21,540 --> 00:10:24,843 TOO SMALL FOR ANYONE TO READ. 267 00:10:24,843 --> 00:10:27,479 BUT THOUGHT IT WAS IMPORTANT TO 268 00:10:27,479 --> 00:10:30,582 INCLUDE A LIST OF THE NUMBER OF 269 00:10:30,582 --> 00:10:32,050 CONDITIONS AND I WILL SHARE WITH 270 00:10:32,050 --> 00:10:34,019 YOU ITS INCREDIBLY BROAD FOR 271 00:10:34,019 --> 00:10:35,354 MULTIPLE FORMS OF 272 00:10:35,354 --> 00:10:37,890 NEURODEGENERATION TO AUTISM, TO 273 00:10:37,890 --> 00:10:42,060 DEPRESSION AND ANXIETY. THERE 274 00:10:42,060 --> 00:10:44,596 ARE A NUMBER OF CLINICAL 275 00:10:44,596 --> 00:10:46,598 CONDITIONS THAT WOULD LIKELY 276 00:10:46,598 --> 00:10:49,568 BENEFIT FROM HAVING A CLEAR 277 00:10:49,568 --> 00:10:51,937 ASSOCIATION, BETTER 278 00:10:51,937 --> 00:10:53,038 UNDERSTANDING OF WHY LOSS OF 279 00:10:53,038 --> 00:11:00,312 SMELL IS DRIVING THIS DISEASE. 280 00:11:00,312 --> 00:11:02,548 WE TALK A LOT ABOUT BIOMARKERS. 281 00:11:02,548 --> 00:11:04,449 BIOMARKERS ARE CRITICAL TOOLS TO 282 00:11:04,449 --> 00:11:07,486 HELP US BRIDGE THIS GAP, TO 283 00:11:07,486 --> 00:11:08,854 UNDERSTAND IF THE LOSS OF SMALL 284 00:11:08,854 --> 00:11:11,857 IS TRULY ASSOCIATED WITH 285 00:11:11,857 --> 00:11:15,394 SOMETHING ELSE. BUT FOR A 286 00:11:15,394 --> 00:11:16,929 CLINICAL BIOMARKER TO BE 287 00:11:16,929 --> 00:11:18,864 RELEVANT, TO BE USEFUL IN THE 288 00:11:18,864 --> 00:11:22,835 CLINIC, IT HAS TO HAVE A FEW 289 00:11:22,835 --> 00:11:24,770 PREREQUISITES. THE BIOMARKER OR 290 00:11:24,770 --> 00:11:27,105 THE LOSS OF SMELL IN THIS CASE 291 00:11:27,105 --> 00:11:30,008 HAS TO PRECEDE OTHER SYMPTOMS OF 292 00:11:30,008 --> 00:11:31,577 IMPROVEMENT. TALKING ABOUT MY 293 00:11:31,577 --> 00:11:33,478 PATIENT WITH PARKINSON'S, ONCE 294 00:11:33,478 --> 00:11:36,181 HE DEVELOPED THE MORE CLASSIC 295 00:11:36,181 --> 00:11:38,817 MOTOR SYMPTOMS, OTHER FINDINGS, 296 00:11:38,817 --> 00:11:41,420 HIS LOSS OF SMELL BECOMES LESS 297 00:11:41,420 --> 00:11:44,056 RELEVANT. WE CAN DIAGNOSE WITH 298 00:11:44,056 --> 00:11:46,959 MORE TRADITIONAL MEANS. DOES THE 299 00:11:46,959 --> 00:11:48,694 DIAGNOSIS, THE BIOMARKER HELP TO 300 00:11:48,694 --> 00:11:51,196 EXPEDITE TREATMENT? THIS IS A 301 00:11:51,196 --> 00:11:52,998 BIG REASON WHY THERE'S NEWBORN 302 00:11:52,998 --> 00:11:57,502 SCREENING FOR HEARING LOSS. BY 303 00:11:57,502 --> 00:11:59,571 IDENTIFYING THE DEFICIENCY EARLY 304 00:11:59,571 --> 00:12:01,707 ON THAT GIVINGS US THE 305 00:12:01,707 --> 00:12:03,408 OPPORTUNITY TO INTERVENE TO HELP 306 00:12:03,408 --> 00:12:05,944 RESTORE HEARING OR PROTECT 307 00:12:05,944 --> 00:12:08,180 WHAT'S THERE. FINALLY, IS THERE 308 00:12:08,180 --> 00:12:11,817 A TREATMENT AT ALL? DOES 309 00:12:11,817 --> 00:12:14,453 IDENTIFYING THE BIOMARKER LEAD 310 00:12:14,453 --> 00:12:16,788 TO NUMBER TWO, A NEW TREATMENT, 311 00:12:16,788 --> 00:12:18,123 AND THEN NUMBER THREE, DOES THAT 312 00:12:18,123 --> 00:12:22,394 TREATMENT IMPROVE DISEASE? 313 00:12:22,394 --> 00:12:23,662 ECONOMISTS ARGUE THAT IF WE 314 00:12:23,662 --> 00:12:27,199 DON'T HAVE THESE THREE, IT IS 315 00:12:27,199 --> 00:12:29,234 NOT WORTH TESTING NOT WORTH 316 00:12:29,234 --> 00:12:30,569 LOOKING FOR A BIOMARKER THAT 317 00:12:30,569 --> 00:12:32,437 DOESN'T HAVE A CLINICAL 318 00:12:32,437 --> 00:12:37,843 RELEVANCE ASSOCIATED WITH IT. 319 00:12:37,843 --> 00:12:39,177 USING POST EARLY VIRAL OLFACTORY 320 00:12:39,177 --> 00:12:40,746 DYSFUNCTION ARE THOSE CASES 321 00:12:40,746 --> 00:12:43,515 PRESENTED AT THE TOP IS MY 322 00:12:43,515 --> 00:12:46,518 ANSWER, WHY SMELL IS A CRITICAL 323 00:12:46,518 --> 00:12:48,420 BIOMARKER AND SOMETHING THAT AS 324 00:12:48,420 --> 00:12:50,555 A FIELD WE SHOULD BE FURTHER 325 00:12:50,555 --> 00:12:54,626 EVALUATING AND TAKING NOTE OF. 326 00:12:54,626 --> 00:12:58,830 WITH POST VIRAL OLFACTORY LOSS, 327 00:12:58,830 --> 00:12:59,965 SELF-REPORTED SCHAPPING IN SMELL 328 00:12:59,965 --> 00:13:02,100 IS NOT ONLY AN EARLY SIGN IT IS 329 00:13:02,100 --> 00:13:07,306 ACTUALLY MORE PREDICTIVE THAN A 330 00:13:07,306 --> 00:13:08,974 FEVER. ALL THOSE YEARS WHERE I 331 00:13:08,974 --> 00:13:10,442 WAS GETTING SCREENED FOR A FEVER 332 00:13:10,442 --> 00:13:13,211 AS I WENT IN THE HOSPITAL, NO 333 00:13:13,211 --> 00:13:14,880 ONE ONCE ASKED HAS YOUR SENSE OF 334 00:13:14,880 --> 00:13:16,014 SMELL CHANGED? WE WOULD HAVE 335 00:13:16,014 --> 00:13:21,420 DONE A BETTER JOB IF WE HAD. WE 336 00:13:21,420 --> 00:13:24,523 ALSO HAVE ANTIVIRAL MEDICATIONS. 337 00:13:24,523 --> 00:13:26,224 IF WE CATCH SOMEONE EARLY STAGES 338 00:13:26,224 --> 00:13:28,927 IS OF ONE OF HE IS VIRAL 339 00:13:28,927 --> 00:13:30,062 ILLNESSES WE CAN TREAT IT, 340 00:13:30,062 --> 00:13:31,697 MINIMIZE THEIR DISEASE, MINIMIZE 341 00:13:31,697 --> 00:13:33,065 THE CHANCE OF SPREADING THE 342 00:13:33,065 --> 00:13:36,702 DISEASE TO OTHERS. THIS IS WHY 343 00:13:36,702 --> 00:13:42,741 WE ARE TALKING SMELL. SMELL IS 344 00:13:42,741 --> 00:13:46,044 MUCH BIGGER THAN JUST A 345 00:13:46,044 --> 00:13:49,047 BIOMARKER. SMELL DRAMATICALLY 346 00:13:49,047 --> 00:13:51,383 IMPACTS OUR QUALITY OF LIFE, OUR 347 00:13:51,383 --> 00:13:52,284 ABILITY TO COMPLETE ACTIVITIES 348 00:13:52,284 --> 00:13:55,287 OF DAILY LIVING. THERE IS 349 00:13:55,287 --> 00:13:57,122 NUTRITIONAL CONCERNS. 350 00:13:57,122 --> 00:13:58,924 PATIENTS WITH SMELL LOSS REPORT 351 00:13:58,924 --> 00:14:01,059 REDUCED FOOD ENJOYMENT WITH 352 00:14:01,059 --> 00:14:04,930 ALTERATIONS IN EATING HABIT HAB. 353 00:14:04,930 --> 00:14:07,366 SOMETIMES QUITE SEVERE AS WE 354 00:14:07,366 --> 00:14:08,934 WILL TALK ABOUT TOWARDS THE END, 355 00:14:08,934 --> 00:14:10,836 AND NUTRITIONAL DEFICIENCIES IN 356 00:14:10,836 --> 00:14:12,371 UP TO HALF THE PATIENTS THAT 357 00:14:12,371 --> 00:14:14,840 REPORT CHANGES TO THEIR SENSE OF 358 00:14:14,840 --> 00:14:19,177 SMELL. WE KNOW CHANGES IN TASTE 359 00:14:19,177 --> 00:14:22,114 CORRELATE WITH SMELL TO THE 360 00:14:22,114 --> 00:14:24,883 EXTENT THAT UP TO 80% OF THE 361 00:14:24,883 --> 00:14:26,551 PATIENTS WE SEE IN CLINIC THAT 362 00:14:26,551 --> 00:14:28,854 COME IN PRIMARILY BECAUSE OF 363 00:14:28,854 --> 00:14:30,989 DIFFICULTY TASTING SOMETHING, 364 00:14:30,989 --> 00:14:33,325 THEIR TASTE BUDS, TASTE SYSTEM 365 00:14:33,325 --> 00:14:35,127 WORKS FINE, IT IS LOSS OF SMELL. 366 00:14:35,127 --> 00:14:36,628 THEY CAN'T DETECT THE FLAVOR OF 367 00:14:36,628 --> 00:14:39,898 FOODS. THERE IS A HUGE SAFETY 368 00:14:39,898 --> 00:14:43,402 COMPONENT AS WELL. SMELL I WOULD 369 00:14:43,402 --> 00:14:45,404 SAY FIRST AN FOREMOST IS A 370 00:14:45,404 --> 00:14:49,608 WARNING SYSTEM FOR OUR BODIES. A 371 00:14:49,608 --> 00:14:52,010 GAS LEAK, FOR EXAMPLE. WE 372 00:14:52,010 --> 00:14:53,245 INTENTIONALLY ADD CHEMICALS THAT 373 00:14:53,245 --> 00:14:54,913 ARE UNIQUE AND DISTINCTIVE TO US 374 00:14:54,913 --> 00:14:58,216 SO THAT WE CAN PICK UP ON THEM 375 00:14:58,216 --> 00:15:00,018 AND UTILIZE THAT AS SAFETY 376 00:15:00,018 --> 00:15:02,621 SIGNAL. THEN THE EMOTIONAL 377 00:15:02,621 --> 00:15:05,791 IMPACT. THIS VARIES BY THE 378 00:15:05,791 --> 00:15:07,192 SPECIFIC TYPE OF SMELL 379 00:15:07,192 --> 00:15:10,762 CONDITION, AND OF COURSE AMONG 380 00:15:10,762 --> 00:15:13,265 EACH PATIENT. BUT IN GENERAL, 381 00:15:13,265 --> 00:15:15,333 OVER HALF OF PATIENTS WITH 382 00:15:15,333 --> 00:15:19,404 CHRONIC SMELL LOSS DEVELOP 383 00:15:19,404 --> 00:15:21,406 SYMPTOMS, CLINICALLY RELEVANT 384 00:15:21,406 --> 00:15:23,408 DEPRESSION AND SOCIAL ISOLATION. 385 00:15:23,408 --> 00:15:27,379 THIS IS A TREMENDOUS ISSUE. THIS 386 00:15:27,379 --> 00:15:28,947 IS AN OLDER STUDY NOW BUT I WANT 387 00:15:28,947 --> 00:15:35,654 TO INCLUDE IT BOTH TO MAKE THE 388 00:15:35,654 --> 00:15:37,722 POINT WE USE OLDER DATA AN SINCE 389 00:15:37,722 --> 00:15:39,324 2020 WORLDS CHANGED SO THIS IS 390 00:15:39,324 --> 00:15:41,726 AN OPPORTUNITY WE HAVE TO UPDATE 391 00:15:41,726 --> 00:15:45,230 OUR FIGURES UPDATE OUR 392 00:15:45,230 --> 00:15:46,331 UNDERSTANDING OF THE IMPACT OF 393 00:15:46,331 --> 00:15:52,003 THIS CONDITION. BUT IF YOU 394 00:15:52,003 --> 00:15:54,372 SURVEY PATIENTS THIS ON X AXIS 395 00:15:54,372 --> 00:15:58,610 HERE 0 TO 100% SURVEYED 396 00:15:58,610 --> 00:15:59,811 RESPONDENTS, THESE ARE PATIENTS 397 00:15:59,811 --> 00:16:01,713 WITH SMELL DISORDERS, EITHER 398 00:16:01,713 --> 00:16:03,582 CAN'T SMELL AT ALL, THEY CAN 399 00:16:03,582 --> 00:16:05,684 SMELL LITTLE OR THERE IS AN 400 00:16:05,684 --> 00:16:06,785 ALTERATION IN WHAT THEY SMELL, 401 00:16:06,785 --> 00:16:13,925 IT IS NOT CORRECT. WE SEE OVER 402 00:16:13,925 --> 00:16:16,261 HALF, IF WE GO UP THIS LINE 403 00:16:16,261 --> 00:16:19,331 HERE, HAVE EATEN SPOILED FOOD, 404 00:16:19,331 --> 00:16:24,336 DIFFICULTIES COOKING, RISK OF 405 00:16:24,336 --> 00:16:25,904 PAIL YOUR TO PERCEIVE LIFE 406 00:16:25,904 --> 00:16:27,105 THREATENING THINGS LIKE A FIRE 407 00:16:27,105 --> 00:16:31,910 OR GAS LEAK. THIS IS INCREDIBLY 408 00:16:31,910 --> 00:16:35,914 CLINICALLY RELEVANT. I MENTION 409 00:16:35,914 --> 00:16:37,449 ANXIETY AND DEPRESSION BEING 410 00:16:37,449 --> 00:16:40,652 ASSOCIATED WITH LOSS OF SMELL. 411 00:16:40,652 --> 00:16:43,221 WE ALSO BELIEVE LOSS OF SMELL 412 00:16:43,221 --> 00:16:46,324 CAUSES THE DEPRESSION, THE 413 00:16:46,324 --> 00:16:48,660 ANXIETY, THIS IS AGAIN, AN OLDER 414 00:16:48,660 --> 00:16:53,965 STUDY, TEN YEARS OLD NOW, BUT IT 415 00:16:53,965 --> 00:16:55,433 TAKES THE VEXED DEPRESSION 416 00:16:55,433 --> 00:16:58,069 INVENTORY, A SCREENING TOOL TO 417 00:16:58,069 --> 00:16:59,871 IDENTIFY PATIENTS LIKELY TO HAVE 418 00:16:59,871 --> 00:17:02,440 CLINICALLY RELEVANT DEPRESSION, 419 00:17:02,440 --> 00:17:04,342 SCALE OF TEN, ANYTHING BELOW IS 420 00:17:04,342 --> 00:17:12,083 CONSIDERED NORMAL. ANYTHING 421 00:17:12,083 --> 00:17:22,460 ABOVE (LOSS OF AUDIO) 422 00:18:35,200 --> 00:18:37,535 O EPITHELIUM. THESE ARE 423 00:18:37,535 --> 00:18:39,738 RECEPTORS THAT BINDS THE 424 00:18:39,738 --> 00:18:40,705 SPECIFIC ODE RANTS THAT 425 00:18:40,705 --> 00:18:41,940 ALLOWS US TO IDENTIFY THIS 426 00:18:41,940 --> 00:18:46,544 IS A ROSE. FROM THERE, THE 427 00:18:46,544 --> 00:18:49,814 SIGNALING MOVES ON TO WHAT 428 00:18:49,814 --> 00:18:54,619 IS CALLED THE OLFACTORY 429 00:18:54,619 --> 00:18:55,220 BULB, THIS WORM STRUCTURE 430 00:18:55,220 --> 00:18:59,791 RIGHT HERE. SO WE ARE 431 00:18:59,791 --> 00:19:00,659 TRANSITIONING FROM THE 432 00:19:00,659 --> 00:19:02,093 OUTSIDE WORLD INSIDE OUR 433 00:19:02,093 --> 00:19:03,695 NOSE, UP NOW TO THE BRAIN TO 434 00:19:03,695 --> 00:19:06,164 THE CENTRAL NERVOUS SYSTEM. 435 00:19:06,164 --> 00:19:08,700 THE OLFACTORY BULB IS ALSO 436 00:19:08,700 --> 00:19:11,002 CALLED CRANIAL NERVE 1, 437 00:19:11,002 --> 00:19:14,706 TAKES THE SIGNAL AND POP 438 00:19:14,706 --> 00:19:16,775 GATES IT CENTRALLY, WHERE IT 439 00:19:16,775 --> 00:19:18,643 GOES TO KEY CENTERS OF THE 440 00:19:18,643 --> 00:19:21,179 BRAIN, THE LIMBIC SYSTEM, 441 00:19:21,179 --> 00:19:25,317 THE HOME OF EMOTION. IS 442 00:19:25,317 --> 00:19:26,851 DIRECTLY CONNECTED THROUGH 443 00:19:26,851 --> 00:19:28,720 OLFACTORY PATHWAYS. IT IS 444 00:19:28,720 --> 00:19:30,155 PART OF THE REASON THERE'S 445 00:19:30,155 --> 00:19:31,890 SUCH STRONG EMOTIONAL SUCH 446 00:19:31,890 --> 00:19:33,258 STRONG MEMORY COMPONENTS 447 00:19:33,258 --> 00:19:38,730 WITH THE SENSE OF SMELL. 448 00:19:38,730 --> 00:19:39,931 OTHER THINGS THAT SENSE OF 449 00:19:39,931 --> 00:19:42,267 SMELL HELPS US WITH IS 450 00:19:42,267 --> 00:19:44,302 EATING AND HUNGER CONTROL 451 00:19:44,302 --> 00:19:46,171 ARE ACTUALLY INSULIN 452 00:19:46,171 --> 00:19:47,138 RECEPTORS ASSOCIATED WITH 453 00:19:47,138 --> 00:19:49,441 THIS SYSTEM. CONNECTING WITH 454 00:19:49,441 --> 00:19:51,343 OTHER PEOPLE, THE SOCIAL 455 00:19:51,343 --> 00:19:54,579 ELEMENT IS TREMENDOUS. 456 00:19:54,579 --> 00:19:59,451 AGAIN, SAFETY. IF WE LOOK A 457 00:19:59,451 --> 00:20:01,586 LITTLE BIT CLOSER AT THIS 458 00:20:01,586 --> 00:20:05,990 KEY REGION OF THE OLFACTORY 459 00:20:05,990 --> 00:20:07,859 EPITHELIUM, THERE IS 6 TO 10 460 00:20:07,859 --> 00:20:09,994 MILLION OLFACTORY RECEPTORS 461 00:20:09,994 --> 00:20:11,262 THAT ARE EXPRESSED IN THIS 462 00:20:11,262 --> 00:20:13,832 AREA. THEY REPLICATE 463 00:20:13,832 --> 00:20:15,200 THROUGHOUT LIFE WHICH IS 464 00:20:15,200 --> 00:20:16,668 SOMEWHAT UNIQUE, EXTREMELY 465 00:20:16,668 --> 00:20:20,872 UNIQUE. AND THEY ARE CAPABLE 466 00:20:20,872 --> 00:20:23,875 OF DETECTING THOUSANDS OF 467 00:20:23,875 --> 00:20:26,544 DIFFERENT ODORANTS. FROM 468 00:20:26,544 --> 00:20:28,380 THERE, THIS PIECE IS 469 00:20:28,380 --> 00:20:30,715 IMPORTANT. IT IS GOING TO 470 00:20:30,715 --> 00:20:32,250 COME UP AGAIN WHEN I TALK 471 00:20:32,250 --> 00:20:35,920 ABOUT PEROSMIIA. EACH NEURON 472 00:20:35,920 --> 00:20:38,757 HAS RECEPTOR FOR ONE 473 00:20:38,757 --> 00:20:41,526 ODORANT. SO THESE THREE 474 00:20:41,526 --> 00:20:43,261 NEURONS HERE ALL GO O THE 475 00:20:43,261 --> 00:20:46,965 SAME STRUCTURE HERE, THE 476 00:20:46,965 --> 00:20:48,500 GLOMERULUS, IT IS A ONE TO 477 00:20:48,500 --> 00:20:50,769 ONE ASSOCIATION. HOW WE CAN 478 00:20:50,769 --> 00:20:52,604 DIFFERENTIATE AN APPLE FROM 479 00:20:52,604 --> 00:20:54,272 AN ORANGE ISN'T BECAUSE WE 480 00:20:54,272 --> 00:20:57,776 HAVE ONE UNIQUE RECEPTOR FOR 481 00:20:57,776 --> 00:20:58,977 EVERY ONE OF THE TENS OF 482 00:20:58,977 --> 00:21:02,280 THOUSANDS OF ODORS THAT WE 483 00:21:02,280 --> 00:21:06,418 SMELL, IT IS BECAUSE EACH 484 00:21:06,418 --> 00:21:11,289 ODORANT ACTIVATES SEVERAL OF 485 00:21:11,289 --> 00:21:13,892 THESE. SO YOU HAVE 10,000 486 00:21:13,892 --> 00:21:15,393 RECEPTOR, 52 ACTIVATED BY A 487 00:21:15,393 --> 00:21:18,630 ROSE AND THOSE 52 TELL OUR 488 00:21:18,630 --> 00:21:19,697 BRAIN THEY ARE SMELLING A 489 00:21:19,697 --> 00:21:21,966 ROSE. THAT'S IMPORTANT 490 00:21:21,966 --> 00:21:23,501 BECAUSE WE BELIEVE ONE TO 491 00:21:23,501 --> 00:21:26,070 ONE RELATIONSHIP IS 492 00:21:26,070 --> 00:21:27,806 DISRUPTED IN OTHER FORMS OF 493 00:21:27,806 --> 00:21:28,973 DISEASE. WE WILL TALK ABOUT 494 00:21:28,973 --> 00:21:33,912 THAT AT END. SO I HAVE 495 00:21:33,912 --> 00:21:35,914 COVERED MOST OF THIS AGAIN 496 00:21:35,914 --> 00:21:37,849 FROM ODOR DETECTION TO A 497 00:21:37,849 --> 00:21:38,983 SINGLE TRANSDUCTIONS FROM 498 00:21:38,983 --> 00:21:41,486 THE NOSE TO THE BRAIN TO 499 00:21:41,486 --> 00:21:42,887 NEURAL PROCESSING TO ALLOW 500 00:21:42,887 --> 00:21:45,790 US TO UNDERSTAND NOT ONLY 501 00:21:45,790 --> 00:21:47,625 THE ODOR YOU ARE SMELLING 502 00:21:47,625 --> 00:21:51,996 BUT THE ASSOCIATED EMOTIONAL 503 00:21:51,996 --> 00:21:54,732 MEMORY COMPONENTS WHICH ALL 504 00:21:54,732 --> 00:21:55,467 TOLD TOGETHER LEAD TO 505 00:21:55,467 --> 00:22:01,272 PERCEPTION. HOWEVER, DESPITE 506 00:22:01,272 --> 00:22:02,073 EVERYTHING THAT I HAVE 507 00:22:02,073 --> 00:22:05,276 SHARED SO FAR TODAY, SENSE 508 00:22:05,276 --> 00:22:07,812 OF SMELL IS OFTEN 509 00:22:07,812 --> 00:22:09,547 UNDERAPPRECIATED, SO WHAT? 510 00:22:09,547 --> 00:22:12,417 IS A VERY COMMON QUESTION 511 00:22:12,417 --> 00:22:14,586 PATIENTS FACE THAT I HAVE 512 00:22:14,586 --> 00:22:16,488 BEEN ASKED, YOU LOSE YOUR 513 00:22:16,488 --> 00:22:18,523 SMELL IT IS NOT GOING TO 514 00:22:18,523 --> 00:22:20,859 KILL YOU. WHY ARE WE 515 00:22:20,859 --> 00:22:25,897 WORRIED? WELL, WE KNOW SMELL 516 00:22:25,897 --> 00:22:27,098 IS DIRECTLY CONNECTED TO 517 00:22:27,098 --> 00:22:29,534 MEMORY AND EMOTION, CRITICAL 518 00:22:29,534 --> 00:22:32,504 FOR DETECTING ENVIRONMENTAL 519 00:22:32,504 --> 00:22:34,105 HAZARDS, ESSENTIAL FOR 520 00:22:34,105 --> 00:22:35,373 FLAVOR PERCEPTION AND 521 00:22:35,373 --> 00:22:37,242 NUTRITION, AND AGAIN, AN 522 00:22:37,242 --> 00:22:39,477 EMERGING BIOMARKER FOR 523 00:22:39,477 --> 00:22:45,049 NEUROLOGIC HEALTH. SO WHY 524 00:22:45,049 --> 00:22:47,218 DOES THIS SENSE NOT GET AS 525 00:22:47,218 --> 00:22:48,786 MUCH ATTENTION AS IT 526 00:22:48,786 --> 00:22:50,088 DESERVES? THERE IS A COUPLE 527 00:22:50,088 --> 00:22:51,823 OF REASONS. I WANT TO CALL 528 00:22:51,823 --> 00:22:55,360 OUT MY PARTNER IN CRIME PAUL 529 00:22:55,360 --> 00:22:56,794 HERE TO HELPED ME PUT 530 00:22:56,794 --> 00:22:57,862 TOGETHER A FEW OF THESE 531 00:22:57,862 --> 00:22:58,763 SLIDES AND MAKE SURE WE WERE 532 00:22:58,763 --> 00:23:04,402 ON THE SAME PAGE. AS I 533 00:23:04,402 --> 00:23:06,170 MENTIONED SMELL IS EXPECTED 534 00:23:06,170 --> 00:23:08,206 TO WORSEN WITH AGE, IT 535 00:23:08,206 --> 00:23:10,742 COMPLICATES QUITE A BIT OUR 536 00:23:10,742 --> 00:23:11,309 ABILITY TO UNDERSTAND WHAT 537 00:23:11,309 --> 00:23:15,313 IS NORMAL AND WHAT IS NOT. 538 00:23:15,313 --> 00:23:16,514 SMELL IS AN EARLY WARNING 539 00:23:16,514 --> 00:23:18,783 SIGN AS I SAID BUT IT CAN BE 540 00:23:18,783 --> 00:23:21,686 A REMOTE EARLY SIGN WHICH IS 541 00:23:21,686 --> 00:23:23,555 WONDERFUL, THAT GIVES US THE 542 00:23:23,555 --> 00:23:25,823 OPPORTUNITY TO TREAT 543 00:23:25,823 --> 00:23:27,392 PARKINSON'S FIVE YEARS 544 00:23:27,392 --> 00:23:29,527 BEFORE NEUROLOGIC SYMPTOMS 545 00:23:29,527 --> 00:23:30,762 DEVELOP BEFORE THE 546 00:23:30,762 --> 00:23:33,865 PATHOLOGIC PLAQUES FORM IN 547 00:23:33,865 --> 00:23:35,033 THE BRAIN BUT THAT ALSO 548 00:23:35,033 --> 00:23:38,670 LEAVES INCREDIBLY LONG 549 00:23:38,670 --> 00:23:39,971 RUNWAY TO FORGET ABOUT 550 00:23:39,971 --> 00:23:41,105 CHANGE IN SMELL OR THINK IT 551 00:23:41,105 --> 00:23:43,408 WAS SOMETHING ELSE. I DIDN'T 552 00:23:43,408 --> 00:23:46,277 HAVE PARKINSON'S UNTIL MY 553 00:23:46,277 --> 00:23:47,779 TREMORS STARTED FIVE YEARS 554 00:23:47,779 --> 00:23:52,450 AFTER I LOST MY SMELL. IT 555 00:23:52,450 --> 00:23:53,518 IS OFTEN IGNORED OUTRIGHT. 556 00:23:53,518 --> 00:23:55,753 IT IS LACK OF TRAINING, LACK 557 00:23:55,753 --> 00:23:56,454 OF UNDERSTANDING IN OUR 558 00:23:56,454 --> 00:23:59,123 MEDICAL COMMUNITY. THE 559 00:23:59,123 --> 00:24:01,859 SECOND PATIENT I SHARED THE 560 00:24:01,859 --> 00:24:03,795 UNDIAGNOSED PARKINSON'S, 561 00:24:03,795 --> 00:24:04,596 WITHIN THE FIRST FOUR YEARS 562 00:24:04,596 --> 00:24:07,131 I WAS SEEING HIM I SENT HIM 563 00:24:07,131 --> 00:24:09,867 TO NEUROLOGY WITH THIS 564 00:24:09,867 --> 00:24:12,737 SPECIFIC CONCERN. 565 00:24:12,737 --> 00:24:14,405 NEUROLOGISTS WROTE ME BACK. 566 00:24:14,405 --> 00:24:16,908 AND SAID YOU ARE WASTING MY 567 00:24:16,908 --> 00:24:19,711 TIME, YOU ARE WASTING YOUR 568 00:24:19,711 --> 00:24:21,179 PATIENT'S TIME. DO NOT SEND 569 00:24:21,179 --> 00:24:22,280 THESE PATIENTS UNLESS THEY 570 00:24:22,280 --> 00:24:26,417 HAVE A FOCAL DEFICIT. SMELL 571 00:24:26,417 --> 00:24:29,821 IS A FOCAL NEUROLOGIC 572 00:24:29,821 --> 00:24:31,990 DEFICIT. BUT TO ME THAT 573 00:24:31,990 --> 00:24:33,057 HIGHLIGHTS THAT WE NEED TO 574 00:24:33,057 --> 00:24:36,027 DO A BETTER JOB OF TEACHING 575 00:24:36,027 --> 00:24:41,399 GIVING SEMINARS LIKE THESE. 576 00:24:41,399 --> 00:24:43,701 SO WITHIN THE 130 PLUS 577 00:24:43,701 --> 00:24:44,369 CONDITIONS WE HAVE 578 00:24:44,369 --> 00:24:46,904 ASSOCIATED WITH LOSS OF 579 00:24:46,904 --> 00:24:49,907 SMELL, WHAT IS MOST COMMON? 580 00:24:49,907 --> 00:24:52,477 VIRAL INFECTION AS WE HAVE 581 00:24:52,477 --> 00:24:56,047 MENTIONED IS RELATIVELY 582 00:24:56,047 --> 00:24:59,484 COMMON WITH A HUGE SPIKE IN 583 00:24:59,484 --> 00:24:59,984 PREVALENCE OVER THE LAST 584 00:24:59,984 --> 00:25:01,486 FIVE YEARS. NEUROLOGIC 585 00:25:01,486 --> 00:25:04,656 DISORDERS AGAIN NOT JUST 586 00:25:04,656 --> 00:25:08,159 PARKINSON'S, TALK ABOUT 587 00:25:08,159 --> 00:25:09,827 ALZHEIMER'S AS WELL AS 588 00:25:09,827 --> 00:25:12,630 OTHERS SUPERNUCLEAR, PALSY, 589 00:25:12,630 --> 00:25:14,966 NUMBER OF NEUROLOGIC 590 00:25:14,966 --> 00:25:15,867 DEGENERATIVE CONDITIONS. 591 00:25:15,867 --> 00:25:18,069 HEAD TRAUMA, AGING AND A 592 00:25:18,069 --> 00:25:21,005 HUGE NUMBER OF MEDICATIONS. 593 00:25:21,005 --> 00:25:22,407 IF YOU ARE DEPRESSED YOU MAY 594 00:25:22,407 --> 00:25:24,342 BE PUT ON AN ANTIDEPRESSANT 595 00:25:24,342 --> 00:25:26,811 BECAUSE OF YOUR SMELL LOSS. 596 00:25:26,811 --> 00:25:28,379 YOUR ANTIDEPRESSANT CAN 597 00:25:28,379 --> 00:25:29,814 CAUSE SMELL LOSS TOO. SO 598 00:25:29,814 --> 00:25:32,083 THERE'S A LOT OF INFORMATION 599 00:25:32,083 --> 00:25:39,023 TO CONSIDER. SO WE MENTION 600 00:25:39,023 --> 00:25:40,692 HOW SMELL LOSS CONNECTS TO 601 00:25:40,692 --> 00:25:43,227 BRAIN DISEASES BEYOND 602 00:25:43,227 --> 00:25:45,430 PARKINSON'S. AS AN EARLY 603 00:25:45,430 --> 00:25:47,632 WARNING SIGN, A NUMBER OF 604 00:25:47,632 --> 00:25:51,069 CONDITIONS INCLUDING 605 00:25:51,069 --> 00:25:52,470 PARKINSON'S THEY LOSE SMELL 606 00:25:52,470 --> 00:25:54,105 FIRST BECAUSE THE PATHOLOGIC 607 00:25:54,105 --> 00:25:56,140 DEPOSITS THE AGGREGATES IN 608 00:25:56,140 --> 00:25:58,342 THE BRAIN ACTUALLY FORM 609 00:25:58,342 --> 00:26:00,278 WITHIN THE OLFACTORY SYSTEM 610 00:26:00,278 --> 00:26:02,613 FIRST. IT CAN EVEN CAPTURE 611 00:26:02,613 --> 00:26:04,282 THEM WITHIN THE NOSE IN THE 612 00:26:04,282 --> 00:26:05,683 OLFACTORY EPITHELIUM, 613 00:26:05,683 --> 00:26:07,719 PATIENTS WITH BOTH 614 00:26:07,719 --> 00:26:09,987 ALZHEIMER'S AND PARKINSON'S 615 00:26:09,987 --> 00:26:11,522 BEFORE ANY OTHER SYMPTOMS. 616 00:26:11,522 --> 00:26:13,758 THOSE ARE THE BRAIN CHANGES. 617 00:26:13,758 --> 00:26:15,727 THEN THE PATTERN OF DECLINE, 618 00:26:15,727 --> 00:26:16,928 THERE'S ACTUALLY A 619 00:26:16,928 --> 00:26:19,897 PREDICTIVE ELEMENT TO THIS 620 00:26:19,897 --> 00:26:21,933 AND A PATIENT WHO HAS 621 00:26:21,933 --> 00:26:24,602 SEVERELY LOST THEIR SENSE OF 622 00:26:24,602 --> 00:26:26,170 SMELL IS MORE LIKELY TO HAVE 623 00:26:26,170 --> 00:26:28,339 MORE ADVANCED SYMPTOMS O 624 00:26:28,339 --> 00:26:29,273 THEIR NEURODEGENERATIVE 625 00:26:29,273 --> 00:26:37,081 DISEASE. AGAIN, ALL OF 626 00:26:37,081 --> 00:26:38,583 THESE THINGS LEAD TO THE 627 00:26:38,583 --> 00:26:40,051 CONCLUSION THAT SMELL LOSS 628 00:26:40,051 --> 00:26:43,020 IS AN IMPORTANT BIOMARKER 629 00:26:43,020 --> 00:26:46,457 SPECIFICALLY FOR 630 00:26:46,457 --> 00:26:49,227 NEURODEGENERATION. I WANT TO 631 00:26:49,227 --> 00:26:50,762 DRIVE THIS POINT HOME WITH 632 00:26:50,762 --> 00:26:54,098 TWO LAST SLIDES, THIS 633 00:26:54,098 --> 00:26:56,367 COVERING PARKINSON'S AND 634 00:26:56,367 --> 00:26:58,302 NEXT ALZHEIMER'S. AS I 635 00:26:58,302 --> 00:26:59,337 MENTION THIS IS THE 636 00:26:59,337 --> 00:27:01,105 STRONGEST KNOWN LINK 637 00:27:01,105 --> 00:27:02,573 ASSOCIATION BETWEEN LOSS OF 638 00:27:02,573 --> 00:27:04,675 SMELL AND NEURODEGENERATIVE 639 00:27:04,675 --> 00:27:09,280 DISEASE. UP TO 90% OF 640 00:27:09,280 --> 00:27:10,648 PARKINSON PATIENT EXPERIENCE 641 00:27:10,648 --> 00:27:12,483 SMELL LOSS OFTEN YEARS PRIOR 642 00:27:12,483 --> 00:27:15,386 TO CLASSIC MOTOR SYMPTOMS. 643 00:27:15,386 --> 00:27:17,321 LEWY BODIES ARE THE 644 00:27:17,321 --> 00:27:19,791 PATHOLOGIC AGGREGATES APPEAR 645 00:27:19,791 --> 00:27:22,794 FIRST IN THE OLFACTORY BULB, 646 00:27:22,794 --> 00:27:24,962 CRANIAL NERVE 1 AND SPREAD 647 00:27:24,962 --> 00:27:26,531 FROM THERE WELL BEFORE IT I 648 00:27:26,531 --> 00:27:29,400 WANT PACTS THE SUBSTANTIA 649 00:27:29,400 --> 00:27:31,803 NIGRA OR ONE OF THE CRITICAL 650 00:27:31,803 --> 00:27:34,338 STRUCTURE WE THINK OF WITH 651 00:27:34,338 --> 00:27:36,474 PARKINSONS. THERE IS A LAND 652 00:27:36,474 --> 00:27:38,342 MARK STUDY THAT SHOWED 653 00:27:38,342 --> 00:27:40,878 AMONGST PATIENTS WITH 654 00:27:40,878 --> 00:27:42,146 UNEXPLAINED SMELL LOSS, 655 00:27:42,146 --> 00:27:42,914 GENTLEMEN THAT PRESENTEDDED 656 00:27:42,914 --> 00:27:44,949 IN THE SECOND SLIDE, THEY 657 00:27:44,949 --> 00:27:47,618 ARE UP TO FIVE TIMES HIGHER 658 00:27:47,618 --> 00:27:49,754 RISK OF DEVELOPING 659 00:27:49,754 --> 00:27:50,621 PARKINSON'S WITHIN THE NEXT 660 00:27:50,621 --> 00:27:53,524 FOUR YEARS. AGAIN 661 00:27:53,524 --> 00:27:54,559 INCREDIBLY IMPORTANT 662 00:27:54,559 --> 00:27:57,929 PREDICTIVE MARKER. IF WE 663 00:27:57,929 --> 00:28:00,464 LOOK AT ALZHEIMER'S AND WE 664 00:28:00,464 --> 00:28:03,568 GO FROM STAGE 1 OR 665 00:28:03,568 --> 00:28:04,936 PRE-CLINICAL STAGE GOING 666 00:28:04,936 --> 00:28:06,470 DOWN WITH ADVANCEMENT OF 667 00:28:06,470 --> 00:28:08,272 SYMPTOMS WE SEE SMELL IS 668 00:28:08,272 --> 00:28:09,941 IMPACTED IN AND PLAYS A ROLE 669 00:28:09,941 --> 00:28:11,275 THROUGHOUT THE COURSE OF 670 00:28:11,275 --> 00:28:13,744 THIS DISEASE. THE 671 00:28:13,744 --> 00:28:15,780 PRE-CLINICAL STAGE BETA 672 00:28:15,780 --> 00:28:18,516 AMYLOID THE PATHOGNOMONIC 673 00:28:18,516 --> 00:28:22,286 STRUCTURE IN ALZHEIMER, THAT 674 00:28:22,286 --> 00:28:24,355 AND TAU APPEAR AGAIN IN THE 675 00:28:24,355 --> 00:28:29,327 OLFACTORY BULB AND THE 676 00:28:29,327 --> 00:28:31,028 INTRARINAL CORTEX FIRST 677 00:28:31,028 --> 00:28:32,196 WEIGH STATION OF THE BRAIN 678 00:28:32,196 --> 00:28:35,099 PROCESSING OLFACTORY SIGNALS 679 00:28:35,099 --> 00:28:35,733 YEARS BEFORE CLINICAL 680 00:28:35,733 --> 00:28:37,435 SYMPTOMS. AS THE PATIENTS 681 00:28:37,435 --> 00:28:41,572 ADVANCE AND NOW DISPLAY MILD 682 00:28:41,572 --> 00:28:44,475 COGNITIVE IMPAIRMENT, 70 TO 683 00:28:44,475 --> 00:28:47,211 80% PATIENTS SHOW IMPAIRED 684 00:28:47,211 --> 00:28:49,814 ODOR IDENTIFICATION. THOSE 685 00:28:49,814 --> 00:28:51,015 WITH MILD COGNITIVE 686 00:28:51,015 --> 00:28:53,718 IMPAIRMENTS AND DECREASE 687 00:28:53,718 --> 00:28:55,353 SENSITIVITY TO SMELLS, THEY 688 00:28:55,353 --> 00:28:56,454 ARE SIGNIFICANTLY MORE 689 00:28:56,454 --> 00:28:59,257 LIKELY TO CONVERT TO FULL 690 00:28:59,257 --> 00:29:01,926 PLEDGE ALZHEIMER'S. YEAH. 691 00:29:01,926 --> 00:29:02,126 YEAH. 692 00:29:02,126 --> 00:29:12,303 (OFF MIC) 693 00:29:14,505 --> 00:29:19,644 >> THAT IS A GREAT QUESTION. SO 694 00:29:19,644 --> 00:29:22,146 HOW DO YOU -- YES, YES. THE 695 00:29:22,146 --> 00:29:25,883 QUESTION IS HOW DO YOU 696 00:29:25,883 --> 00:29:26,851 DIFFERENTIATE IN THIS EXACT 697 00:29:26,851 --> 00:29:28,653 PATIENT THE CAUSE? ARE THEY 698 00:29:28,653 --> 00:29:29,987 HAVING DIFFICULTY IDENTIFYING 699 00:29:29,987 --> 00:29:32,757 THE SENSE OF SMELL THAT THEIR 700 00:29:32,757 --> 00:29:34,258 OLFACTORY SYSTEM IS REGISTERING? 701 00:29:34,258 --> 00:29:35,960 OR IS IT THEY ARE NOT 702 00:29:35,960 --> 00:29:40,298 REGISTERING THAT SENSE OF SMELL? 703 00:29:40,298 --> 00:29:41,766 UNFORTUNATELY IT'S COMPLICATED 704 00:29:41,766 --> 00:29:44,268 AND MY VIEW IS THAT IT REALLY 705 00:29:44,268 --> 00:29:46,170 INVOLVES A THOROUGH EVALUATION 706 00:29:46,170 --> 00:29:48,839 OF THE PATIENT AND A BETTER 707 00:29:48,839 --> 00:29:50,841 UNDERSTANDING OF HOW IMPAIRED 708 00:29:50,841 --> 00:29:58,316 THEY ARE COGNITIVELY. WHAT WE 709 00:29:58,316 --> 00:30:00,184 NEED AND THERE ARE GROUPS 710 00:30:00,184 --> 00:30:02,853 WORKING ON THAT BUT IT IS NOT 711 00:30:02,853 --> 00:30:04,388 CLINICALLY AVAILABLE, IS AN 712 00:30:04,388 --> 00:30:07,258 OBJECTIVE TEST, SOMETHING TO 713 00:30:07,258 --> 00:30:09,360 MEASURE BRAIN WAVES IN RESPONSE 714 00:30:09,360 --> 00:30:12,129 TO ON ODORANT. WE DON'T HAVE 715 00:30:12,129 --> 00:30:14,231 THAT. AMONG PATIENTS WITH 716 00:30:14,231 --> 00:30:15,599 ESTABLISHED ALZHEIMER'S DISEASE, 717 00:30:15,599 --> 00:30:19,170 UP TO 95% SHOW SIGNIFICANT 718 00:30:19,170 --> 00:30:19,837 ALTERATIONS IN THEIR ABILITY TO 719 00:30:19,837 --> 00:30:27,979 SMELL. I MENTION PSYCHIATRIC 720 00:30:27,979 --> 00:30:29,547 CONDITIONS AS WELL, THIS IMPACTS 721 00:30:29,547 --> 00:30:31,882 WELL BEYOND NEURODEGENERATION 722 00:30:31,882 --> 00:30:36,253 AND THERE'S IMPORTANT RESEARCH 723 00:30:36,253 --> 00:30:38,155 AND STUDY LINKING LOSS OF SMELL 724 00:30:38,155 --> 00:30:41,993 WITH MAJOR DEPRESSIVE 725 00:30:41,993 --> 00:30:43,027 DISOFFEDDER, WITH SKITS 726 00:30:43,027 --> 00:30:45,930 FRIENDSIA AND STUDIES LOOKING AT 727 00:30:45,930 --> 00:30:50,301 AUTISM SPECTRUM. VERY BROAD AREA 728 00:30:50,301 --> 00:30:52,003 THAT'S RICH FOR DISCOVERY TO 729 00:30:52,003 --> 00:30:57,775 ADVANCE PATIENT CARE. FROM SO A 730 00:30:57,775 --> 00:31:00,411 GREAT QUESTION THAT LEADS TO THE 731 00:31:00,411 --> 00:31:03,447 SEGUE, HOW DO WE TEST THE SENSE 732 00:31:03,447 --> 00:31:06,350 OF SMELL? I WILL TELL YOU ON THE 733 00:31:06,350 --> 00:31:09,587 FRONT, SELF-REPORT IS NOT A GOOD 734 00:31:09,587 --> 00:31:12,690 TEST. UP TO 40% OF PATIENTS THAT 735 00:31:12,690 --> 00:31:14,992 COME TO YOU AND SAY I THINK I 736 00:31:14,992 --> 00:31:17,328 HAVE LOST MY SENSE OF SMELL, 737 00:31:17,328 --> 00:31:20,364 ACTUALLY HAVEN'T. WE NEED MORE 738 00:31:20,364 --> 00:31:24,935 DEFINITIVE TESTS. PSYCHOPHYSICAL 739 00:31:24,935 --> 00:31:28,472 TESTS ARE TESTS THAT WE 740 00:31:28,472 --> 00:31:32,009 CRUCIALLY RELY ON IN THE CLINIC. 741 00:31:32,009 --> 00:31:36,180 THEY ARE A TEST THAT RELIES ON A 742 00:31:36,180 --> 00:31:37,214 PATIENT'S RESPONSE. THESE ARE 743 00:31:37,214 --> 00:31:40,418 NOT TRULY OBJECTIVE. THERE ARE 744 00:31:40,418 --> 00:31:42,219 OVER 40 OF THESE TESTS ON THE 745 00:31:42,219 --> 00:31:46,624 MARKET TODAY. AND OVERWHELMING 746 00:31:46,624 --> 00:31:49,060 NUMBER WITH AS MUCH VARIATION AS 747 00:31:49,060 --> 00:31:51,062 YOU CAN IMAGINE IN THE STUDY 748 00:31:51,062 --> 00:31:53,397 BEHIND THE TEST, THE APPROPRIATE 749 00:31:53,397 --> 00:31:56,634 INDICATION, THE APPROPRIATE 750 00:31:56,634 --> 00:31:57,768 PATIENT, ET CETERA. IT IS 751 00:31:57,768 --> 00:32:05,276 CONFUSING FOR ANYONE. SEW LIKE 752 00:32:05,276 --> 00:32:07,812 A GOOD RESEARCH TEAM WE SOUGHT A 753 00:32:07,812 --> 00:32:08,646 STRAIGHT FORWARD NARRATIVE 754 00:32:08,646 --> 00:32:10,815 REVIEW GOING THROUGH PEER REVIEW 755 00:32:10,815 --> 00:32:16,287 CURRENTLY, NOT YET PUBLISHED BUT 756 00:32:16,287 --> 00:32:19,323 WE WE LOOKED AT ALL 40 PLUS 757 00:32:19,323 --> 00:32:20,491 TESTS THE HUNDREDS TO THOUSANDS 758 00:32:20,491 --> 00:32:22,793 OF MANUSCRIPTS THAT SUPPORT 759 00:32:22,793 --> 00:32:26,564 THEM. AND THEN WE DEVELOPED THIS 760 00:32:26,564 --> 00:32:27,665 GRAPHICAL ABSTRACT THAT AS FAR 761 00:32:27,665 --> 00:32:30,434 AS I'M AWARE IS THE FIRST EFFORT 762 00:32:30,434 --> 00:32:36,240 TO REALLY TAKE THE DIFFERENT 763 00:32:36,240 --> 00:32:37,208 VARIATIONS, DIFFERENT CAUSES OF 764 00:32:37,208 --> 00:32:41,479 LOSS OF SMELL AND MAKE 765 00:32:41,479 --> 00:32:42,379 RECOMMENDATIONS FOR THE 766 00:32:42,379 --> 00:32:42,980 DIFFERENT SPECIFIC TESTS THAT 767 00:32:42,980 --> 00:32:46,350 CAN BE USED. WHILE I HOPE THIS 768 00:32:46,350 --> 00:32:48,919 IS IMPACTFUL FOR OUR PATIENTS 769 00:32:48,919 --> 00:32:51,155 AND I CERTAINLY AM HOPEFUL THEY 770 00:32:51,155 --> 00:32:52,690 WILL HAVE ACCESS TO THIS AND 771 00:32:52,690 --> 00:32:57,027 WILL READ IT, I THINK IT IS 772 00:32:57,027 --> 00:33:02,333 CRITICAL FOR MY COLLEAGUES IN 773 00:33:02,333 --> 00:33:03,367 OTO LARYNGOLOGY NEUROLOGY FAMILY 774 00:33:03,367 --> 00:33:05,302 PRACTICE THERE IS NO 775 00:33:05,302 --> 00:33:07,204 REIMBURSEMENT FOR SMELL TEST, IT 776 00:33:07,204 --> 00:33:08,939 IS CURRENTLY NOT SUPPORTED. BUT 777 00:33:08,939 --> 00:33:12,910 THEY ARE INEXPENSIVE AND 778 00:33:12,910 --> 00:33:14,912 CLINICALLY IMPORTANT. SO WE VIEW 779 00:33:14,912 --> 00:33:19,183 THIS AS AN OPPORTUNITY FOR 780 00:33:19,183 --> 00:33:22,286 INTERESTED CLINICIAN TO GET 781 00:33:22,286 --> 00:33:26,624 GUIDANCE TO UNDERSTAND WHICH 782 00:33:26,624 --> 00:33:30,961 TESTS AND FOR WHICH PATIENT. I 783 00:33:30,961 --> 00:33:34,498 WANT TO GIVE KUDOS TO NIDCD IN 784 00:33:34,498 --> 00:33:39,937 THAT TWO YEARS AGO WE FUNDED A 785 00:33:39,937 --> 00:33:41,739 GRANT CALLED CHEMO SENSORY 786 00:33:41,739 --> 00:33:45,176 TESTING. THIS IS A REALLY UNIQUE 787 00:33:45,176 --> 00:33:47,444 MULTI-DISCIPLINARY MEETING THAT 788 00:33:47,444 --> 00:33:49,813 BROUGHT TOGETHER BROAD SPECTRUM 789 00:33:49,813 --> 00:33:52,249 OF INDUSTRY, CLINICIANS, 790 00:33:52,249 --> 00:33:55,953 PATIENTS AND THEIR ADVOCACY 791 00:33:55,953 --> 00:33:59,757 GROUPS, TO UNDERSTAND WHY THERE 792 00:33:59,757 --> 00:34:01,425 IS NOT UNIVERSAL TESTING OF THE 793 00:34:01,425 --> 00:34:03,460 SENSE OF SMELL, WHY IS IT NOT 794 00:34:03,460 --> 00:34:05,062 CONSIDERED A VITAL SIGN THAT 795 00:34:05,062 --> 00:34:07,464 SHOULD BE MONITORED JUST LIKE 796 00:34:07,464 --> 00:34:13,771 BLOOD PRESSURE. SURVEY UNRELATE 797 00:34:13,771 --> 00:34:16,407 TOTTED THAT MEETING FOUND 90% OF 798 00:34:16,407 --> 00:34:19,210 PATIENTS APPRECIATE BEING ASKED 799 00:34:19,210 --> 00:34:24,248 TO TEST THEIR SENSE OF SMELL 800 00:34:24,248 --> 00:34:27,084 THESE TESTS ARE NON-INVASIVE, 801 00:34:27,084 --> 00:34:28,152 RELATIVELY QUICK AND GIVES 802 00:34:28,152 --> 00:34:32,856 INSIGHT. 60% OF PEOPLE, 40% OF 803 00:34:32,856 --> 00:34:34,625 PEOPLE THAT HAD THOUGHT THEY 804 00:34:34,625 --> 00:34:38,028 LOST THEIR SENSE OF SMELL 805 00:34:38,028 --> 00:34:39,163 HAVEN'T, FLIP THAT AROUND 806 00:34:39,163 --> 00:34:40,731 PATIENTS THINK THEIR SENSE OF 807 00:34:40,731 --> 00:34:42,866 SMELL IS FINE, YOU IDENTIFY 808 00:34:42,866 --> 00:34:46,203 DEFICIENCY, THIS IS A SOMETHING 809 00:34:46,203 --> 00:34:48,005 THAT SAN EASY ASK IN MY 810 00:34:48,005 --> 00:34:51,108 EXPERIENCE. -- IS AN EASY ASK 811 00:34:51,108 --> 00:34:52,810 IN MY EXPERIENCE. IT SAVES 812 00:34:52,810 --> 00:34:55,179 MONEY. THAT'S THE ECONOMIC 813 00:34:55,179 --> 00:34:56,480 ARGUMENT, IF WE IDENTIFY 814 00:34:56,480 --> 00:34:59,950 DISEASES SOONER, WE CAN TREAT 815 00:34:59,950 --> 00:35:03,087 THEM SOONER, WE CAN SPARE MONEY, 816 00:35:03,087 --> 00:35:04,455 WE CAN SAVE FUNDS FOR OTHER 817 00:35:04,455 --> 00:35:06,590 THINGS, MORE RESEARCH TO ADVANCE 818 00:35:06,590 --> 00:35:11,195 SCIENCE FURTHER. AGAIN AN 819 00:35:11,195 --> 00:35:12,663 AVERAGE OF FIVE TO TEN YEARS OF 820 00:35:12,663 --> 00:35:16,333 EARLIER DIAGNOSIS FOR MANY OF 821 00:35:16,333 --> 00:35:22,239 THESE CONDITIONS. PSYCHOPHYSICAL 822 00:35:22,239 --> 00:35:23,574 TESTING AS I MENTION IS LIMITED 823 00:35:23,574 --> 00:35:26,744 AND THERE IS A NUMBER OF 824 00:35:26,744 --> 00:35:31,882 ADDITIONAL DEVICES APPROACHES TO 825 00:35:31,882 --> 00:35:33,350 OBJECTIVELY MEASURE SENSE OF 826 00:35:33,350 --> 00:35:38,222 SMELSMELL. OLFACTOMETERS A DIGIL 827 00:35:38,222 --> 00:35:39,890 DEVICE TO REDUCE SENSE OF SMELL 828 00:35:39,890 --> 00:35:41,392 IS BEING ACTIVELY DEVELOPED BY 829 00:35:41,392 --> 00:35:43,627 SOME OF THE BIGGEST FORTUNE 500 830 00:35:43,627 --> 00:35:46,497 COMPANIES INTERNATIONALLY. THEY 831 00:35:46,497 --> 00:35:49,933 SEE THE MARKET FOR THIS AND HAVE 832 00:35:49,933 --> 00:35:52,836 REALLY BEEN VERY INTERESTING 833 00:35:52,836 --> 00:35:58,242 PARTNERS, NON-MEDICAL -- I WILL 834 00:35:58,242 --> 00:36:00,244 LEAVE AT THAT BUT INDUSTRY WANTS 835 00:36:00,244 --> 00:36:02,146 TO CONTRIBUTE. AND THEY ARE 836 00:36:02,146 --> 00:36:04,248 LENDING THEIR EXPERTISE TO HELP 837 00:36:04,248 --> 00:36:08,886 TO DEVELOP NEW TOOLS. FUNCTIONAL 838 00:36:08,886 --> 00:36:10,254 NEUROIMAGING, THIS CURRENTLY IS 839 00:36:10,254 --> 00:36:12,456 LIMITED TO THE RESEARCH SETTING, 840 00:36:12,456 --> 00:36:15,626 PARTICULARLY HERE AT THE NIH. 841 00:36:15,626 --> 00:36:18,062 BUT IT ALLOW US TO GET TO THAT 842 00:36:18,062 --> 00:36:21,131 OBJECTIVE QUESTION, CAN WE SEE A 843 00:36:21,131 --> 00:36:22,800 FUNCTIONAL CHANGE IN ACTIVITY 844 00:36:22,800 --> 00:36:24,902 WHEN SOMEONE IS EXPOSED TO AN 845 00:36:24,902 --> 00:36:28,906 ODOR THAT TELLS US THE SYSTEM IS 846 00:36:28,906 --> 00:36:31,775 INTACT? AGAIN, BIOMARKER 847 00:36:31,775 --> 00:36:34,411 INTEGRATION. I MENTION WE CAN 848 00:36:34,411 --> 00:36:35,579 COLLECT TAU PROTEIN IN THE NOSE 849 00:36:35,579 --> 00:36:37,448 OF SOMEONE WITH EARLY 850 00:36:37,448 --> 00:36:41,785 ALZHEIMER'S DISEASE. THESE ARE 851 00:36:41,785 --> 00:36:43,787 CRITICAL ADVANCEMENTS WAITING TO 852 00:36:43,787 --> 00:36:47,758 BE ESTABLISHED AND UTILIZED. SO 853 00:36:47,758 --> 00:36:53,130 WHAT ARE WE GOING TO DO? AS LISA 854 00:36:53,130 --> 00:36:54,331 MENTIONED, A YEAR AGO WE HAVE 855 00:36:54,331 --> 00:36:56,133 OPENED THE NATIONAL SMELL AND 856 00:36:56,133 --> 00:36:57,768 TASTE CENTER. I WILL TELL YOU 857 00:36:57,768 --> 00:37:01,372 ALL THIS WAS THE PUSH FOR ME TO 858 00:37:01,372 --> 00:37:03,540 LEAVE WHAT I ABSOLUTELY LOVED IN 859 00:37:03,540 --> 00:37:07,811 ATLANTA AND TO COME BACK HOME TO 860 00:37:07,811 --> 00:37:09,613 JOIN THE NIH AND TO MAKE A 861 00:37:09,613 --> 00:37:11,315 DIFFERENCE, THAT HAS ALWAYS BEEN 862 00:37:11,315 --> 00:37:13,717 MY DRIVING PRINCIPLE. I IMAGINE 863 00:37:13,717 --> 00:37:15,753 IT IS SOMETHING NEAR AND DEAR TO 864 00:37:15,753 --> 00:37:17,855 Y'ALL AS WELL. WE ARE HERE TO 865 00:37:17,855 --> 00:37:21,325 IMPACT OUR PATIENTS. THE SMELL 866 00:37:21,325 --> 00:37:24,361 AND TASTE CENTER IS A CLINICAL 867 00:37:24,361 --> 00:37:25,863 RESEARCH HOME FOR CHEMO 868 00:37:25,863 --> 00:37:26,997 SENSATION, SMELL AND TASTE 869 00:37:26,997 --> 00:37:30,467 STUDIES AT THE NIH. WE ARE 870 00:37:30,467 --> 00:37:32,603 INTENTIONALLY PATIENT CENTERED, 871 00:37:32,603 --> 00:37:34,538 LOOKING TO LEAD TRANSLATIONAL 872 00:37:34,538 --> 00:37:36,840 SCIENCE TO BRIDGE THE GAP FROM 873 00:37:36,840 --> 00:37:39,243 THE CRITICAL BASIC STUDIES THAT 874 00:37:39,243 --> 00:37:41,345 OUR INVESTIGATORS ARE MAKING TO 875 00:37:41,345 --> 00:37:46,216 THE BEDSIDE. WHERE IT CAN IMPACT 876 00:37:46,216 --> 00:37:48,185 OUR PATIENTS. OUR INAUGURAL 877 00:37:48,185 --> 00:37:49,520 SEMINAR WAS IN BUILDING 35 878 00:37:49,520 --> 00:37:51,054 AROUND THE CORNER AND WE WERE 879 00:37:51,054 --> 00:37:53,957 VERY HONORED TO HAVE PROFESSOR 880 00:37:53,957 --> 00:37:58,362 THOMAS HUMMEL AS OUR INAUGURAL 881 00:37:58,362 --> 00:38:00,831 SPEAKER. THIS IS A GROUP PHOTO 882 00:38:00,831 --> 00:38:02,166 AND SOMETHING I LOVE HANGING IN 883 00:38:02,166 --> 00:38:03,500 MY OFFICE. THIS IS A BIT OF 884 00:38:03,500 --> 00:38:05,702 WHO'S WHO WITHIN THE FIELD AND 885 00:38:05,702 --> 00:38:08,906 REALLY WAS JUST AN AMAZING 886 00:38:08,906 --> 00:38:11,608 OPPORTUNITY TO SHARE ADVANCES 887 00:38:11,608 --> 00:38:15,012 AND AREAS OF INTEREST AND 888 00:38:15,012 --> 00:38:20,017 FURTHER RESEARCH WITH THIS 889 00:38:20,017 --> 00:38:22,386 GROUP. INTENTIONALLY WE ARE NOT 890 00:38:22,386 --> 00:38:25,422 LIMITING OURSELVES TO THE NIH 891 00:38:25,422 --> 00:38:27,558 INTRAMURAL PROGRAM. WE WITH THE 892 00:38:27,558 --> 00:38:30,160 HELP OF OUR CONGRESSIONAL TEAM 893 00:38:30,160 --> 00:38:34,832 WE REACHED OUT TO CONGRESS AND 894 00:38:34,832 --> 00:38:38,502 HAVE RECORDED VIDEOS, THOUGHTFUL 895 00:38:38,502 --> 00:38:39,870 WORDS OF SUPPORT FROM A NUMBER 896 00:38:39,870 --> 00:38:41,805 OF CONGRESSMEN AN WOMEN TO 897 00:38:41,805 --> 00:38:44,475 REALLY TO ME SPEAKS TO THE 898 00:38:44,475 --> 00:38:45,542 IMPORTANCE OF WHAT WE ARE TRYING 899 00:38:45,542 --> 00:38:48,579 TO DO. THE MISSION STATEMENT FOR 900 00:38:48,579 --> 00:38:49,713 THE NATIONAL SMELL AND TASTE 901 00:38:49,713 --> 00:38:53,650 CENTER AT THE NIH IS TO ADVANCE 902 00:38:53,650 --> 00:38:56,386 THE UNDERSTANDING OF CHEMICAL 903 00:38:56,386 --> 00:38:57,888 SENSES, SMELL AND TASTE AND 904 00:38:57,888 --> 00:39:00,090 RELATED DISORDERS THROUGH 905 00:39:00,090 --> 00:39:03,060 COMPREHENSIVE RESEARCH, 906 00:39:03,060 --> 00:39:05,429 EDUCATION, PATIENT CARE. THOSE 907 00:39:05,429 --> 00:39:07,631 ARE OUR BULLETS. OUR PILLAR, IF 908 00:39:07,631 --> 00:39:11,101 YOU WILL. INNOVATIVE RESEARCH, 909 00:39:11,101 --> 00:39:12,369 COMPREHENSIVE CARE, AND 910 00:39:12,369 --> 00:39:15,205 EDUCATION AND OUTREACH. WITHOUT 911 00:39:15,205 --> 00:39:16,773 ALL THREE OF THESE WE WILL NOT 912 00:39:16,773 --> 00:39:21,678 HAVE THE IMPACT THAT OUR 913 00:39:21,678 --> 00:39:25,215 PATIENTS DESERVE. OUR CENTER IS 914 00:39:25,215 --> 00:39:27,718 LED BY PAULY AND I. HOWEVER THIS 915 00:39:27,718 --> 00:39:30,120 TAKES A VILLAGE. AS ALL 916 00:39:30,120 --> 00:39:32,356 RESEARCH DOES. MANY OF YOU IN 917 00:39:32,356 --> 00:39:33,657 THIS ROOM AND I WILL CALL YOU 918 00:39:33,657 --> 00:39:37,127 OUT WITH ACKNOWLEDGMENTS ARE 919 00:39:37,127 --> 00:39:39,730 CRITICAL TO THIS NOT ONLY 920 00:39:39,730 --> 00:39:42,466 YESTERDAY BUT TODAY AND FUTURE. 921 00:39:42,466 --> 00:39:45,269 THIS RESEARCH PROGRAM WILL NOT 922 00:39:45,269 --> 00:39:48,405 SURVIVE WITHOUT DIR AND THE 923 00:39:48,405 --> 00:39:49,773 IMMENSE ADMINISTRATIVE SUPPORT 924 00:39:49,773 --> 00:39:54,411 WE GET ALMOST ON A DAILY BASIS. 925 00:39:54,411 --> 00:39:55,779 I'M LOOK RIGHT AT YOU AS I SAY 926 00:39:55,779 --> 00:40:00,984 THAT. WE HAVE VERY UNIQUE 927 00:40:00,984 --> 00:40:02,886 RESOURCES. THIS IS THE DRIVING 928 00:40:02,886 --> 00:40:05,989 THINGS THAT I POINT TO WHEN 929 00:40:05,989 --> 00:40:08,525 ASKED WHAT IS UNIQUE ABOUT THIS 930 00:40:08,525 --> 00:40:10,360 PROGRAM? IN THE PICTURE ON THE 931 00:40:10,360 --> 00:40:12,162 RIGHT YOU SEE OUR RESEARCH 932 00:40:12,162 --> 00:40:14,231 PARTICIPANT HOOKED UP TO A 933 00:40:14,231 --> 00:40:16,199 MACHINE IN THE BACKGROUND, BUNCH 934 00:40:16,199 --> 00:40:19,970 OF CANISTERS AND TUBES. THIS IS 935 00:40:19,970 --> 00:40:23,473 AN OLFACTOMETER. WHAT WE KNOW 936 00:40:23,473 --> 00:40:25,042 ABOUT SENSE OF SMELL IS STUDYING 937 00:40:25,042 --> 00:40:28,879 IT IS NOT EASY AND IT CHANGES TO 938 00:40:28,879 --> 00:40:30,814 CONCENTRATION OF THE ODORANT, 939 00:40:30,814 --> 00:40:32,316 TEMPERATURE OF THE AIR, THE 940 00:40:32,316 --> 00:40:35,819 RELATIVE HUMIDITY OF THE AIR. 941 00:40:35,819 --> 00:40:37,254 CHANGES PERCEPTION, CHANGES THE 942 00:40:37,254 --> 00:40:42,025 SIGNAL. SO JUST LIKE AN AUDIO 943 00:40:42,025 --> 00:40:43,760 PETRI BOOTH YOU HAVE OBJECTIVE 944 00:40:43,760 --> 00:40:45,829 STRUCTURED SIGNAL TO PRESENT TO 945 00:40:45,829 --> 00:40:50,067 THE PATIENT FOR SMELL WE HAVE 946 00:40:50,067 --> 00:40:52,135 OLFACTOMETERS. WHAT WE HAVE HERE 947 00:40:52,135 --> 00:40:53,670 IS BUILT IN GERMANY. THEY ARE 948 00:40:53,670 --> 00:40:56,006 NOT ASSEMBLED IN THE STATES. 949 00:40:56,006 --> 00:40:58,609 AND FOR ME TO BE TRAINED ON IT, 950 00:40:58,609 --> 00:41:00,944 I ACTUALLY HAD TO FLY AN HOUR 951 00:41:00,944 --> 00:41:07,250 NORTH OF MONTREAL TO THE NEAREST 952 00:41:07,250 --> 00:41:08,285 OLFACTOMETER DEVELOP AND USED 953 00:41:08,285 --> 00:41:09,586 CLINICALLY BY THIS RESEARCH 954 00:41:09,586 --> 00:41:13,757 TEAM. THERE ARE OTHER 955 00:41:13,757 --> 00:41:14,791 OLFACTOMETERS OUT THERE BUT THIS 956 00:41:14,791 --> 00:41:16,393 IS THE MOST ESTABLISHED AND 957 00:41:16,393 --> 00:41:18,261 GIVES US THE GREATEST 958 00:41:18,261 --> 00:41:21,531 OPPORTUNITY TO HAVE A UNIQUE 959 00:41:21,531 --> 00:41:22,733 IMPRINT. OUR CENTER IS NOT 960 00:41:22,733 --> 00:41:25,402 LIMITED TO SMELL. WE ALSO HAVE 961 00:41:25,402 --> 00:41:28,538 A GUTOMETER WHICH IS THE SAME 962 00:41:28,538 --> 00:41:31,274 ANALOGY THAT IS IN AUDIOLOGY 963 00:41:31,274 --> 00:41:35,312 BOOTH FOR TASTE H. WE ARE 964 00:41:35,312 --> 00:41:39,249 ACQUIRING AN EEG TO MEASURE 965 00:41:39,249 --> 00:41:40,917 BRAIN ACTIVITY AND NEURAL 966 00:41:40,917 --> 00:41:42,753 ACTIVATION WITH THESE 967 00:41:42,753 --> 00:41:44,521 STANDARDIZED EXPOSURES. WE WILL 968 00:41:44,521 --> 00:41:47,090 BE USING THIS BOTH IN THE CLINIC 969 00:41:47,090 --> 00:41:48,892 AND IN ASSOCIATION WITH 970 00:41:48,892 --> 00:41:51,294 FUNCTIONAL MRI. SO WE WILL 971 00:41:51,294 --> 00:41:54,097 GENERATE A TON OF DATA AND 972 00:41:54,097 --> 00:41:57,934 INSIGHT TO SEE WHAT IS GOING 973 00:41:57,934 --> 00:42:00,137 WRONG AND HOW WE CAN FIX THESE 974 00:42:00,137 --> 00:42:04,307 ISSUES. THERE ALSO IS A 975 00:42:04,307 --> 00:42:07,110 PARTNERSHIP THAT WE ARE FORMING 976 00:42:07,110 --> 00:42:08,612 WITH NINDS WHERE I THINK IT IS 977 00:42:08,612 --> 00:42:12,582 MY LAST SLIDE, I WILL HIGHLIGHT 978 00:42:12,582 --> 00:42:13,750 INTRACRANIAL RECORDINGS O. 979 00:42:13,750 --> 00:42:16,453 PATIENTS UNDERGOING NEUROSURGE 980 00:42:16,453 --> 00:42:17,621 PROCEDURES AT CLINICAL CENTER 981 00:42:17,621 --> 00:42:19,056 WILL BE EXPOSED TO TESTING 982 00:42:19,056 --> 00:42:21,191 BATTERY AND WILL HAVE THAT MUCH 983 00:42:21,191 --> 00:42:22,459 GREATER DETAIL OF THE NEURAL 984 00:42:22,459 --> 00:42:29,032 ACTIVITY. SO THIS IS A QUICK 985 00:42:29,032 --> 00:42:31,435 SUMMARY OF THE DIFFERENT TYPES 986 00:42:31,435 --> 00:42:34,604 OF SMELL DYSFUNCTION. THERE IS 987 00:42:34,604 --> 00:42:39,543 NOT ONE FORM. I MENTIONED DEPOS 988 00:42:39,543 --> 00:42:42,312 MENTIONA AND ANOSMIA AND I FOX 989 00:42:42,312 --> 00:42:46,183 OUT PEROSMIA A QUALITATIVE SMELL 990 00:42:46,183 --> 00:42:47,984 DISORDER. THIS IS THE FOCUS OF 991 00:42:47,984 --> 00:42:49,486 FIRST PROTOCOL AND I WILL WIND 992 00:42:49,486 --> 00:42:51,254 UP WITH A FEW SLIDES GIVING YOU 993 00:42:51,254 --> 00:42:55,258 GREATER DETAIL ABOUT THIS STUDY 994 00:42:55,258 --> 00:42:58,762 BUT THE REASON WE WANT TO STUDY 995 00:42:58,762 --> 00:43:00,397 QUALITATIVE SMELLS, QUALITATIVE 996 00:43:00,397 --> 00:43:03,333 SMELL DISORDERS, IS THAT THE 997 00:43:03,333 --> 00:43:05,102 PREVALENCE HAS DRAMATICALLY 998 00:43:05,102 --> 00:43:08,205 INCREASED OVER FIVE YEARS. WE 999 00:43:08,205 --> 00:43:09,706 DON'T HAVE THE POPULATION BASED 1000 00:43:09,706 --> 00:43:14,111 DATA TO GIVE YOU A FIRM NUMBER, 1001 00:43:14,111 --> 00:43:15,812 THIS MANY PARTICIPANTS HAVE 1002 00:43:15,812 --> 00:43:17,881 DEVELOPED QUALITATIVE KISS 1003 00:43:17,881 --> 00:43:20,550 ORDERS. BUDDIES ORDERS BUT WE 1004 00:43:20,550 --> 00:43:24,621 KNOW IT IS SIGNIFICANT. IT IS 1005 00:43:24,621 --> 00:43:26,757 RELATIVELY UNDERSTUDIED FOR THAT 1006 00:43:26,757 --> 00:43:29,526 REASON. AND IT IS A COMMON AND 1007 00:43:29,526 --> 00:43:31,762 DEFINING SYMPTOM OF PATIENTS 1008 00:43:31,762 --> 00:43:34,831 WITH LONG COVID. THIS IS A 1009 00:43:34,831 --> 00:43:39,369 PREVALENT CONCERNING DISORDER. 1010 00:43:39,369 --> 00:43:41,905 BEFORE LAST FIVE YEARS, 2007 THE 1011 00:43:41,905 --> 00:43:45,475 POPULATION BASED PREVALENCE WAS 1012 00:43:45,475 --> 00:43:47,477 3.9%. NOT RARE DISEASE BY ANY 1013 00:43:47,477 --> 00:43:49,379 MEANS BUT THIS NUMBER IS 1014 00:43:49,379 --> 00:43:54,651 SEVERELY LOW. GOING TO JUMP 1015 00:43:54,651 --> 00:44:00,056 THROUGH A COUPLE FOR THE SAKE OF 1016 00:44:00,056 --> 00:44:06,663 TIME. WHAT IS PAAROSMIA IN IT IS 1017 00:44:06,663 --> 00:44:08,665 DRAMATIC. PATIENTS THAT DEVELOP 1018 00:44:08,665 --> 00:44:11,635 STRONGLY NEGATIVE PERCEPTION 1019 00:44:11,635 --> 00:44:14,004 WHEN EXPOSED TO A TRIGGERING 1020 00:44:14,004 --> 00:44:16,139 ODOR. THIS CLOUD MAP ON THE TOP 1021 00:44:16,139 --> 00:44:19,075 RIGHT ARE THE MOST COMMON 1022 00:44:19,075 --> 00:44:21,611 TRIGGERS. YOU CAN SEE THERE ARE 1023 00:44:21,611 --> 00:44:25,348 THINGS I PARTICULARLY LIKE. 1024 00:44:25,348 --> 00:44:27,417 COFFEE, IMAGINE YOU WAKE UP ONE 1025 00:44:27,417 --> 00:44:28,985 MORNING TO HAVE YOUR FAVORITE 1026 00:44:28,985 --> 00:44:31,855 CUP OF COFFEE AND IT SMELLS LIKE 1027 00:44:31,855 --> 00:44:33,723 SEWAGE. NOT ONLY THAT, IT IS 1028 00:44:33,723 --> 00:44:36,126 TRIGGERED A PANIC ATTACK AND YOU 1029 00:44:36,126 --> 00:44:37,494 PHYSICALLY HAVE TO REMOVE 1030 00:44:37,494 --> 00:44:39,896 YOURSELF FROM THE ROOM. THIS IS 1031 00:44:39,896 --> 00:44:42,599 NOT AN EXAGGERATION. THIS IS 1032 00:44:42,599 --> 00:44:46,236 VERY TYPICAL FOR THESE PATIENTS. 1033 00:44:46,236 --> 00:44:50,373 THEY ARE MORE LIKELY TO AFFECT A 1034 00:44:50,373 --> 00:44:52,475 YOUNGER FEMALE PATIENT THAN NOT 1035 00:44:52,475 --> 00:44:54,911 THOUGH IT CAN PRESENT THROUGHOUT 1036 00:44:54,911 --> 00:44:59,950 THE GENDER AND AGE SPECTRUM. 1037 00:44:59,950 --> 00:45:01,484 TYPICALLY THREE TO 12 MONTHS 1038 00:45:01,484 --> 00:45:03,854 FOLLOWING A VIRAL ILLNESS IS 1039 00:45:03,854 --> 00:45:08,491 WHEN THIS APPEARS. WE NOTICE 1040 00:45:08,491 --> 00:45:12,062 SEVERE EMOTIONAL STRAIN AS I 1041 00:45:12,062 --> 00:45:14,397 MENTION, THIS CAN LEAD TO FOOD 1042 00:45:14,397 --> 00:45:16,800 AVOIDANCE AND WHAT WE CONSIDER 1043 00:45:16,800 --> 00:45:20,370 COMPULSIVE EATING DISORDERS. 1044 00:45:20,370 --> 00:45:22,138 SASHLY SITTING IN THE BACK -- 1045 00:45:22,138 --> 00:45:23,740 ASHLEY SITTING IN THE BACK 1046 00:45:23,740 --> 00:45:25,909 RECEIVED A GRANT FOR COMPULSIVE 1047 00:45:25,909 --> 00:45:27,477 EATING DISORDERS BEHAVIORS TO 1048 00:45:27,477 --> 00:45:29,546 STUDY THIS FOR THIS REASON. WE 1049 00:45:29,546 --> 00:45:31,381 KNOW ASSOCIATION BUT IT HASN'T 1050 00:45:31,381 --> 00:45:36,253 BEEN I STUDIED OR DEFINED. WORST 1051 00:45:36,253 --> 00:45:39,155 OF ALL, TREATMENT IS LIMITED. 1052 00:45:39,155 --> 00:45:40,857 WHEN I SEE THESE PATIENTS IN 1053 00:45:40,857 --> 00:45:43,426 CLINIC I HAVE A SMALL PIT IN MY 1054 00:45:43,426 --> 00:45:44,728 STOMACH, ALL I CAN OFFER IS 1055 00:45:44,728 --> 00:45:46,463 SUPPORTIVE CARE AND HOPE THAT 1056 00:45:46,463 --> 00:45:50,767 THESE SYMPTOMS RESOLVE OVER THE 1057 00:45:50,767 --> 00:45:53,737 NEXT FEW YEARS. SO WHAT IS THE 1058 00:45:53,737 --> 00:45:57,507 CAUSE OF PAROSMIA? THIS IS OUR 1059 00:45:57,507 --> 00:46:01,044 FIRST PROTOCOL. I MENTIONED THE 1060 00:46:01,044 --> 00:46:02,879 IMPORTANCE OF THE GLOMERULI AND 1061 00:46:02,879 --> 00:46:04,447 THIS ONE TO ONE CONNECTION 1062 00:46:04,447 --> 00:46:05,715 BETWEEN OLFACTORY SENSE ARE I 1063 00:46:05,715 --> 00:46:08,818 NEURONS TO A SPECIFIC ODORANT IN 1064 00:46:08,818 --> 00:46:11,855 THE GLOMERULUS WHERE IT CONNECTS 1065 00:46:11,855 --> 00:46:17,661 CENTRALLY. THESE ON THE RIGHT 1066 00:46:17,661 --> 00:46:21,197 HIGHLIGHT THAT NORMAL FUNCTION 1067 00:46:21,197 --> 00:46:24,567 RECEPTOR ACTIVATES A NERVE, 1068 00:46:24,567 --> 00:46:27,604 ACTIVATES A GLOMERULUS. ON THE 1069 00:46:27,604 --> 00:46:29,306 RIGHT WHAT WE BELIEVE TO BE A 1070 00:46:29,306 --> 00:46:31,274 MISWIRING WHERE THAT ONE 1071 00:46:31,274 --> 00:46:33,009 OLFACTORY SENSORY NEURON BECAUSE 1072 00:46:33,009 --> 00:46:35,145 OF MAYBE RECOVERY FROM VIRAL 1073 00:46:35,145 --> 00:46:36,913 INJURY NO LONGER ATTACHES TO THE 1074 00:46:36,913 --> 00:46:39,783 RIGHT GLOMERULUS. THERE IS A 1075 00:46:39,783 --> 00:46:41,251 MIX UP MANY THE CODE. AND 1076 00:46:41,251 --> 00:46:43,153 BECAUSE OF THAT, THERE IS A MIX 1077 00:46:43,153 --> 00:46:46,389 UP IN MANY THE PERCEPTION OF THE 1078 00:46:46,389 --> 00:46:49,326 SMELL. WE KNOW THIS IS NOT ONLY 1079 00:46:49,326 --> 00:46:51,461 PERIPHERAL, HOWEVER. WE KNOW 1080 00:46:51,461 --> 00:46:53,229 THAT THE BRAIN STRUCTURALLY 1081 00:46:53,229 --> 00:46:56,866 CHANGES WITH PAROSMIA. THERE IS 1082 00:46:56,866 --> 00:46:58,735 REDUCED VOLUME OF THE OLFACTORY 1083 00:46:58,735 --> 00:47:01,171 BULB, ATROPHY OF CORTICAL 1084 00:47:01,171 --> 00:47:04,607 REGIONS WITHIN THE BRAIN. AND 1085 00:47:04,607 --> 00:47:06,343 FUNCTIONALLY, WE KNOW THERE IS 1086 00:47:06,343 --> 00:47:08,912 REDUCED CONNECTIVITY, THE 1087 00:47:08,912 --> 00:47:11,081 PATHWAYS FOR WHICH OUR BRAIN 1088 00:47:11,081 --> 00:47:13,717 INTERPRETS SMELL, IS ALTERED. 1089 00:47:13,717 --> 00:47:19,022 AND I HAVE CIRCLED IN RED HERE 1090 00:47:19,022 --> 00:47:21,358 (INDISCERNIBLE) NEW RECRUITS NEW 1091 00:47:21,358 --> 00:47:24,361 POST-DOCS WITHIN THE NIDCD I 1092 00:47:24,361 --> 00:47:25,562 WOULD PARTLY BECAUSE OF THIS 1093 00:47:25,562 --> 00:47:30,133 EXACT WORK. SO HERE IS 1094 00:47:30,133 --> 00:47:31,701 (INDISCERNIBLE). THE THEMES OF 1095 00:47:31,701 --> 00:47:33,870 THE STUDY ARE TO INVESTIGATE 1096 00:47:33,870 --> 00:47:35,572 CHANGES IN NEURONAL CONNECTIVITY 1097 00:47:35,572 --> 00:47:38,375 THAT ALTERS OLFACTORY PERCEPTION 1098 00:47:38,375 --> 00:47:44,247 IN PAROSMIA AND ASSOCIATE NEURAL 1099 00:47:44,247 --> 00:47:45,782 INFLAMMATION WITH THESE 1100 00:47:45,782 --> 00:47:46,583 FUNCTIONAL CHANGES. I BELIEVE 1101 00:47:46,583 --> 00:47:48,118 THE UNDERLYING CAUSE IS 1102 00:47:48,118 --> 00:47:50,653 UNRESOLVED INFLAMMATION BOTH 1103 00:47:50,653 --> 00:47:51,654 PERIPHERALLY AS WELL AS 1104 00:47:51,654 --> 00:47:56,026 CENTRALLY. HERE IS OUR STUDY 1105 00:47:56,026 --> 00:47:59,429 DESIGN. WE WILL BE RECRUITING 80 1106 00:47:59,429 --> 00:48:02,198 PARTICIPANTS. SO 20 WITHIN FOUR 1107 00:48:02,198 --> 00:48:03,733 COHORT, WE WILL FOLLOW THEM OVER 1108 00:48:03,733 --> 00:48:08,405 A YEAR. THIS IS A SUMMARY OF 1109 00:48:08,405 --> 00:48:11,875 STUDY ACTIVITIES. WE WILL BE 1110 00:48:11,875 --> 00:48:13,710 MEASURING QUALITY OF LIFE, 1111 00:48:13,710 --> 00:48:15,845 PATIENT SELF-ASSESSMENT, WE WILL 1112 00:48:15,845 --> 00:48:20,050 BE DOING PSYCHOMETRIC TESTING. 1113 00:48:20,050 --> 00:48:23,887 AND RETRO NASAL TESTING, THE WE 1114 00:48:23,887 --> 00:48:26,022 BREATHE IN AN MATERIALLY, HOW IS 1115 00:48:26,022 --> 00:48:27,424 SENSE OF SMELL WORKING, IF WE 1116 00:48:27,424 --> 00:48:29,225 EAT SOMETHING THE ODOR GOES 1117 00:48:29,225 --> 00:48:30,827 BEHIND YOUR PALATE. HOW IS THAT 1118 00:48:30,827 --> 00:48:32,395 WORKING? THEN WE WILL 1119 00:48:32,395 --> 00:48:35,331 OBJECTIVELY MEASURE WITH EEG 1120 00:48:35,331 --> 00:48:40,670 FUNCTIONAL AND STRUCTURAL MRI. 1121 00:48:40,670 --> 00:48:41,671 I EXPECT TO FIND A LOT OF 1122 00:48:41,671 --> 00:48:43,606 THINGS. THIS IS A PROGRAM 1123 00:48:43,606 --> 00:48:45,842 BUILDING STUDY, NOT A SMALL 1124 00:48:45,842 --> 00:48:49,079 STUDY THAT I EXPECT TO BE 1125 00:48:49,079 --> 00:48:50,814 FINISHED IN THE NEXT SIX MONTHS 1126 00:48:50,814 --> 00:48:54,217 SADLY. I EXPECT WE WILL DESCRIBE 1127 00:48:54,217 --> 00:48:56,820 ALTER CONNECTIVITY PATTERNS THAT 1128 00:48:56,820 --> 00:48:59,255 INVOLVE MOTION CENTERS AND 1129 00:48:59,255 --> 00:49:00,723 RESOLVE WITH PATIENT SYMPTOMS 1130 00:49:00,723 --> 00:49:05,428 TOWARDS RECOVERY. WILL CORRELATE 1131 00:49:05,428 --> 00:49:07,897 CENTRAL FINDINGS WITH NEURAL 1132 00:49:07,897 --> 00:49:08,898 INFLAMMATION PATIENT REPORTED 1133 00:49:08,898 --> 00:49:12,102 OUTCOMES AND TESTING. ESTABLISH 1134 00:49:12,102 --> 00:49:15,805 THE ASSOCIATION OF PAROSMIA WITH 1135 00:49:15,805 --> 00:49:18,007 COMPULSIVE EATING DISORDERS AS I 1136 00:49:18,007 --> 00:49:19,809 MENTION AND IDENTIFY THERAPEUTIC 1137 00:49:19,809 --> 00:49:24,681 TARGETS FOR FUTURE STUDY. THIS 1138 00:49:24,681 --> 00:49:26,449 CENTER, THIS PROGRAM, IS 1139 00:49:26,449 --> 00:49:29,152 INCREDIBLY UNIQUE TO THE NIH 1140 00:49:29,152 --> 00:49:32,322 INTRAMURAL PROGRAM. I AM THE 1141 00:49:32,322 --> 00:49:35,492 LUCKIEST PERSON THAT I KNOW. I'M 1142 00:49:35,492 --> 00:49:40,463 IN A CENTER, A PLACE WITH Y'ALL 1143 00:49:40,463 --> 00:49:42,932 THAT VALUES THIS WORK AND HAS 1144 00:49:42,932 --> 00:49:45,768 WORLD-LEADING EXPERTS IN AREAS 1145 00:49:45,768 --> 00:49:48,605 THAT DOVE TAIL BEAUTIFULLY. 1146 00:49:48,605 --> 00:49:50,306 CENTER FOR ALZHEIMER'S AND 1147 00:49:50,306 --> 00:49:52,041 RELATE DEMENTIAS, WE ARE 1148 00:49:52,041 --> 00:49:53,977 PARTNERING WITH THEM TO HAVE A 1149 00:49:53,977 --> 00:49:55,678 PRESENCE IN THEIR NEW CLINIC IN 1150 00:49:55,678 --> 00:49:57,514 THE CLINICAL CENTER, BOTH FOR 1151 00:49:57,514 --> 00:49:59,382 HEARING TESTING AS WELL AS SMELL 1152 00:49:59,382 --> 00:50:04,020 AND TASTE. THE RESOURCES 1153 00:50:04,020 --> 00:50:05,788 UNBELIEVABLE. SAME IS SAID WITH 1154 00:50:05,788 --> 00:50:07,690 THE BALTIMORE LONGITUDINAL STUDY 1155 00:50:07,690 --> 00:50:10,393 OF AGING, DESPITE THE DISTANCE 1156 00:50:10,393 --> 00:50:12,862 IN BALTIMORE WE ARE PARTNERING 1157 00:50:12,862 --> 00:50:16,166 AND REALLY LEVERAGING THAT YOU 1158 00:50:16,166 --> 00:50:17,267 ARE DATA SET AN INTEREST IN 1159 00:50:17,267 --> 00:50:21,304 SMELL AND TASTE. AND THEN 1160 00:50:21,304 --> 00:50:24,574 FINALLY, THE FUNCTION PAL 1161 00:50:24,574 --> 00:50:27,076 NEUROSURGERY SECTION OF SENIOR 1162 00:50:27,076 --> 00:50:30,647 PI IS PRETTY COOL. THIS IS A 1163 00:50:30,647 --> 00:50:32,315 STUDY THAT'S VERY SIMILAR TO ONE 1164 00:50:32,315 --> 00:50:34,684 THAT WAS JUST PUBLISHED IN 1165 00:50:34,684 --> 00:50:38,221 NATURE, THAT USED INTRACRANIAL 1166 00:50:38,221 --> 00:50:39,522 ELECTRODES, THIS IS CALLED A 1167 00:50:39,522 --> 00:50:43,660 UTAH ARRAY ARRAY. WHICH IS CLIY 1168 00:50:43,660 --> 00:50:45,395 USED TO PLACE ON THE SURFACE OF 1169 00:50:45,395 --> 00:50:49,899 BRAIN AND IDENTIFY REGIONS OR 1170 00:50:49,899 --> 00:50:51,901 FOCI OF EPILEPSY. THESE PATIENTS 1171 00:50:51,901 --> 00:50:53,102 COME TO CLINICAL CENTER MONDAY 1172 00:50:53,102 --> 00:50:56,406 OR TUESDAY, SPEND THE REST OF 1173 00:50:56,406 --> 00:50:57,941 THE WEEK WAITING FOR SOMETHING 1174 00:50:57,941 --> 00:50:59,842 TO HAPPEN. CHIP IS ON THEIR 1175 00:50:59,842 --> 00:51:01,511 BRAIN, THEY ARE FUNCTIONAL, 1176 00:51:01,511 --> 00:51:04,948 AWAKE AND ABOUT, BUT THEY ARE 1177 00:51:04,948 --> 00:51:06,416 BORED. WE ARE GOING TO BRING 1178 00:51:06,416 --> 00:51:10,520 THEM TO OUR MRI SUITE WE WILL 1179 00:51:10,520 --> 00:51:15,425 EXPOSE THEM O ODORS WITH 1180 00:51:15,425 --> 00:51:17,126 OLFACTOMETER AND LOOK AT NEURAL 1181 00:51:17,126 --> 00:51:18,328 ACTIVITY DOWN TO THE SINGLE 1182 00:51:18,328 --> 00:51:22,198 NEURONAL LEVE LEVEL. INCREDIBLY 1183 00:51:22,198 --> 00:51:29,973 POWERFUL. Z SOFUL. IN SUMMARY OS 1184 00:51:29,973 --> 00:51:31,241 TOP PERIPHERAL MECHANISMS THAT 1185 00:51:31,241 --> 00:51:32,542 UNDERLIE THE SENSE OF SMELL AN 1186 00:51:32,542 --> 00:51:34,210 DISEASE, FOCUS ON HUMAN SUBJECTS 1187 00:51:34,210 --> 00:51:37,247 RESEARCH TO PROMOTE TRANSLATION, 1188 00:51:37,247 --> 00:51:38,848 IDENTIFY NOVEL TAUGHTS FOR 1189 00:51:38,848 --> 00:51:40,783 THERAPEUTIC STUDY AND 1190 00:51:40,783 --> 00:51:44,487 DEVELOPMENT INNOVATIVE TOOLS. 1191 00:51:44,487 --> 00:51:45,722 THIS IS THE MOST IMPORTANT 1192 00:51:45,722 --> 00:51:50,793 SLIDE. NONE OF THIS WOULD BE 1193 00:51:50,793 --> 00:51:53,630 POSSIBLE WITHOUT OUR 1194 00:51:53,630 --> 00:51:56,566 ADMINISTRATIVE SCIENTIFIC AND 1195 00:51:56,566 --> 00:51:58,401 VISION, THE SUPPORT AND HELP 1196 00:51:58,401 --> 00:51:59,502 FROM ALL OF YOU IS CRITICAL AND 1197 00:51:59,502 --> 00:52:02,238 I WANT TO MAKE SURE EVERYONE 1198 00:52:02,238 --> 00:52:04,140 RECOGNIZES IRAB, AT THE BOTTOM 1199 00:52:04,140 --> 00:52:08,911 OF THE DIR WITHOUT SCOTT 1200 00:52:08,911 --> 00:52:10,713 BATTERER, JOE I CALLED YOU OUT, 1201 00:52:10,713 --> 00:52:12,548 LYNN, SARA, RALPH, NONE OF THIS 1202 00:52:12,548 --> 00:52:17,353 WOULD BE POSSIBLE. I'M INC ABLY 1203 00:52:17,353 --> 00:52:22,091 GRATEFUL TO OUR ENTIRE TEAM. 1204 00:52:22,091 --> 00:52:26,529 THESE ARE MY GIRLS, BUDDING 1205 00:52:26,529 --> 00:52:27,897 NEUROSCIENTIST, AND WITH THAT, I 1206 00:52:27,897 --> 00:52:28,998 BELIEVE WE HAVE A COUPLE OF 1207 00:52:28,998 --> 00:52:29,599 MINUTES FOR QUESTIONS. THANK 1208 00:52:29,599 --> 00:52:33,036 YOU. 1209 00:52:33,036 --> 00:52:43,212 [APPLAUSE] 1210 00:52:48,051 --> 00:52:50,053 >> JOSH, THANK YOU. WHEN YOU 1211 00:52:50,053 --> 00:52:52,288 TALKED ABOUT BIOMARKERS YOU SAID 1212 00:52:52,288 --> 00:52:55,458 ONE OF THE IMPORTANT THINGS IS 1213 00:52:55,458 --> 00:52:59,429 THAT IDENTIFYING THIS EARLY CAN 1214 00:52:59,429 --> 00:53:02,632 CHANGE THE TREATMENT. SO I'M 1215 00:53:02,632 --> 00:53:04,967 THINKING ABOUT NEUROLOGIST WHO 1216 00:53:04,967 --> 00:53:07,003 SAID THAT THEY DIDN'T WANT TO 1217 00:53:07,003 --> 00:53:08,571 SEE YOUR PATIENT. I'M TRYING TO 1218 00:53:08,571 --> 00:53:10,606 THINK ABOUT THAT NEUROLOGIST 1219 00:53:10,606 --> 00:53:13,276 WOULD NEED. IF YOU IDENTIFY 1220 00:53:13,276 --> 00:53:15,611 PARKINSON'S DISEASE FOUR OR FIVE 1221 00:53:15,611 --> 00:53:18,748 YEARS EARLY, IS THERE ANYTHING 1222 00:53:18,748 --> 00:53:20,817 TO BE DONE? ALSO DO PEOPLE WHO 1223 00:53:20,817 --> 00:53:22,285 HAVE THOSE PLAQUES IN THEIR 1224 00:53:22,285 --> 00:53:24,287 NOSE, DO YOU HAVE A LOT OF 1225 00:53:24,287 --> 00:53:26,322 PEOPLE WHO HAVE THOSE PLAQUE'S 1226 00:53:26,322 --> 00:53:28,458 YOU SAID THE OLFACTORY BULB, 1227 00:53:28,458 --> 00:53:30,059 THAT DON'T GO ON TO GET -- ARE 1228 00:53:30,059 --> 00:53:31,661 THEY DEFINITIVE OR SOME PEOPLE 1229 00:53:31,661 --> 00:53:33,629 WHO HAVE THOSE DON'T GO ON TO 1230 00:53:33,629 --> 00:53:35,198 GET THESE DISORDERS? 1231 00:53:35,198 --> 00:53:38,701 >> FANTASTIC QUESTION, LISA. TO 1232 00:53:38,701 --> 00:53:41,371 ANSWER THE FIRST ONE FIRST. WE 1233 00:53:41,371 --> 00:53:45,341 DON'T KNOW. THE DISCOVERY OR THE 1234 00:53:45,341 --> 00:53:47,276 DESCRIPTION OF BEING ABLE TO 1235 00:53:47,276 --> 00:53:48,745 CAPTURE THESE PATHOGNOMONIC 1236 00:53:48,745 --> 00:53:50,680 PLAQUE THE NOSE, WE KNOW THEY 1237 00:53:50,680 --> 00:53:52,682 FORM THE OLFACTORY BULB AS WELL. 1238 00:53:52,682 --> 00:53:54,517 BUT WITHOUT PUTTING A PATIENT 1239 00:53:54,517 --> 00:53:55,651 THROUGH SURGERY, THIS IS 1240 00:53:55,651 --> 00:53:58,788 SOMETHING WE CAN DO IN A CLINIC, 1241 00:53:58,788 --> 00:54:01,090 THAT ONE STUDY HAS NOT BEEN 1242 00:54:01,090 --> 00:54:02,925 REPLICATED. IT IS ABOUT FOUR OR 1243 00:54:02,925 --> 00:54:07,430 FIVE YEARS OLDS NOW AND IT IS 1244 00:54:07,430 --> 00:54:09,866 RIPE FOR INVESTIGATION AND 1245 00:54:09,866 --> 00:54:12,034 VALIDATION, IT IS JUST TOO EARLY 1246 00:54:12,034 --> 00:54:13,302 TO KNOW THESE IMPORTANT 1247 00:54:13,302 --> 00:54:18,341 PRACTICAL QUESTIONS. YOUR FIRST 1248 00:54:18,341 --> 00:54:22,111 QUESTION, REMIND ME. 1249 00:54:22,111 --> 00:54:22,678 (OFF MIC) 1250 00:54:22,678 --> 00:54:26,949 >> OH, YES. SO YES. IN THIS CASE 1251 00:54:26,949 --> 00:54:30,319 WITH PARKINSON'S THERE ARE 1252 00:54:30,319 --> 00:54:31,454 EARLIER MEDICATIONS THAT CAN BE 1253 00:54:31,454 --> 00:54:34,123 TRIALED WITH THE THOUGHT OF 1254 00:54:34,123 --> 00:54:36,192 SLOWING PROGRESSION OR SEVERITY 1255 00:54:36,192 --> 00:54:39,162 OF DISEASE. WHAT IS TRULY NEED 1256 00:54:39,162 --> 00:54:42,031 REDIRECT EXAMINATION RANDOMIZED 1257 00:54:42,031 --> 00:54:45,635 STUDIES TO DEFINE TIME FRAMES 1258 00:54:45,635 --> 00:54:46,569 AND EFFECT AND BECAUSE OF THIS 1259 00:54:46,569 --> 00:54:50,039 LACK OF UNDERSTANDING AND 1260 00:54:50,039 --> 00:54:51,307 ADOPTION FROM OTHER COMMUNITIES 1261 00:54:51,307 --> 00:54:53,810 THAT JUST HASN'T BEEN DONE YET. 1262 00:54:53,810 --> 00:54:55,711 IT IS SOMETHING THAT WAS FRONT 1263 00:54:55,711 --> 00:54:57,780 OF MIND WHEN PAULE AND I FORMED 1264 00:54:57,780 --> 00:55:00,116 THE SMELL AND TASTE CENTER. I 1265 00:55:00,116 --> 00:55:01,884 DIDN'T MENTION WE HAVE AN 1266 00:55:01,884 --> 00:55:03,553 ADVISERY BOARD OF 25 ADVISORS 1267 00:55:03,553 --> 00:55:05,822 FROM ACROSS DISCIPLINE, ACROSS 1268 00:55:05,822 --> 00:55:09,725 THE WORLD. WE WERE VERY 1269 00:55:09,725 --> 00:55:10,526 THOUGHTFUL IN OUR FIRST MEETING 1270 00:55:10,526 --> 00:55:14,096 TO TALK ABOUT THIS AND WHO ARE 1271 00:55:14,096 --> 00:55:16,666 THE INFLUENCERS FOR LACK OF 1272 00:55:16,666 --> 00:55:19,035 BETTER WORD, WITHIN THE 1273 00:55:19,035 --> 00:55:22,038 NEUROLOGY SPACE WHO CAN WE 1274 00:55:22,038 --> 00:55:23,706 ELICIT TO PROMOTE THE IMPORTANCE 1275 00:55:23,706 --> 00:55:27,777 OF THIS. 1276 00:55:27,777 --> 00:55:29,212 >> THANK YOU. THIS WAS VERY 1277 00:55:29,212 --> 00:55:31,214 EDUCATIONAL FOR ME. I HAD A 1278 00:55:31,214 --> 00:55:37,487 SPECIFIC QUESTION. IS THE -- IN 1279 00:55:37,487 --> 00:55:39,222 ALZHEIMER'S OR PARKINSON DO YOU 1280 00:55:39,222 --> 00:55:41,123 HAVE GENERALIZED LOSS OF SMELL 1281 00:55:41,123 --> 00:55:42,959 OR CAN YOU IDENTIFY PATTERNS OR 1282 00:55:42,959 --> 00:55:44,227 DISTINGUISH DISEASE LIKES YOU 1283 00:55:44,227 --> 00:55:50,366 SAID DROVES AS 52 URINES LIKE 1284 00:55:50,366 --> 00:55:53,336 ROSE JASMINE AND SANDAL WOOD, DO 1285 00:55:53,336 --> 00:55:53,970 YOU KNOW SOMETHING IS WRONG? 1286 00:55:53,970 --> 00:55:56,272 >> IT IS A QUESTION PAULE AND I 1287 00:55:56,272 --> 00:55:58,207 HAVE DISCUSSED A NUMBER OF 1288 00:55:58,207 --> 00:56:00,743 TIMES. THE DIVERSITY OF ODORANTS 1289 00:56:00,743 --> 00:56:02,011 ARE OVERWHELMING. TENS OF 1290 00:56:02,011 --> 00:56:05,681 THOUSANDS OF UNIQUE SIGNALS. AND 1291 00:56:05,681 --> 00:56:10,253 WHILE WE STRUCTURALLY YOU 1292 00:56:10,253 --> 00:56:11,954 ACTIVATE THIS REGION YOU GET 1293 00:56:11,954 --> 00:56:15,358 CITRUS AS A FAMILY, AN ORANGE 1294 00:56:15,358 --> 00:56:17,827 WILL HAVE SIMILAR COMPOUNDS TO A 1295 00:56:17,827 --> 00:56:19,829 TANGERINE, THAT IS NOT 1296 00:56:19,829 --> 00:56:21,964 NECESSARILY TRUE AND FROM A 1297 00:56:21,964 --> 00:56:23,232 FUNCTIONAL STANDPOINT WE DON'T 1298 00:56:23,232 --> 00:56:27,570 THINK IT IS TRUE. BOB PRESENTED 1299 00:56:27,570 --> 00:56:29,338 AT THE WALS LECTURE A FEW WEEKS 1300 00:56:29,338 --> 00:56:32,208 AGO WHICH ANYONE HASN'T SEEN ON 1301 00:56:32,208 --> 00:56:33,876 VIDEOCAST, IT WAS UNBELIEVABLE, 1302 00:56:33,876 --> 00:56:39,048 BUT HE FAILED TO FIND A 1303 00:56:39,048 --> 00:56:43,619 STRUCTURAL MAP OR A AORBIATION 1304 00:56:43,619 --> 00:56:46,589 OF AREA OF OLFACTORY EPITHELIUM 1305 00:56:46,589 --> 00:56:49,692 AND DIFFERENT ODORANTS. SO IT IS 1306 00:56:49,692 --> 00:56:53,629 A VERY LONG WAY OF SAYING WE 1307 00:56:53,629 --> 00:56:55,598 DON'T KNOW HOW LIKE SIMILAR 1308 00:56:55,598 --> 00:56:58,000 SMELLS AR ARE. AND HOW THEY ARE 1309 00:56:58,000 --> 00:57:05,708 REPRESENTED IN DISEASE. 1310 00:57:05,708 --> 00:57:07,310 >> I BELIEVE THAT'S ALL THE TIME 1311 00:57:07,310 --> 00:57:11,547 WE HAVE FOR QUESTIONS. 1312 00:57:11,547 --> 00:57:12,381 >> THANK Y'ALL. 1313 00:57:12,381 --> 00:57:16,886 [APPLAUSE] 1314 00:57:16,886 --> 00:57:19,288 >> THANK YOU SO MUCH, EVERYONE, 1315 00:57:19,288 --> 00:57:20,256 FOR YOUR EXCELLENT QUESTIONS, 1316 00:57:20,256 --> 00:57:22,792 THANK YOU FOR MODERATING OUR Q&A 1317 00:57:22,792 --> 00:57:24,894 SECTION AND MOST IMPORTANTLY, 1318 00:57:24,894 --> 00:57:27,730 THANK YOU JOSH FOR A VERY 1319 00:57:27,730 --> 00:57:29,532 INFORMATIVE PRESENTATION TODAY. 1320 00:57:29,532 --> 00:57:31,100 THANKS TO ALL OF YOU FOR JOINING 1321 00:57:31,100 --> 00:57:33,002 US FOR TODAY'S BEYOND THE LAB, 1322 00:57:33,002 --> 00:57:34,804 UNDERSTANDING COMMUNICATION 1323 00:57:34,804 --> 00:57:37,039 DISORDER SPEAKER SERIES. I HOPE 1324 00:57:37,039 --> 00:57:39,675 YOU CERTAINLY ENJOYED JOSH'S 1325 00:57:39,675 --> 00:57:41,811 PRESENTATION TODAY, EXCELLENT, 1326 00:57:41,811 --> 00:57:43,179 EXCELLENT PRESENTATION. REALLY 1327 00:57:43,179 --> 00:57:45,781 LEARNED ABOUT OUR INSTITUTES 1328 00:57:45,781 --> 00:57:46,983 RESEARCH EFFORTS TOWARDS 1329 00:57:46,983 --> 00:57:48,584 ADDRESSING OLFACTORY 1330 00:57:48,584 --> 00:57:50,753 DYSFUNCTION. OUR NEXT BEYOND THE 1331 00:57:50,753 --> 00:57:52,955 LAB TALK WILL BE HELD NEXT YEAR 1332 00:57:52,955 --> 00:57:55,157 AND OF COURSE WE WILL BE SENDING 1333 00:57:55,157 --> 00:57:56,759 OUT MORE INFORMATION AS THE 1334 00:57:56,759 --> 00:57:58,728 DETAILS ARE FINALIZED. SO 1335 00:57:58,728 --> 00:58:00,262 PLEASE BE ON THE LOOK OUT FOR 1336 00:58:00,262 --> 00:58:01,931 THAT. AGAIN, I WANT TO THANK ALL 1337 00:58:01,931 --> 00:58:04,800 OF YOU FOR ATTENDING TODAY'S 1338 00:58:04,800 --> 00:58:06,602 TALK AND WITH THAT I WILL 1339 00:58:06,602 --> 00:58:07,637 CONCLUDE TODAY'S PRESENTATION. 1340 00:58:07,637 --> 00:58:09,271 THANK YOU SO MUCH FOR ATTENDING 1341 00:58:09,271 --> 00:58:19,448 [APPLAUSE]