Association of oral health–related quality of life and Alzheimer disease: A systematic review

Abstract

Alzheimer disease (AD) is a neurodegenerative disorder and accounts for 60% to 80% of all dementias among the elderly. 1,2 The pathophysiology of AD has been associated with the extracellular deposition of amyloidb protein in brain tissues, resulting in disrupted synaptic connectivity and tau protein hyperphosphorylation, which in turn leads to intracellular neurofibrillary tangles. 2,3 The resultant pathophysiological changes cause neuronal loss and progressive atrophy of cortical areas (including hippocampus, entorhinal cortex, and amygdala). 4,5 The degree of impairment tends to deteriorate as AD progresses and is primarily expressed as reduced cognitive and physical abilities in daily activities. 6

Oral Health and Care for Elderly People with Alzheimer’s Disease

“…A recent systematic review found that elderly people with dementia have higher incidents of coronal and root caries, retained roots and plausible causes of orofacial pain [ 20 ]. Moreover, elderly people with dementia generally have oral hygiene issues, which are to be expected due not only to age but also to dementia [ 8 ]. Specifically, they tend to have more prevalent periodontal problems, including gingival bleeding, periodontitis, and attachment loss.…”

“…Yet, the number of self-reports on pain has been fewer than expected [ 20 ]. It is unclear whether the nature of Alzheimer’s disease causes a reduced perception of pain [ 8 ], or if short-term memory loss and/or communication issues in elderly people with dementia can explain the situation [ 30 ]. The concern is when pain—The body’s way of signalling a problem—Is present but goes undetected, thus causing elderly people to suffer.…”

“…Elderly people with Alzheimer’s disease may be on multiple medications that cause xerostomia [ 10 ]. A systematic review reported that elderly people with Alzheimer’s disease presented reduced stimulated and resting submandibular salivary flows [ 8 ]. The ill effects of xerostomia on oral health can include dental caries, periodontal disease, fungal infections, denture stomatitis, and masticatory discomfort [ 32 ].…”

“…In addition, xerostomia potentiates the adverse effects that poor oral health has on the quality of life of elderly people. For instance, pain from oral diseases, burning mouth syndrome, reduced food intake, impaired salivary cleansing, taste, mastication, and swallowing may invariably influence the systemic and psychological well-being of elderly people; thus, impacting their daily living activities and reducing their joy and comfort [ 8 ]. All of these add to the importance of oral care for elderly people.…”

“…The age of onset for this degenerative disorder is usually 65 or above [ 6 ]. Elderly people often present with cerebral cortical atrophy and show a significant increase in intracellular neurofibrillary tangles due to tau protein hyperphosphorylation as well as neurotic plaques containing beta-amyloid [ 8 ]. Elderly people may suffer from the progressive loss of intellectual and social abilities that will eventually interfere with daily functioning [ 9 ].…”