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

Abstract

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.

Oral Health Status in Subjects with Amnestic Mild Cognitive Impairment and Alzheimer’s Disease: Data from the Zabút Aging Project

“…Several researchers have investigated the association between cognitive impairment and oral health status, with particular attention to chronic periodontitis; the direction of this association needs to be clarified [11,13,[40][41][42][43][44][45][46]. Chen et al have demonstrated that periodontitis increased the risk of AD 1.7-fold after 10 years [42].…”

Working together to learn new oral hygiene techniques: Pilot of a carepartner-assisted intervention for persons with cognitive impairment

“…1,2 Individuals with cognitive impairment are one subgroup of the older population that is at particularly high risk of poor oral health, including those with mild cognitive impairment and mild dementia. 3,4 Evidence shows that individuals with cognitive impairment have more oral plaque, more severe periodontal disease, more caries, and fewer teeth than cognitively intact older adults. 2,[5][6][7] Research shows that inadequate oral hygiene practices primarily contribute to poor oral health for individuals with cognitive impairment.…”

The association between periodontal disease and dementia: a systematic review and meta-analysis

“…A constant challenge when conducting any systematic reviews of periodontal disease are the different case definitions used as they can influence overall estimates. The cohort study by Iwasaki and colleagues (26) included in this review is a prime example. They assessed the association between periodontitis and cognitive impairment across both the European Workshop in Periodontology (where 'severe' periodontitis was associated with an adjusted OR 3.58 (95% CI 1.45-8.87)) and the Centres for Disease Control and Prevention and American Academy of Periodontology definition of 'severe' periodontitis where the adjusted OR was 2.61 (95% CI 1.08-6.28).…”

“…Descriptive summaries of 23 included articles published between 1994 and 2018, are chronologically presented in (Supplement Tables 1 and 2) [14,. The studies were conducted in four continents including Europe, North America, South America and Asia (Supplement Tables 1 & 2) [14,22,23,[26][27][28][29][30][31][32][33][34][35][38][39][40][41][42][43][44][45]. The number of participants in each study ranged from 42 in the study by Ship and Puckett to 27,963 in the study by Chen [14,38].…”

“…In contrast, the study by Syrjälä reported no associations between periodontal disease and cognitive decline [41]. Four studies were combined into meta-analysis to quantify the association between periodontal disease and dementia [14,26,31,42]. People with periodontal disease were more likely to suffer from dementia (OR=1.17, 95% CI=1.02-1.34, P heterogeneity=0.33, I2 =13%) ( Figure 2) compared to people without periodontal disease.…”