Periodontitis, tooth loss and cognitive functions among older adults
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This study aims to evaluate the potential association between periodontitis, the number of teeth and cognitive functions in a cohort of older adults in Sweden.
Material and methods
In total, 775 individuals from 60 to 99 years of age were selected for the study. A clinical and radiographic examination was performed. The number of teeth and prevalence of periodontal pockets and bone loss was calculated and categorised. Cognitive functions were assessed using the Mini-Mental State Examination (MMSE) and clock test. The education level was obtained from a questionnaire. Data were analysed using chi-square tests and multivariate logistic regression.
Age and gender were associated with the prevalence of bone loss. Age and education were associated with lower number of teeth. Gender was also associated with the presence of pockets. The multivariate logistic regression analysis demonstrated a statistically significant association between prevalence of bone loss, the number of teeth and the outcome on MMSE test. This association remained even after adjustment for age, education and gender. Tooth loss was also associated with lower outcome on clock test. Presence of periodontal pockets ≥ 5 mm was not associated with cognitive test outcome.
A history of periodontitis and tooth loss may be of importance for cognitive functions among older adults.
Diseases with and inflammatory profile may have an impact on cognitive decline.
KeywordsDementia Epidemiology Mild cognitive impairment Periodontal diseases and tooth loss
We are grateful to the participants, the participating counties and municipalities.
The work was supported by the Region Halland, Sweden, Southern Health Care Region, Sweden, and the Swedish Dental Society. The Swedish National Study on Ageing and Care, SNAC (www.snac.org), is financially supported by the Ministry of Health and Social Affairs, Sweden, and the participating county councils, municipalities and university departments.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in the study were in accordance with the ethical standards of the regional research ethics committee and with the 1964 Helsinki Declaration and its later amendments.
Informed consent was obtained from all individual participants included in the study.
- 1.Ferri CP, Prince M, Brayne C, Brodaty H, Fratiglioni L, Ganguli M, Hall K, Hasegawa K, Hendrie H, Huang Y, Jorm A, Mathers C, Menezes PR, Rimmer E, Scazufca M, Alzheimer’s Disease International (2005) Global prevalence of dementia: a Delphi consensus study. Lancet 366(9503):2112–2117. https://doi.org/10.1016/S0140-6736(05)67889-0 CrossRefPubMedPubMedCentralGoogle Scholar
- 2.Gauthier S, Reisberg B, Zaudig M, Petersen RC, Ritchie K, Broich K, Belleville S, Brodaty H, Bennett D, Chertkow H, Cummings JL, de Leon M, Feldman H, Ganguli M, Hampel H, Scheltens P, Tierney MC, Whitehouse P, Winblad B, International Psychogeriatric Association Expert Conference on mild cognitive impairment (2006) Mild cognitive impairment. Lancet. https://doi.org/10.1016/S0140-6736(06)68542-5
- 3.Palmqvist S, Hertze J, Minthon L, Wattmo C, Zetterberg H, Blennow K, Londos E, Hansson O (2012) Comparison of brief cognitive tests and CSF biomarkers in predicting Alzheimer’s disease in mild cognitive impairment: six-year follow-up study. PLoS One 7(6):e38639. https://doi.org/10.1371/journal.pone.0038639 CrossRefPubMedPubMedCentralGoogle Scholar
- 4.Nilsson H, Berglund J, Renvert S (2014) Tooth loss and cognitive functions among older adults. Acta Odontol Scand. https://doi.org/10.3109/00016357.2014.882983
- 5.Noble JM, Scarmeas N, Papapanou PN (2013) Poor oral health as a chronic, potentially modifiable dementia risk factor: review of the literature. Curr Neurol Neurosci Rep. https://doi.org/10.1007/s11910-013-0384-x
- 6.Gil-Montoya JA, Sanchez-Lara I, Carnero-Pardo C, Fornieles F, Montes J, Vilchez R, Burgos JS, Gonzalez-Moles MA, Barrios R, Bravo M (2014) Is periodontitis a risk factor for cognitive impairment and dementia? A case-control study. J Periodontol. https://doi.org/10.1902/jop.2014.140340
- 7.Schmidt R, Schmidt H, Curb JD, Masaki K, White LR, Launer LJ (2002) Early inflammation and dementia: a 25-year follow-up of the Honolulu-Asia aging study. Ann Neurol. https://doi.org/10.1002/ana.10265
- 8.Engelhart MJ, Geerlings MI, Meijer J, Kiliaan A, Ruitenberg A, van Swieten JC, Stijnen T, Hofman A, Witteman JC, Breteler MM (2004) Inflammatory proteins in plasma and the risk of dementia: the rotterdam study. Arch Neurol. https://doi.org/10.1001/archneur.61.5.668
- 9.Kassebaum NJ, Bernabe E, Dahiya M, Bhandari B, Murray CJ, Marcenes W (2014) Global burden of severe periodontitis in 1990–2010: a systematic review and meta-regression. J Dent Res. https://doi.org/10.1177/0022034514552491
- 10.Chapple IL, Genco R, working group 2 of the joint EFP/AAP workshop (2013) Diabetes and periodontal diseases: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. J Periodontol. https://doi.org/10.1902/jop.2013.1340011
- 11.Tonetti MS, Van Dyke TE, Working group 1 of the joint EFP/AAP workshop (2013) Periodontitis and atherosclerotic cardiovascular disease: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. J Clin Periodontol. https://doi.org/10.1111/jcpe.12089
- 12.Paraskevas S, Huizinga JD, Loos BG (2008) A systematic review and meta-analyses on C-reactive protein in relation to periodontitis. J Clin Periodontol. https://doi.org/10.1111/j.1600-051X.2007.01173.x
- 13.Linden GJ, Lyons A, Scannapieco FA (2013) Periodontal systemic associations: review of the evidence. J Clin Periodontol. https://doi.org/10.1111/jcpe.12064
- 14.Wu B, Fillenbaum GG, Plassman BL, Guo L (2016) Association between oral health and cognitive status: a systematic review. J Am Geriatr Soc. https://doi.org/10.1111/jgs.14036
- 15.Lagergren M, Fratiglioni L, Hallberg IR, Berglund J, Elmstahl S, Hagberg B, Holst G, Rennemark M, Sjolund BM, Thorslund M, Wiberg I, Winblad B, Wimo A (2004) A longitudinal study integrating population, care and social services data. The Swedish National study on Aging and Care (SNAC). Aging Clin Exp Res 16(2):158–168Google Scholar
- 16.Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12(3):189–198Google Scholar
- 17.Manos PJ, Wu R (1994) The ten point clock test: a quick screen and grading method for cognitive impairment in medical and surgical patients. Int J Psychiatry Med 24(3):229–244Google Scholar
- 18.Manos PJ (1997) The utility of the ten-point clock test as a screen for cognitive impairment in general hospital patients. Gen Hosp Psychiatry 19(6):439–444Google Scholar
- 19.Perry VH, Cunningham C, Holmes C (2007) Systemic infections and inflammation affect chronic neurodegeneration. Nat Rev Immunol 7(2):161–167Google Scholar
- 20.Cunningham C (2013) Microglia and neurodegeneration: the role of systemic inflammation. Glia. https://doi.org/10.1002/glia.22350
- 21.Di Bona D, Rizzo C, Bonaventura G, Candore G, Caruso C (2012) Association between interleukin-10 polymorphisms and Alzheimer’s disease: a systematic review and meta-analysis. J Alzheimers Dis. https://doi.org/10.3233/JAD-2012-111838
- 22.Nicoll JA, Mrak RE, Graham DI, Stewart J, Wilcock G, MacGowan S, Esiri MM, Murray LS, Dewar D, Love S, Moss T, Griffin WS (2000) Association of interleukin-1 gene polymorphisms with Alzheimer’s disease. Ann Neurol 47(3):365–368Google Scholar
- 23.McGeer PL, Schulzer M, McGeer EG (1996) Arthritis and anti-inflammatory agents as possible protective factors for Alzheimer’s disease: a review of 17 epidemiologic studies. NeurologyGoogle Scholar
- 24.Noble JM, Scarmeas N, Celenti RS, Elkind MS, Wright CB, Schupf N, Papapanou PN (2014) Serum IgG antibody levels to periodontal microbiota are associated with incident Alzheimer disease. PLoS One. https://doi.org/10.1371/journal.pone.0114959
- 26.Dubois B, Feldman HH, Jacova C, Dekosky ST, Barberger-Gateau P, Cummings J, Delacourte A, Galasko D, Gauthier S, Jicha G, Meguro K, O'brien J, Pasquier F, Robert P, Rossor M, Salloway S, Stern Y, Visser PJ, Scheltens P (2007) Research criteria for the diagnosis of Alzheimer’s disease: revising the NINCDS-ADRDA criteria. Lancet Neurol. https://doi.org/10.1016/S1474-4422(07)70178-3
- 27.Chertkow H, Whatmough C, Saumier D, Duong A (2008) Cognitive neuroscience studies of semantic memory in Alzheimer’s disease. Prog Brain Res. https://doi.org/10.1016/S0079-6123(07)00025-8
- 29.Serino G, Wennstrom JL, Lindhe J, Eneroth L (1994) The prevalence and distribution of gingival recession in subjects with a high standard of oral hygiene. J Clin Periodontol 21(1):57–63Google Scholar
- 30.Akesson L, Hakansson J, Rohlin M (1992) Comparison of panoramic and intraoral radiography and pocket probing for the measurement of the marginal bone level. J Clin Periodontol 19(5):326–332Google Scholar
- 31.Molander B, Ahlqwist M, Grondahl HG (1995) Image quality in panoramic radiography. Dentomaxillofac Radiol. https://doi.org/10.1259/dmfr.24.1.8593902