Tooth Loss, Apolipoprotein E, and Decline in Delayed Word Recall

Stein, Pamela; Kryscio, Richard J.; Desrosiers, Mark F.; Donegan, Sara Jean; Gibbs, Michael

doi:10.1177/0022034509357881

Cited by 64 publications

(88 citation statements)

References 30 publications

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“…Our findings are not consistent, however, with previous studies that found edentulism to predict more rapid cognitive decline and greater incidence of dementia (6,24). In fact, our study found a slower cognitive decline in edentulous participants.…”

Section: Discussioncontrasting

confidence: 99%

“…Whereas many studies report associations of fewer teeth and complete tooth loss with poorer cognitive function (3,5,14,22–24), evidence regarding the association between actual periodontal disease and cognitive ability is mixed (3,6–8,14,15). Furthermore, periodontal disease exposure in earlier studies has been assessed with measures, such as the community periodontal index (CPI), which are based on clinical signs that do not provide much information about the underlying biology of periodontal disease (7).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Tooth loss, periodontal disease, and cognitive decline in the Atherosclerosis Risk in Communities (ARIC) study

Naorungroj

Schoenbach

Wruck

et al. 2014

Comm Dent Oral Epid

105

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Objective The purpose of this prospective study was to investigate whether poor oral health predicted eight-year cognitive function change in predominantly late middle adults in the Atherosclerosis Risk in Communities (ARIC) study. Methods Participants included a subset of ARIC participants aged 52–75 years at 1996–1998 from two study sites: Forsyth County NC and Jackson MS. All subjects completed cognitive function assessments both in 1996–1998 and 2004–2006, and the same subjects received a dental examination at the initial visit. Cognitive assessment consisted of Delayed Word Recall (DWR), Digit Symbol Substitution (DSS), and Word Fluency (WF) tests. In the analysis, cognitive function for 911 dentally screened participants was evaluated, and 558 of 785 dentate participants received comprehensive oral examinations, including periodontal probing. Measures of oral health included dental status, number of teeth, and periodontal disease classified by the Biofilm-Gingival Interface (BGI) index. The generalized estimating equations (GEE) method was used to analyze repeated measures of cognitive scores with adjustment for socio-demographic characteristics and cardiovascular risk factors. Results Of 911 study participants, 13.8% were edentulous. About 13 % of dentally examined participants had periodontal pockets (≥4 mm) with severe bleeding. At the follow-up visit, DWR and WF scores were lower in edentulous compared to dentate people, whereas other oral health measures were not associated with cognitive function. Mean values declined over time for all three cognitive measures, although poor oral health conditions were not associated with greater degree of decline in cognitive function. Conclusions In these late-middle aged adults, complete tooth loss was significantly associated with lower cognitive performance. However, neither edentulism, number of teeth, nor periodontal disease predicted greater subsequent cognitive decline.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Tooth loss, periodontal disease, and cognitive decline in the Atherosclerosis Risk in Communities (ARIC) study

Naorungroj

Schoenbach

Wruck

et al. 2014

Comm Dent Oral Epid

105

View full text Add to dashboard Cite

show abstract

“…Salient points are that periodontal disease is co-morbid with clinically demented subjects [4][5][6][7]. Tooth loss in early and midlife has consequences for poor memory in later life [4,[7][8][9][10][11][12]. A prospective longitudinal study reported by Ide et al [7] upholds the view that periodontitis is associated with a marked increase in cognitive decline, which is independent of base line cognition, in men with a mild to moderate clinical diagnosis of dementia.…”

Section: Making a Case For Periodontitis As A Risk Factor For Alzheimmentioning

confidence: 99%

“…First, there are significant correlations between the rate of cognitive decline and measures of periodontal disease progression, such as pocket depth, alveolar bone loss and tooth loss [37]. Currently, the relevance of newly identified risk factor, cognitive deficit for periodontitis [8], is more difficult to measure and pinpoint. We have suggested an explanation following our studies performed in the P. ginigivalis mono-infection model of periodontal disease in apolipoprotein E knockout (ApoE -/-) mice (see section on blood-brain barrier below).…”

Section: Periodontal Diseasementioning

confidence: 99%

Can Better Management of Periodontal Disease Delay the Onset and Progression of Alzheimer’s Disease?

Harding

Robinson

Crean

et al. 2017

JAD

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A risk factor relationship exists between periodontal disease and Alzheimer's disease (AD) via tooth loss, and improved memory following dental intervention. This links the microbial contribution from indigenous oral periodontal pathogens to the manifestation of chronic conditions, such as AD. Here, we use Porphyromonas gingivalis infection to illustrate its effect on mental health. P. gingivalis infection, in its primary sub-gingival niche, can cause polymicrobial synergy and dysbiosis. Dysbiosis describes the residency of select commensals from the oral cavity following co-aggregation around the dominant keystone pathogen, such as P. gingivalis, to gain greater virulence. The initial process involves P. gingivalis disturbing neutrophil mediated innate immune responses in the healthy gingivae and then downregulating adaptive immune cell differentiation and development to invade, and subsequently, establish new dysbiotic bacterial communities. Immune responses affect the host in general and functionally via dietary adjustments caused by tooth loss. Studies from animals orally infected with P. gingivalis confirm this bacterium can transmigrate to distant organ sites (the brain) and contribute toward peripheral and intracerebral inflammation, and compromise vascular and microvascular integrity. In another study, P. gingivalis infection caused sleep pattern disturbances by altering glial cell light/dark molecular clock activity, and this, in turn, can affect the clearance of danger associated molecular patterns, such as amyloid-␤, via the glymphatic system. Since P. gingivalis can transmigrate to the brain and modulate organ-specific inflammatory innate and adaptive immune responses, this paper explores whether better management of indigenous periodontal bacteria could delay/prevent the onset and/or progression of dementia.

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“…In 144 nuns, those encoding APOEɛ4 and who had fewer teeth experienced more rapid cognitive decline than those with neither or either of these risk factors (188). Clinical and epidemiological studies showed that loss of teeth is associated with poor memory (6,96,187,189).…”

Section: Genetic Nutritional and Environmental Factors Promoting Admentioning

confidence: 99%

Inflammasome Involvement in Alzheimer’s Disease

Olsen

Singhrao

2016

JAD

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Alzheimer's disease (AD) is a scourge of longevity that will drain enormous resources from public health budgets in the future. Currently, there is no diagnostic biomarker and/or treatment for this most common form of dementia in humans. AD can be of early familialonset or sporadic with a late-onset. Apart from the two main hallmarks, amyloid-beta and neurofibrillary tangles, inflammation is a characteristic feature of AD neuropathology.Inflammation may be caused by a local central nervous system insult and/or by peripheral infections. Numerous microorganisms are suspected in AD brains ranging from bacteria (mainly oral and non-oral Treponema species), viruses (Herpes simplex type I) and yeasts (Candida species). A causal relationship between periodontal pathogens/non-oral Treponema species of bacteria has been proposed via the amyloid-beta and inflammatory links.Periodontitis constitutes a peripheral oral infection that can provide the brain with intact bacteria and virulence factors and inflammatory mediators due to daily, transient bacteraemias. If and when genetic risk factors meet environmental risk factors in the brain, disease is expressed, in which neurocognition may be impacted, leading to the development of dementia. To achieve the goal of finding a diagnostic biomarker and possible prophylactic treatment for AD, there is an initial need to solve the etiological puzzle contributing to its pathogenesis. This review therefore addresses oral infection as the plausible aetiology of late onset AD (LOAD). ___________________________________________________________________________Keywords: Alzheimer's disease; pathogenesis; microorganisms; oral bacteria; direct cause 3 Alzheimer's disease (AD) is a neurodegenerative disease and the most common example of a group of diseases that manifest as dementia. It is associated with atrophy and specific neuronal death particularly in the hippocampal region of the brain (1). Research into AD pathogenesis, has flagged two main categories of the disease: the familial onset presentation accounts for around 2% of all AD cases and the sporadic form of late-onset AD also referred to as LOAD constitutes approximately 98% of the cases. LOAD displays genetic susceptibility traits of which the well-known risk factor is inheritance of the apolipoprotein (APOEɛ4) gene allele (2) and, appears to require an environmental factor for disease expression. For example a pathogen-host interaction can exacerbate neurocognition in some elderly individuals who if in their 80+ years likely become diagnosed with LOAD (3, 4). The rationale for this review therefore is to try to explain the aetiology in the vast proportion of LOAD cases that relies upon common risk factors. Several scientists have proposed, one of these to be peripheral infections (5-11), and the accompanying systemic and local inflammatory mediators (11)(12)(13). Of these, the plausible risk from oral infection is the main focus of this review. PREVALENCE OF ADAD is a burden of longevity resulting from the superior qualit...

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Tooth Loss, Apolipoprotein E, and Decline in Delayed Word Recall

Cited by 64 publications

References 30 publications

Tooth loss, periodontal disease, and cognitive decline in the Atherosclerosis Risk in Communities (ARIC) study

Tooth loss, periodontal disease, and cognitive decline in the Atherosclerosis Risk in Communities (ARIC) study

Can Better Management of Periodontal Disease Delay the Onset and Progression of Alzheimer’s Disease?

Inflammasome Involvement in Alzheimer’s Disease

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