Periodontal Disease Associated with Higher Risk of Dementia: Population‐Based Cohort Study in Taiwan

Lee, Ya-Ling; Hu, Hsiao Yun; Huang, Li; Chou, Pesus; Chu, Dachen

doi:10.1111/jgs.14944

Cited by 45 publications

(89 citation statements)

References 44 publications

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“…Our findings are in agreement with recent findings from epidemiological studies reporting a significant association between periodontitis and cognitive impairment, although very few of these studies involved detailed clinical evaluations of periodontal status. One strength of the current study is that we used data from full‐mouth assessments of periodontal status involving examinations of six sites on all teeth, allowing us to define periodontitis by two commonly used case definitions as well as calculate PISA.…”

Section: Discussionsupporting

confidence: 93%

“…A putative link between periodontitis and cognitive impairment/dementia has been reported . There are several possible underlying mechanisms for this association.…”

Section: Introductionmentioning

confidence: 99%

“…A putative link between periodontitis and cognitive impairment/ dementia has been reported. [7][8][9][10][11][12][13][14][15] There are several possible underlying mechanisms for this association. First, periodontitis can pose a chronic systemic inflammatory burden through the presence of elevated levels of inflammatory mediators, such as interleukin-1β and tumor necrosis factorα.…”

Section: Introductionmentioning

confidence: 99%

“…18 Second, periodontitis is reported to be associated with endothelial dysfunction, 19 which plays a role in the pathogenesis of vascular cognitive impairment. 20 An increasing number of studies have been conducted to examine the association between periodontitis and cognitive impairment/ dementia; [7][8][9][10][11][12][13][14][15] however, recent systematic reviews have revealed that the evidence is insufficiently conclusive. 21,22 To the best of our knowledge, no study has investigated the longitudinal association between periodontal status as determined from detailed clinical evaluations and MCI in the community-based population.…”

Section: Introductionmentioning

confidence: 99%

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Periodontitis, periodontal inflammation, and mild cognitive impairment: A 5‐year cohort study

Iwasaki

Kimura

Ogawa

et al. 2018

J of Periodontal Research

105

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Background and Objectives Identification of modifiable factors for mild cognitive impairment (MCI) is important since individuals with MCI are at a high risk of dementia and disability. Previous studies have suggested a potential association between periodontitis and cognitive impairment, but the results remain inconclusive. We designed a 5‐year longitudinal study to explore the association between MCI and periodontitis and periodontal inflammation in older adults. Methods This study included 179 community‐dwelling dentate individuals (62 men and 117 women, average age: 80.1 years). A full‐mouth periodontal examination at six sites per tooth was performed at baseline. Case definitions provided by the European Workshop in Periodontology Group C (EWP definition) and the Centers for Disease Control/American Academy of Periodontology (CDC/AAP definition) were used to define severe periodontitis. Additionally, the periodontal inflamed surface area (PISA), reflecting the amount of inflamed periodontal tissue, was calculated using clinical periodontal parameters. Follow‐up cognitive examinations for MCI diagnosis were performed by neurologists 1, 2, 3, and 5 years after baseline. Odds ratios (ORs) for MCI according to the presence of periodontitis and periodontal inflammation at baseline were calculated using multilevel mixed‐effects logistic regression. Results At baseline, 56.4% and 27.4% of the participants had severe periodontitis by the EWP and CDC/AAP definitions, respectively. After adjusting for follow‐up period and other baseline health characteristics (age, sex, smoking status, educational level, physical activity level, obesity, depression, and diabetes), severe periodontitis by either definition was significantly associated with MCI (for the EWP definition: adjusted OR = 3.58, 95% confidence interval [CI] = 1.45‐8.87; for the CDC/AAP definition: adjusted OR = 2.61, 95% CI = 1.08‐6.28). Periodontal inflammation assessed by PISA was also significantly associated with a higher OR for MCI (adjusted OR = 1.05, 95% CI = 1.01‐1.10, per 10‐mm2 increase in PISA). Conclusion Severe periodontitis and periodontal inflammation were associated with incident MCI among older community‐dwelling men and women.

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Section: Discussionsupporting

confidence: 93%

“…A putative link between periodontitis and cognitive impairment/dementia has been reported . There are several possible underlying mechanisms for this association.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Periodontitis, periodontal inflammation, and mild cognitive impairment: A 5‐year cohort study

Iwasaki

Kimura

Ogawa

et al. 2018

J of Periodontal Research

105

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show abstract

“…11 However, most investigations have reported an association of periodontitis or tooth loss with cognitive function or the presence of dementia, suggesting the involvement of peripheral inflammation as a likely causal factor, although this relationship was not addressed in these studies. 12,[22][23][24] A recent study in a broad Taiwanese sample concluded that periodontitis in the older adult was associated with a greater risk of developing dementia (hazard ratio:1.16), 44 but there was no examination of underlying physiopathological mechanisms.…”

Section: Discussionmentioning

confidence: 99%

Systemic inflammatory impact of periodontitis on cognitive impairment

et al. 2019

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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.

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Combined association of cognitive impairment and poor oral health on mortality risk in older adults: Results from the NHANES with 15 years of follow‐up

Chen

Visser

et al. 2021

Journal of Periodontology

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Background: Cognitive impairment and poor oral health are frequently seen among older adults. Both conditions have been identified as risk factors for mortality. However, the combined associations of cognitive impairment and poor oral health with mortality have not been well studied and are therefore the aim of this cohort study. Methods: We analyzed data from the National Health and Nutrition Examination Survey (1999 linked with mortality data obtained from the 2015 public-use linked mortality file. Cognitive impairment was defined as a digit symbol substitution test score lower than the lowest quartile. Oral health status was assessed based on presence of untreated caries, moderate to severe periodontitis, and edentulism. The combined effects of caries/periodontitis or edentulism and cognitive impairment on all-cause and cardiometabolic mortality were examined using the Cox proportional hazard models after adjusting for potential confounders including demographic characteristics, lifestyle, biomarkers, and comorbidities. Results:In total, 1973 participants were enrolled in the prospective study. At a median follow-up of 13.4 years, 978 participants had died (264 deaths because of cardiometabolic disease). Cognitive impairment, periodontitis, and edentulism were each found to be significant predictors of all-cause mortality. Caries, however, was not significantly related to mortality. When analyzing these predictors in combination, a diagnosis of cognitive impairment and periodontitis was associated with an 83.1% increase in all-cause mortality risk and an 87.7% increase in cardiometabolic mortality risk compared with healthy controls. Similarly, the risk for all-cause mortality was highest in cases where impaired cognition and edentulism co-occurred (adjusted hazard ratio = 1.701, 1.338-2.161).

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Periodontal Disease Associated with Higher Risk of Dementia: Population‐Based Cohort Study in Taiwan

Abstract: Subjects who had more severe PD or did not receive periodontal treatment were at greater risk of developing dementia.

Cited by 45 publications

References 44 publications

Periodontitis, periodontal inflammation, and mild cognitive impairment: A 5‐year cohort study

Periodontitis, periodontal inflammation, and mild cognitive impairment: A 5‐year cohort study

Systemic inflammatory impact of periodontitis on cognitive impairment

Combined association of cognitive impairment and poor oral health on mortality risk in older adults: Results from the NHANES with 15 years of follow‐up

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