Background. Dementia is a multi-etiologic syndrome characterized by multiple cognitive deficits but not always by the presence of cognitive impairment. Cognitive impairment is associated with multiple non-modifiable risk factors but few modifiable factors. Epidemiological studies have shown an association between periodontitis, a potentially modifiable risk factor, and cognitive impairment.Objectives. To determine whether clinical periodontitis is associated with the diagnosis of cognitive impairment/dementia after controlling for known risk factors, including age, sex, and educational level.Methods. A case-control study was conducted in Granada, Spain, in two groups of dentate individuals over 50 years of age: cases with a firm diagnosis of mild cognitive impairment or dementia of any type or severity, and controls with no subjective memory loss complaints and a score >30 in the "Phototest" cognitive test (screening test for cognitive impairment). Periodontitis was evaluated by measuring tooth loss, plaque and bleeding indexes, pocket depths, and clinical attachment loss.Results. The study included 409 dentate adults, 180 with cognitive impairment and 229 without. A moderate and statistically significant association was observed between clinical attachment loss and cognitive impairment after controlling for age, sex, educational level, oral hygiene habits, and hyperlipidemia (p=0.049). No significant association was found between tooth loss and cognitive impairment.Conclusion. Periodontitis appears to be associated with cognitive impairment after controlling for confounders such as age, sex, and educational level. KEY WORDS.Periodontitis, periodontal attachment loss, mild cognitive impairment, dementia.Dementia is a multi-etiologic syndrome characterized by the acquired involvement of multiple cognitive/behavioral domains that compromise the sufferer's functional capacity 1 . It largely affects the elderly, although it can commence at any age 1 . Mild cognitive impairment is an intermediate state, frequently appearing before the development of dementia, in which the cognitive and behavioral impairment is not sufficiently severe to have functional repercussions 2 . The main cause of dementia is Alzheimer's Disease (AD), a neurodegenerative process of multifactorial and complex etiology associated with multiple risk and protective factors; its prevalence increases exponentially with age from 65 years on, and it represents one of the main socio-health problems faced by the developed world 3 . It is estimated that there will be 35.6 million individuals with dementia worldwide in 2010 and that this number will double every 20 years, reaching more than 115 million by 2050 1 . The magnitude of the challenge and the 1 Journal of Periodontology; absence of curative treatments make the development of preventive measures a matter of extreme urgency. Although many risk factors are non-modifiable (e.g., age, sex, and genetic risk factors), others are susceptible to modification through individual choices, e.g., certain dieta...

The control of bacterial dental plaque through daily oral hygiene is essential to prevent oral diseases such as caries or periodontal disease, especially in at-risk populations, including the elderly with mild cognitive impairment and dementia. The aim of this study was to determine the association between different levels of cognitive impairment and dementia in an elderly population and their capacity to maintain adequate oral hygiene. A case-control study (elderly with versus without mild cognitive impairment or dementia) was performed in Granada, Spain. Outcome variables were tooth/prosthesis-brushing frequency/day, bacterial plaque index, and gingival bleeding index. Statistical models were adjusted by age, sex, educational level, and tobacco and alcohol habits. The study included 240 cases and 324 controls. The final model, adjusted by age, sex, educational level, and tobacco and alcohol consumption, showed a significant association between degree of cognitive impairment and daily oral hygiene, accumulation of bacterial plaque, and gingival bleeding. In summary, deficient daily oral hygiene, evidenced by greater bacterial dental plaque accumulation and gingival inflammation, is independently associated with cognitive impairment, even at its earliest stage.

Plasma Aβ levels are higher in individuals who have severe periodontal disease. The presence of periodontitis may modify the association between Aβ and cognitive impairment.

Objectives The role in dementia of systemic inflammation derived from periodontal disease is not fully elucidated. The objective of our study was to examine the impact of inflammation on the relationship between periodontitis and cognitive impairment. Methods We have designed a case (n = 171) and control (n = 131) study to determine the periodontal health status, grade of cognitive impairment/dementia and systemic inflammation level, the last being measured by analysis of 29 inflammatory biomarkers using multiplex techniques. Results At the time of sampling, 11 of the 29 inflammatory biomarkers were associated with cognitive impairment in patients with more severe periodontitis. However, the inflammatory response to severe periodontitis was more reduced (lower biomarker concentrations) in cases (with cognitive impairment or dementia) than in (cognitively healthy) controls, an unexpected finding. Conclusions Based on these results, we cannot confirm that systemic inflammation derived from periodontal disease plays a relevant role in the aetiology of cognitive impairment.

More than 70 % of participants diagnosed with cognitive impairment or dementia had xerostomia. Anticholinesterases and memantine were both associated with the presence of xerostomia. In the case of memantine, this association was independent of the consumption of the other drugs considered.