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The researchers have discovered that the sense of smell could be a reliable tool to determine the recovery rate and survival of patients with severe brain injuries.
A study, published April 29 in the journal Nature, exposes how a cheap, conventional ‘smell test’ could help doctors diagnose and treat patients with consciousness-related illnesses.
In the study, all patients who initially had little or no awareness of the outside world regained consciousness after reacting to the smell test. Ninety-one percent of these patients have been found to survive their brain injuries even after three and a half years later.
Anat Arzi, the principal investigator for the Department of Psychology at the University of Cambridge and the Israel Weizmann Institute of Science, said the accuracy of the screening test is exceptional. Arzi and the rest of the team hope it will help treat brain-injured patients worldwide.
In the study, Arzi worked alongside Professor Noam Sobel of Israel’s Weizmann Institute of Science and Dr. Yaron Sacher of Israel’s Loewenstein Rehabilitation Hospital.
The research was funded by the Royal Society, the Blavatnik Family Foundation, the Rob and Cheryl McEwen Fund for Brain Research and the European Organization for Molecular Biology.
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According to Brainline, a traumatic brain injury can lead to five abnormal states with respect to a person’s level of consciousness. These are stupor, coma, persistent vegetative state, nailing syndrome, and brain death.
After severe brain injury, doctors often find it difficult to accurately determine a person’s level of consciousness. Errors in diagnosis are made in up to 40% of cases. An accurate diagnosis is crucial because it guides clinicians in organizing their treatment plans, such as pain management, and can control decisions regarding the patient’s long-term survival.
According to Noam Sobel, if you approach an unconscious patient and present him with a particular smell to smell, he will resume consciousness at some point and will probably live for at least three years.
Scientists say that the sense of smell is a fundamental mechanism that is based on structures deep within the brain. The brain automatically changes the way we smell in response to different smells. In healthy people, the smell response occurs in both waking and dream states of consciousness.
Shampoo and rotten fish aromas
The research was conducted in 43 patients with severe brain injuries. They were presented with different vials containing different items with various scents and smelling them through a nasal cannula. The facilitator explained the procedure and the content of each bottle, without any indication of understanding by the patients.
The researchers found that slightly conscious patients naturally inhaled less in response to odors. However, they showed no bias between pleasant and horrible smells. These patients also adjusted their nasal airflow in response to the odorless bottle. This behavior indicates an awareness of the bottle or a learned expectation of an odor.
In patients in the vegetative state, some patients changed their breathing in response to either odor, while others did. Arzi said they discovered that if patients in this state had a sniffing response, they later went into at least a slightly conscious state. He added that in some cases, it was the only signal hinting that the patient’s brain was going to recover.
Dr. Tristan Bekinschtein of the Cambridge University Department of Psychology said that when the smell response works normally, it may indicate that the patient may still be conscious at some point, even when other signs are not apparent.
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