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October 22, 1997, Vol 278, No. 16 >
ARTICLE | October 22, 1997

Taste and Smell Losses in Normal Aging and Disease FREE

Susan S. Schiffman, PhD
[+] Author Affiliations

Reprints: Susan S. Schiffman, PhD, Department of Psychiatry, Duke University Medical Center, Box 3259, Durham, NC 27710.


JAMA. 1997;278(16):1357-1362. doi:10.1001/jama.1997.03550160077042
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Published online
Article
References

Objective.  —To review the scientific literature on the alterations in the senses of taste and smell in the elderly, including causes, diagnosis, prognosis, and treatment.

Data Sources.  —Original reports and reviews obtained through MEDLINE searches from 1966 through June 1997 using the MeSH headings of "taste," "taste buds," "taste disorders," "taste thresholds," "smell," "odors," "aged," and "aging." Articles frequently cited in reference lists were also included.

Study Selection.  —All articles were reviewed, tabulated, and summarized.

Data Extraction.  —Criteria for extraction included data quality and validity, statistical treatment of the data, venue of publication, and relevance to clinical care.

Conclusion.  —Losses of taste and smell are common in the elderly and result from normal aging, certain disease states (especially Alzheimer disease), medications, surgical interventions, and environmental exposure. Deficits in these chemical senses cannot only reduce the pleasure and comfort from food, but represent risk factors for nutritional and immune deficiencies as well as adherence to specific dietary regimens. Chemosensory decrements can lead to food poisoning or over-exposure to environmentally hazardous chemicals that are otherwise detectable by taste and smell. Use of flavor-enhanced food can increase enjoyment of food and have a positive effect on food intake and immune status.

REFERENCES

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Statistical Abstract of the United States 1996. Washington, DC: US Bureau of the Census; 1996:15-16.
2 +
Wattenberg BJ. The Statistical History of the United States: From Colonial Times to the Present . New York, NY: Basic Books; 1976;:15.
3 +
A Profile of Older Americans. Washington, DC: American Association of Retired Persons; 1995:1-13.
4 +
Kline DW.  Optimizing the visibility of displays for older observers . Exp Aging Res . 1994;;20:11-23.
5 +
Schiffman S.  Changes in taste and smell with age: psychophysical aspects . In: Ordy JM, Brizzee K, eds. Sensory Systems and Communication in the Elderly: Aging, Volume 10 . New York, NY: Raven Press; 1979;:227-246.
6 +
Schiffman SS.  Perception of taste and smell in elderly persons . Crit Rev Food Sci Nutr . 1993;;33:17-26.
7 +
Schiffman SS.  Taste and smell in disease . N Engl J Med . 1983;;308:1275-1279, 1337-1343.
8 +
Doty RL, Shaman P, Applebaum SL, et al.  Smell identification ability: changes with age . Science . 1984;;226:1441-1443.
9 +
Doty RL.  Olfactory capacities in aging and Alzheimer's disease . Ann N Y Acad Sci . 1991;;640:20-27.
10 +
Stevens JC, Cruz LA, Hoffman JM, Patterson MQ.  Taste sensitivity and aging . Chem Senses . 1995;;20:451-459.
11 +
Cain WS, Gent JF.  Olfactory sensitivity . J Exp Psychol Hum Percept Perform . 1991;;17:382-391.
12 +
Cain WS, Stevens JC.  Uniformity of olfactory loss in aging . Ann N Y Acad Sci . 1989;;561:29-38.
13 +
Murphy C.  Nutrition and chemosensory perception in the elderly . Crit Rev Food Sci Nutr . 1993;;33:3-15.
14 +
Murphy C.  Age-related effects on the threshold, psychophysical function, and pleasantness of menthol . J Gerontol . 1983;;38:217-222.
15 +
Schiffman SS, Wedral E.  Contribution of taste and smell losses to the wasting syndrome . Age Nutr . 1996;;7:106-120.
16 +
Mattes RD, Cowart BJ.  Dietary assessment of patients with chemosensory disorders . J Am Diet Assoc . 1994;;94:50-56.
17 +
Duffy VB, Backstrand JR, Ferris AM.  Olfactory dysfunction and related nutritional risk in free-living, elderly women . J Am Diet Assoc . 1995;;95:879-886.
18 +
Cowart BJ, Garrison LB, Young IM, Lowry LD.  A discrepancy between odor thresholds and identification in dysosmia . Chem Senses . 1989;;14:692.
19 +
Nordin S, Murphy C, Davidson TM, et al.  Prevalence and assessment of qualitative olfactory dysfunction in different age groups . Laryngoscope . 1996;;106:739-744.
20 +
Bell IR, Schwartz GE, Peterson JM, Amend D.  Self-reported illness from chemical odors in young adults without clinical syndromes or occupational exposures . Arch Environ Health . 1993;;48:6-13.
21 +
Schiffman SS, Warwick ZS.  Changes in taste and smell over the lifespan . In: Friedman MI, Tordoff MG, Kare MR, eds. Chemical Senses: Appetite and Nutrition, Volume 4 . New York, NY: Marcel Dekker; 1991;:341-365.
22 +
Teff KL, Engelman K.  Palatability and dietary restraint . Physiol Behav . 1996;;60:567-573.
23 +
Schiffman SS, Warwick ZS.  The biology of taste and food intake . In: Bray GA, Ryan DH, eds. The Science of Food Regulation . Baton Rouge: Louisiana State University Press; 1992;:293-312. Pennington Center Nutrition Series, Volume 2.
24 +
Giduck SA, Threatte RM, Kare MR.  Cephalic reflexes . J Nutr . 1987;;117:1191-1196.
25 +
Warwick ZS, Schiffman SS.  Flavor-calorie relationships . Physiol Behav . 1991;;50:465-470.
26 +
Booth DA.  Food-conditioned eating preferences and aversions with interoceptive elements . Ann N Y Acad Sci . 1985;;443:22-41.
27 +
Drewnowski A, Krahn DD, Demitrack MA, Nairn K, Gosnell BA.  Naloxone, an opiate blocker, reduces the consumption of sweet high-fat foods in obese and lean female binge eaters . Am J Clin Nutr . 1995;;61:1206-1212.
28 +
Friedman MI.  Metabolic control of food intake . Bol Asoc Med P R . 1989;;81:111-113.
29 +
Giza BK, Scott TR, Vanderweele DA.  Administration of satiety factors and gustatory responsiveness in the nucleus tractus solitarius of the rat . Brain Res Bull . 1992;;28:637-639.
30 +
Scott TR.  Taste . World Rev Nutr Diet . 1992;;67:1-39.
31 +
Scott TR, Yan J, Rolls ET.  Brain mechanisms of satiety and taste in macaques . Neurobiology . 1995;; 3:281-292.
32 +
Warwick ZS, Hall WG, Pappas TN, Schiffman SS.  Taste and smell sensations enhance the satiating effect of both a high-carbohydrate and a high-fat meal in humans . Physiol Behav . 1993;;53:553-563.
33 +
Schiffman SS, Erickson RP.  Psychophysics . In: Simon SA, Roper SD, eds. Mechanisms of Taste Transduction . Boca Raton, Fla: CRC Press; 1993;: 395-424.
34 +
Plata-Salaman CR, Scott TR, Smith-Swintosky VL.  Gustatory neural coding in the monkey cortex: L-amino acids . J Neurophysiol . 1992;;67:1552-1561.
35 +
Schiffman SS, Graham BG, Vance AR, et al.  Detection thresholds for emulsified oils in young and elderly subjects . Chem Senses . 1992;;17:693.
36 +
Frank ME, Hettinger TP, Mott AE.  The sense of taste . Crit Rev Oral Biol Med . 1992;;3:371-393.
37 +
Cowart BJ, Yokomukai Y, Beauchamp GK.  Bitter taste in aging . Physiol Behav . 1994;;56:1237-1241.
38 +
Schiffman SS, Crumbliss AL, Warwick ZS, Graham BG.  Thresholds for sodium salts in young and elderly subjects . Chem Senses . 1990;;15:671-678.
39 +
Schiffman SS.  The role of taste and smell in appetite and satiety . In: Wahlqvist ML, Truswell AS, Smith R, Nestell PJ, eds. Nutrition in a Sustainable Environment: Proceedings of the XV International Congress of Nutrition: IUNS Adelaide . London, England: Smith-Gordon; Niigata-Shi, Japan: Nishimura; 1994;:728-731.
40 +
Schiffman SS, Lindley MG, Clark TB, Makino C.  Molecular mechanism of sweet taste: relationship of hydrogen bonding to taste sensitivity for both young and elderly . Neurobiol Aging . 1981;;2:173-185.
41 +
Schiffman SS, Clark TB.  Magnitude estimates of amino acids for young and elderly subjects . Neurobiol Aging . 1980;;1:81-91.
42 +
Gilmore MM, Murphy C.  Aging is associated with increased Weber ratios for caffeine, but not for sucrose . Percept Psychophys . 1989;;46:555-559.
43 +
Matsuda T, Doty RL.  Regional taste sensitivity to NaCl . Chem Senses . 1995;;20:283-290.
44 +
Bartoshuk LM, Desnoyers S, Hudson C, et al.  Tasting on localized areas . Ann N Y Acad Sci . 1987;;510:166-168.
45 +
Breslin PA, Beauchamp GK.  Suppression of bitterness by sodium . Chem Senses . 1995;;20:609-623.
46 +
Beauchamp GK, Bertino M, Burke D, Engelman K.  Experimental sodium depletion and salt taste in normal human volunteers . Am J Clin Nutr . 1990;;51:881-889.
47 +
Bradley RM.  Effects of aging on the anatomy and neurophysiology of taste . Gerodontics . 1988;;4:244-248.
48 +
Höfer D, Puschel B, Drenckhahn D.  Taste receptor-like cells in the rat gut identified by expression of alpha-gustducin . Proc Natl Acad Sci U S A . 1996;;93:6631-6634.
49 +
Kinnamon SC, Margolskee RF.  Mechanisms of taste transduction . Curr Opin Neurobiol . 1996;;6:506-513.
50 +
Spielman AI, Huque T, Whitney G, Brand JG.  The diversity of bitter taste signal transduction mechanisms . Soc Gen Physiol Ser . 1992;;47:307-324.
51 +
Glenn JF, Erickson RP.  Gastric modulation of gustatory afferent activity . Physiol Behav . 1976;;16:561-568.
52 +
Pritchard TC.  The primate gustatory system . In: Getchell TV, Doty RL, Bartoshuk LM, Snow JB, eds. Smell and Taste in Health and Disease . New York, NY: Raven Press; 1991;:109-125.
53 +
Van Buskirk RL, Erickson RP.  Odorant responses in taste neurons of the rat NTS . Brain Res . 1977;;135:287-303.
54 +
Green BG.  Chemesthesis . Trends Food Sci Technol . 1996;;7:415-420.
55 +
Mistretta CM.  Aging effects on anatomy and neurophysiology of taste and smell . Gerontology . 1984;;3:131-136.
56 +
Schiffman SS.  Drugs influencing taste and smell perception . In: Getchell TV, Doty RL, Bartoshuk LM, Snow JB, eds. Smell and Taste in Health and Disease . New York, NY: Raven Press; 1991;:845-850.
57 +
Physicians'Desk Reference. 49th ed. Des Moines, Iowa: Medical Economics; 1995.
58 +
Kasper J.  Prescribed medicines: use, expenditures, and sources of payment . In: US Dept of Health and Human Services. National Health Care Expenditures Study Data Preview 9 . Hyattsville, Md: US Dept of Health and Human Services, Public Health Service, National Center for Health Services Research; 1982;. DHHS publication PHS 82-3320.
59 +
Lewis IK, Hanlon JT, Hobbins MJ, Beck JD.  Use of medications with potential oral adverse drug reactions in community-dwelling elderly . Spec Care Dent . 1993;;13:171-176.
60 +
Doty RL, Riklan M, Deems DA, et al.  The olfactory and cognitive deficits of Parkinson's disease . Ann Neurol . 1989;;25:166-171.
61 +
Serby M, Larson P, Kalkstein D.  The nature and course of olfactory deficits in Alzheimer's disease . Am J Psychiatry . 1991;;148:357-360.
62 +
Stevens JC, Cain WS.  Age-related deficiency in the perceived strength of six odorants . Chem Senses . 1985;;10:517-529.
63 +
Stevens JC, Plantinga A, Cain WS.  Reduction of odor and nasal pungency associated with aging . Neurobiol Aging . 1982;;3:125-132.
64 +
Wysocki CJ, Gilbert AN.  National Geographic Smell Survey . Ann N Y Acad Sci . 1989;;561:12-28.
65 +
Schiffman SS, Clark CM, Warwick ZS.  Gustatory and olfactory dysfunction in dementia . Neurobiol Aging . 1990;;11:597-600.
66 +
Breer H.  Odor recognition and second messenger signaling in olfactory receptor neurons . Semin Cell Biol . 1994;;5:25-32.
67 +
Sullivan SL, Ressler KJ, Buck LB.  Odorant receptor diversity and patterned gene expression in the mammalian olfactory epithelium . Prog Clin Biol Res . 1994;;390:75-84.
68 +
Wehr M, Laurent G.  Odour encoding by temporal sequences of firing in oscillating neural assemblies . Nature . 1996;;384:162-166.
69 +
Yousem DM, Geckle RJ, Bilker WB, et al.  Post-traumatic olfactory dysfunction . AJNR Am J Neuroradiol . 1996;;17:1171-1179.
70 +
Leopold DA, Bartoshuk L, Doty RL, et al.  Aging of the upper airway and the senses of taste and smell . Otolaryngol Head Neck Surg . 1989;;100:287-289.
71 +
Morrison EE, Costanzo RM.  Morphology of olfactory epithelium in humans and other vertebrates . Microsc Res Tech . 1992;;23:49-61.
72 +
Schiffman SS, Warwick ZS.  Effect of flavor enhancement of foods for the elderly on nutritional status . Physiol Behav . 1993;;53:395-402.
73 +
Schiffman SS.  Food acceptability and nutritional status . In: Leathwood P, Horisberger M, James WPT, ed. For a Better Nutrition in the 21st Century . New York, NY: Raven Press; 1992;:149-162.
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Shaffer SE, Tepper BJ.  Effects of learned flavor cues on single meal and daily food intake in humans . Physiol Behav . 1994;;55:979-986.
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78 +
Schiffman SS, Covey E.  Changes in taste and smell with age: nutritional aspects . In: Ordy JM, Harman D, Alfin-Slater R, eds. Nutrition in Gerontology . New York, NY: Raven Press; 1984;:43-64.
79 +
Hetherington MM.  Sensory-specific satiety and its importance in meal termination . Neurosci Biobehav Rev . 1996;;20:113-117.
80 +
Bellisle F, Monneuse MO, Chabert M, et al.  Monosodium glutamate as a palatability enhancer in the European diet . Physiol Behav . 1991;;49:869-873.
81 +
Bartoshuk LM, Duffy VB, Reed D, Williams A.  Supertasting, earaches and head injury . Neurosci Biobehav Rev . 1996;;20:79-87.
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Moskowitz HW, Kumaraiah V, Sharma KN, et al.  Cross-cultural differences in simple taste preferences . Science . 1975;;190:1217-1218.
83 +
Rolls BJ.  Appetite, hunger, and satiety in the elderly . Crit Rev Food Sci Nutr . 1993;;33:39-44.
84 +
Pelchat M, LaChaussee JL.  Food cravings and taste aversions in the elderly . Appetite . 1994;;23:193.
85 +
Drewnowski A, Henderson SA, Driscoll A, Rolls BJ.  Salt taste perceptions and preferences are unrelated to sodium consumption in healthy older adults . J Am Diet Assoc . 1996;;96:471-474.
86 +
Nordin S, Monsch AU, Murphy C.  Unawareness of smell loss in normal aging and Alzheimer's disease . J Gerontol B Psychol Sci Soc Sci . 1995;;50:187-192.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Statistical Abstract of the United States 1996. Washington, DC: US Bureau of the Census; 1996:15-16.
2 +
Wattenberg BJ. The Statistical History of the United States: From Colonial Times to the Present . New York, NY: Basic Books; 1976;:15.
3 +
A Profile of Older Americans. Washington, DC: American Association of Retired Persons; 1995:1-13.
4 +
Kline DW.  Optimizing the visibility of displays for older observers . Exp Aging Res . 1994;;20:11-23.
5 +
Schiffman S.  Changes in taste and smell with age: psychophysical aspects . In: Ordy JM, Brizzee K, eds. Sensory Systems and Communication in the Elderly: Aging, Volume 10 . New York, NY: Raven Press; 1979;:227-246.
6 +
Schiffman SS.  Perception of taste and smell in elderly persons . Crit Rev Food Sci Nutr . 1993;;33:17-26.
7 +
Schiffman SS.  Taste and smell in disease . N Engl J Med . 1983;;308:1275-1279, 1337-1343.
8 +
Doty RL, Shaman P, Applebaum SL, et al.  Smell identification ability: changes with age . Science . 1984;;226:1441-1443.
9 +
Doty RL.  Olfactory capacities in aging and Alzheimer's disease . Ann N Y Acad Sci . 1991;;640:20-27.
10 +
Stevens JC, Cruz LA, Hoffman JM, Patterson MQ.  Taste sensitivity and aging . Chem Senses . 1995;;20:451-459.
11 +
Cain WS, Gent JF.  Olfactory sensitivity . J Exp Psychol Hum Percept Perform . 1991;;17:382-391.
12 +
Cain WS, Stevens JC.  Uniformity of olfactory loss in aging . Ann N Y Acad Sci . 1989;;561:29-38.
13 +
Murphy C.  Nutrition and chemosensory perception in the elderly . Crit Rev Food Sci Nutr . 1993;;33:3-15.
14 +
Murphy C.  Age-related effects on the threshold, psychophysical function, and pleasantness of menthol . J Gerontol . 1983;;38:217-222.
15 +
Schiffman SS, Wedral E.  Contribution of taste and smell losses to the wasting syndrome . Age Nutr . 1996;;7:106-120.
16 +
Mattes RD, Cowart BJ.  Dietary assessment of patients with chemosensory disorders . J Am Diet Assoc . 1994;;94:50-56.
17 +
Duffy VB, Backstrand JR, Ferris AM.  Olfactory dysfunction and related nutritional risk in free-living, elderly women . J Am Diet Assoc . 1995;;95:879-886.
18 +
Cowart BJ, Garrison LB, Young IM, Lowry LD.  A discrepancy between odor thresholds and identification in dysosmia . Chem Senses . 1989;;14:692.
19 +
Nordin S, Murphy C, Davidson TM, et al.  Prevalence and assessment of qualitative olfactory dysfunction in different age groups . Laryngoscope . 1996;;106:739-744.
20 +
Bell IR, Schwartz GE, Peterson JM, Amend D.  Self-reported illness from chemical odors in young adults without clinical syndromes or occupational exposures . Arch Environ Health . 1993;;48:6-13.
21 +
Schiffman SS, Warwick ZS.  Changes in taste and smell over the lifespan . In: Friedman MI, Tordoff MG, Kare MR, eds. Chemical Senses: Appetite and Nutrition, Volume 4 . New York, NY: Marcel Dekker; 1991;:341-365.
22 +
Teff KL, Engelman K.  Palatability and dietary restraint . Physiol Behav . 1996;;60:567-573.
23 +
Schiffman SS, Warwick ZS.  The biology of taste and food intake . In: Bray GA, Ryan DH, eds. The Science of Food Regulation . Baton Rouge: Louisiana State University Press; 1992;:293-312. Pennington Center Nutrition Series, Volume 2.
24 +
Giduck SA, Threatte RM, Kare MR.  Cephalic reflexes . J Nutr . 1987;;117:1191-1196.
25 +
Warwick ZS, Schiffman SS.  Flavor-calorie relationships . Physiol Behav . 1991;;50:465-470.
26 +
Booth DA.  Food-conditioned eating preferences and aversions with interoceptive elements . Ann N Y Acad Sci . 1985;;443:22-41.
27 +
Drewnowski A, Krahn DD, Demitrack MA, Nairn K, Gosnell BA.  Naloxone, an opiate blocker, reduces the consumption of sweet high-fat foods in obese and lean female binge eaters . Am J Clin Nutr . 1995;;61:1206-1212.
28 +
Friedman MI.  Metabolic control of food intake . Bol Asoc Med P R . 1989;;81:111-113.
29 +
Giza BK, Scott TR, Vanderweele DA.  Administration of satiety factors and gustatory responsiveness in the nucleus tractus solitarius of the rat . Brain Res Bull . 1992;;28:637-639.
30 +
Scott TR.  Taste . World Rev Nutr Diet . 1992;;67:1-39.
31 +
Scott TR, Yan J, Rolls ET.  Brain mechanisms of satiety and taste in macaques . Neurobiology . 1995;; 3:281-292.
32 +
Warwick ZS, Hall WG, Pappas TN, Schiffman SS.  Taste and smell sensations enhance the satiating effect of both a high-carbohydrate and a high-fat meal in humans . Physiol Behav . 1993;;53:553-563.
33 +
Schiffman SS, Erickson RP.  Psychophysics . In: Simon SA, Roper SD, eds. Mechanisms of Taste Transduction . Boca Raton, Fla: CRC Press; 1993;: 395-424.
34 +
Plata-Salaman CR, Scott TR, Smith-Swintosky VL.  Gustatory neural coding in the monkey cortex: L-amino acids . J Neurophysiol . 1992;;67:1552-1561.
35 +
Schiffman SS, Graham BG, Vance AR, et al.  Detection thresholds for emulsified oils in young and elderly subjects . Chem Senses . 1992;;17:693.
36 +
Frank ME, Hettinger TP, Mott AE.  The sense of taste . Crit Rev Oral Biol Med . 1992;;3:371-393.
37 +
Cowart BJ, Yokomukai Y, Beauchamp GK.  Bitter taste in aging . Physiol Behav . 1994;;56:1237-1241.
38 +
Schiffman SS, Crumbliss AL, Warwick ZS, Graham BG.  Thresholds for sodium salts in young and elderly subjects . Chem Senses . 1990;;15:671-678.
39 +
Schiffman SS.  The role of taste and smell in appetite and satiety . In: Wahlqvist ML, Truswell AS, Smith R, Nestell PJ, eds. Nutrition in a Sustainable Environment: Proceedings of the XV International Congress of Nutrition: IUNS Adelaide . London, England: Smith-Gordon; Niigata-Shi, Japan: Nishimura; 1994;:728-731.
40 +
Schiffman SS, Lindley MG, Clark TB, Makino C.  Molecular mechanism of sweet taste: relationship of hydrogen bonding to taste sensitivity for both young and elderly . Neurobiol Aging . 1981;;2:173-185.
41 +
Schiffman SS, Clark TB.  Magnitude estimates of amino acids for young and elderly subjects . Neurobiol Aging . 1980;;1:81-91.
42 +
Gilmore MM, Murphy C.  Aging is associated with increased Weber ratios for caffeine, but not for sucrose . Percept Psychophys . 1989;;46:555-559.
43 +
Matsuda T, Doty RL.  Regional taste sensitivity to NaCl . Chem Senses . 1995;;20:283-290.
44 +
Bartoshuk LM, Desnoyers S, Hudson C, et al.  Tasting on localized areas . Ann N Y Acad Sci . 1987;;510:166-168.
45 +
Breslin PA, Beauchamp GK.  Suppression of bitterness by sodium . Chem Senses . 1995;;20:609-623.
46 +
Beauchamp GK, Bertino M, Burke D, Engelman K.  Experimental sodium depletion and salt taste in normal human volunteers . Am J Clin Nutr . 1990;;51:881-889.
47 +
Bradley RM.  Effects of aging on the anatomy and neurophysiology of taste . Gerodontics . 1988;;4:244-248.
48 +
Höfer D, Puschel B, Drenckhahn D.  Taste receptor-like cells in the rat gut identified by expression of alpha-gustducin . Proc Natl Acad Sci U S A . 1996;;93:6631-6634.
49 +
Kinnamon SC, Margolskee RF.  Mechanisms of taste transduction . Curr Opin Neurobiol . 1996;;6:506-513.
50 +
Spielman AI, Huque T, Whitney G, Brand JG.  The diversity of bitter taste signal transduction mechanisms . Soc Gen Physiol Ser . 1992;;47:307-324.
51 +
Glenn JF, Erickson RP.  Gastric modulation of gustatory afferent activity . Physiol Behav . 1976;;16:561-568.
52 +
Pritchard TC.  The primate gustatory system . In: Getchell TV, Doty RL, Bartoshuk LM, Snow JB, eds. Smell and Taste in Health and Disease . New York, NY: Raven Press; 1991;:109-125.
53 +
Van Buskirk RL, Erickson RP.  Odorant responses in taste neurons of the rat NTS . Brain Res . 1977;;135:287-303.
54 +
Green BG.  Chemesthesis . Trends Food Sci Technol . 1996;;7:415-420.
55 +
Mistretta CM.  Aging effects on anatomy and neurophysiology of taste and smell . Gerontology . 1984;;3:131-136.
56 +
Schiffman SS.  Drugs influencing taste and smell perception . In: Getchell TV, Doty RL, Bartoshuk LM, Snow JB, eds. Smell and Taste in Health and Disease . New York, NY: Raven Press; 1991;:845-850.
57 +
Physicians'Desk Reference. 49th ed. Des Moines, Iowa: Medical Economics; 1995.
58 +
Kasper J.  Prescribed medicines: use, expenditures, and sources of payment . In: US Dept of Health and Human Services. National Health Care Expenditures Study Data Preview 9 . Hyattsville, Md: US Dept of Health and Human Services, Public Health Service, National Center for Health Services Research; 1982;. DHHS publication PHS 82-3320.
59 +
Lewis IK, Hanlon JT, Hobbins MJ, Beck JD.  Use of medications with potential oral adverse drug reactions in community-dwelling elderly . Spec Care Dent . 1993;;13:171-176.
60 +
Doty RL, Riklan M, Deems DA, et al.  The olfactory and cognitive deficits of Parkinson's disease . Ann Neurol . 1989;;25:166-171.
61 +
Serby M, Larson P, Kalkstein D.  The nature and course of olfactory deficits in Alzheimer's disease . Am J Psychiatry . 1991;;148:357-360.
62 +
Stevens JC, Cain WS.  Age-related deficiency in the perceived strength of six odorants . Chem Senses . 1985;;10:517-529.
63 +
Stevens JC, Plantinga A, Cain WS.  Reduction of odor and nasal pungency associated with aging . Neurobiol Aging . 1982;;3:125-132.
64 +
Wysocki CJ, Gilbert AN.  National Geographic Smell Survey . Ann N Y Acad Sci . 1989;;561:12-28.
65 +
Schiffman SS, Clark CM, Warwick ZS.  Gustatory and olfactory dysfunction in dementia . Neurobiol Aging . 1990;;11:597-600.
66 +
Breer H.  Odor recognition and second messenger signaling in olfactory receptor neurons . Semin Cell Biol . 1994;;5:25-32.
67 +
Sullivan SL, Ressler KJ, Buck LB.  Odorant receptor diversity and patterned gene expression in the mammalian olfactory epithelium . Prog Clin Biol Res . 1994;;390:75-84.
68 +
Wehr M, Laurent G.  Odour encoding by temporal sequences of firing in oscillating neural assemblies . Nature . 1996;;384:162-166.
69 +
Yousem DM, Geckle RJ, Bilker WB, et al.  Post-traumatic olfactory dysfunction . AJNR Am J Neuroradiol . 1996;;17:1171-1179.
70 +
Leopold DA, Bartoshuk L, Doty RL, et al.  Aging of the upper airway and the senses of taste and smell . Otolaryngol Head Neck Surg . 1989;;100:287-289.
71 +
Morrison EE, Costanzo RM.  Morphology of olfactory epithelium in humans and other vertebrates . Microsc Res Tech . 1992;;23:49-61.
72 +
Schiffman SS, Warwick ZS.  Effect of flavor enhancement of foods for the elderly on nutritional status . Physiol Behav . 1993;;53:395-402.
73 +
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To understand the clinical management of acute heart failure syndromes.
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Compression-Only CPR: Pushing the Science Forward
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AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
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