Chewing Efficiency, Global Cognitive Functioning, and Dentition: A Cross-sectional Observational Study in Older People With Mild Cognitive Impairment or Mild to Moderate Dementia

Abstract

Introduction: Previous studies suggest an association between poor mastication and cognitive impairment. The role of chewing efficiency and dentition in this relation is unclear. The aim was to examine global cognitive functioning and dentition as predictors for chewing efficiency, in older people with mild cognitive impairment (MCI) or dementia. Methods: In this observational cross-sectional study, 136 people with MCI or dementia were included. The chewing efficiency was assessed with a two-colored chewing gum and analyzed with the Chewing Efficiency Analysis software. The level of global cognitive functioning was measured with the Mini Mental State Examination (MMSE) by trained clinical staff. An oral examination was performed by a dentist and included the number of present teeth, the number of occluding pairs, and the presence of prostheses. Age, gender, and educational years were derived from the medical records. Univariate and multivariate backward stepwise linear regression analyses were used to evaluate global cognitive functioning and dentition as predictors for chewing efficiency. Results: The mean age of the participants was 82.1 (SD 5.8) years, and 74 (54.4%) were female. The participants had a median MMSE score of 22.4 (IQR 18.0-26.0) and a median Chewing Efficiency Analysis score of 0.46 (IQR 0.14-0.59). The median number of teeth was 13.0 (IQR 0.0-23.0), and the median number of occluding pairs was 0.0 (IQR 0.0-7.0). Sixty-four (47.4%) of the participants wore full prosthesis in the upper jaw. In univariate linear regression analyses, predictive factors for the Chewing Efficiency Analysis score were age, MMSE score, full prosthesis in the

Chewing function and related parameters as a function of the degree of dementia: Is there a link between the brain and the mouth?

“…Lexomboon et al 19 stated that as long as older patients do not have difficulties in chewing hard food, factors, such as using natural teeth or dentures, may not play a significant role in cognitive impairment, which confirms our results (no difference in the number of teeth between different degrees of dementia). Nevertheless, the findings of the current study do not corroborate the findings of other previous studies, which show that the number of teeth, 1 , 20 number of missing teeth 57 , 58 , 59 , 60 , 61 or pairs of antagonistic teeth (ie supporting zones) 20 , 21 is significantly associated with chewing ability 7 or cognitive impairment or dementia 20 , 21 or an increased risk of dementia. 57 , 58 , 59 , 60 , 61 This may be attributed to the long‐term adaptation of the participants suffering from tooth loss and the associated chewing impairment.…”

“…12 Age in general has a heterogeneous effect 9 ; some factors (eg oral mixing ability) show a significant age-related decrease, whereas others (eg masseter muscle volume), in contrast, do not. 13,14 Cognitive impairment or dementia is associated with a reduction in the number of teeth, [15][16][17][18][19] the number of pairs of occluding teeth, 20,21 or worse self-reported chewing ability. 19 Additionally, tooth loss and the resulting deficit in chewing function are related to oral health, which is especially impaired in people with cognitive deficits.…”

“…Cognitive impairment or dementia is associated with a reduction in the number of teeth, 15 , 16 , 17 , 18 , 19 the number of pairs of occluding teeth, 20 , 21 or worse self‐reported chewing ability. 19 Additionally, tooth loss and the resulting deficit in chewing function are related to oral health, which is especially impaired in people with cognitive deficits.…”

“…The aim of this study was to evaluate the associations between chewing efficiency, maximum occlusal force and related parameters as a function of the degree of dementia using a finer subdivision of the values of the Mini‐Mental State Examination (MMSE, 31 ) (Cf. 1 , 20 , 24 , 25 ).…”

Exploring the impact of complex socioeconomic, psychometric and behavioral factors and the social gradient concerning clinical and subjective measures of oral health, in Greek older adults

“…However, in the present study participants are both edentulous and dentate seniors 65 years and older, while in the studies of Wu et al (2007;2008;, participants had at least one tooth and were 60 years and older. Age was reported of greater correlation with cognitive function than with the number or remained teeth (Delwel et al, 2020;Lexomboon et al, 2012); however, in the present study age and cognitive function have the same power (p<0.001) in predicting the number of remained teeth. Lee and Choi (2019) reported that dementia was less common in subjects with periodontitis but was more common in those with removable dentures, suggesting that tooth loss may be conductive to development of dementia.…”