Diagnostic Efficacy of Olfactory Function Test Using Functional Near-Infrared Spectroscopy with Machine Learning in Healthy Adults: A Prospective Diagnostic-Accuracy (Feasibility/Validation) Study in Healthy Adults with Algorithm Development

<b>Background/Objectives</b>: The YSK olfactory function (YOF) test is a culturally adapted psychophysical tool that assesses threshold, discrimination, and identification. This study evaluated whether functional near-infrared spectroscopy (fNIRS) synchronized with routine YOF testing, combined with machine learning, can predict YOF subdomain performance in healthy adults, providing an objective neural correlate to complement behavioral testing. <b>Methods</b>: In this prospective diagnostic-accuracy (feasibility/validation) study in healthy adults with algorithm development, 100 healthy adults completed the YOF test while undergoing prefrontal/orbitofrontal fNIRS during odor blocks. Feature sets from ΔHbO/ΔHbR included time-domain descriptors, complexity (Lempel-Ziv), and information-theoretic measures (mutual information); the identification task used a hybrid attention-CNN. Separate models were developed for threshold (binary classification), discrimination (binary classification), and identification (binary classification). Performance was summarized with accuracy, area under the curve (AUC), F1-score, and (where applicable) sensitivity/specificity, using participant-level cross-validation. <b>Results</b>: The threshold classifier achieved accuracy 0.86, AUC 0.86, and F1 0.86, indicating strong discrimination of correct vs. incorrect threshold responses. The discrimination model yielded accuracy 0.75, AUC 0.76, and F1 0.75. The identification model (attention-convolutional neural network [CNN]) achieved accuracy 0.88, sensitivity 0.86, specificity 0.91, and F1 0.88. Feature-attribution (e.g., SHapley Additive exPlanations [SHAP]) provided interpretable links between fNIRS features and task performance for threshold and discrimination. <b>Conclusions</b>: Olfactory-evoked fNIRS signals can accurately predict YOF subdomain performance in healthy adults, supporting the feasibility of non-invasive, portable, near-real-time olfactory monitoring. These findings are preliminary and not generalizable to clinical populations; external validation in diverse cohorts is warranted. The approach clarifies the scientific essence of the method by (i) aligning psychophysical outcomes with objective hemodynamic signatures and (ii) introducing a feature-rich modeling pipeline (ΔHbO/ΔHbR + Lempel-Ziv complexity/mutual information; attention-CNN) that advances prior work.