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Olfactory dysfunction is an early symptom of synucleinopathies and has been repeatedly associated with the presence of post\u2010mortem LTS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To assess the combined value of a clinician diagnosis of probable RBD (PRBD) and hyposmia in predicting the post\u2010mortem presence of LTS in a broader, less\u2010selected, volunteer elderly population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We studied 652 autopsied subjects from the Arizona Study of Aging and Neurodegenerative Disorders, which were evaluated for PRBD, had completed annual movement and cognitive assessments, and had at least one the University of Pennsylvania Smell Identification Test (UPSIT) olfactory test.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Histological evidence of LTS was significantly more frequent in those who had PRBD (112\/152: 73.7%) than those without (177\/494: 35.8%) (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). LTS was more frequent in cases with PRBD and a low UPSIT score (90.8%) compared to cases with PRBD only (73.7%) (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) or cases with a low UPSIT score only (69.4%) (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). Sensitivity of PRBD diagnosis for predicting LTS was 38.8% and specificity 88.8%, whereas sensitivity of a low UPSIT score was 74.4% and specificity 73.4% (Youden's index\u2009=\u20090.276 for PRBD, 0.478 for UPSIT). When combining both measures, sensitivity was 34.3% and specificity increased to 97.2%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>PRBD, diagnosed without sleep study confirmation, combined with a reduced olfactory performance is highly specific for predicting post\u2010mortem presence of LTS. The combination of both measures may provide a cost\u2010effective means of predicting LTS in a broader community.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mdc3.14244","type":"journal-article","created":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T09:53:52Z","timestamp":1730800432000},"page":"157-165","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Predicting Post\u2010Mortem \u03b1\u2010Synuclein Pathology by the Combined Presence of Probable <scp>REM sleep behavior disorder<\/scp> and Hyposmia"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8460-7421","authenticated-orcid":false,"given":"C\u00e9cilia","family":"Tremblay","sequence":"first","affiliation":[{"name":"Departement of neuropathology Banner Sun Health Research Institute  Sun City Arizona 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Clinic Arizona  Scottsdale Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8750-1160","authenticated-orcid":false,"given":"Parichita","family":"Choudhury","sequence":"additional","affiliation":[{"name":"Departement of neuropathology Banner Sun Health Research Institute  Sun City Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Belden","sequence":"additional","affiliation":[{"name":"Departement of neuropathology Banner Sun Health Research Institute  Sun City Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David R.","family":"Shprecher","sequence":"additional","affiliation":[{"name":"Departement of neuropathology Banner Sun Health Research Institute  Sun City Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joyce K.","family":"Lee\u2010Iannotti","sequence":"additional","affiliation":[{"name":"Department of Neurology, 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