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Meta Analysis of the Correlation between Periodontal Health and Cognitive Impairment in the Older Population

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Abstract

Objective

To explore the correlation between periodontal health and cognitive impairment in the older population to provide the evidence for preventing cognitive impairment from the perspective of oral health care in older adults.

Methods

A comprehensive search was conducted in PubMed, Embase, the Cochrane Library, the Web of Science, the China National Knowledge Infrastructure, Wanfang Data, the China Science and Technology Journal Database, and the China Biomedical Literature Database, to include both cross-sectional and longitudinal cohort studies on the association between periodontal health and cognitive impairment in older adults. The search was completed in April 2023. Following quality assessment and data organization of the included studies, meta-analysis was performed using Review Manager 5.4.

Results

Twenty-two studies involving a total of 4,246,608 patients were included to comprehensively assess periodontal health from four dimensions (periodontitis, tooth loss, occlusal support, and masticatory ability), with the outcome variable of cognitive impairment (including mild cognitive impairment, Alzheimer’s disease and all-cause dementia). Meta-analysis showed that, compared to those of periodontally healthy older adults, the risk of cognitive impairment in older adults with poor periodontal health, after adjusting for confounders, was significantly greater for those with periodontitis (OR=1.45, 95% CI: 1.20–1.76, P<0.001), tooth loss (OR=1.80, 95% CI: 1.50–2.15, P<0.001), compromised occlusal support (OR=1.87, 95% CI: 1.29–2.70, P=0.001), and reduced masticatory ability (OR=1.39, 95% CI: 1.11–1.75, P=0.005). The risk of cognitive impairment was higher in older adults with low-dentition than in those with high-dentition. Subgroup analysis revealed older individuals with fewer remaining teeth were at a higher risk of developing cognitive impairment compared to those with more remaining teeth, as shown by the comparison of number of teeth lost (7–17 teeth compared to 0–6 teeth) (OR=1.64, 95% CI: 1.13–2.39, P=0.01), (9–28 teeth compared to 0–8 teeth) (OR=1.13, 95% CI: 1.06–1.20, P<0.001), (19–28 teeth compared to 0–18 teeth) (OR=2.52, 95% CI: 1.32–4.80, P=0.005), and (28 teeth compared to 0–27 teeth) (OR=2.07, 95% CI: 1.54–2.77, P<0.001). In addition, tooth loss in older adults led to a significantly increased risk of mild cognitive impairment (OR=1.66, 95% CI: 1.43–1.91, P<0.001) and all-cause dementia (OR=1.35, 95% CI: 1.11–1.65, P=0.003), although the correlation between tooth loss and the risk of Alzheimer’s disease was not significant (OR=3.89, 95% CI: 0.68–22.31, P=0.13).

Conclusion

Poor periodontal health, assessed across four dimensions (periodontitis, tooth loss, occlusal support, and masticatory ability), represents a significant risk factor for cognitive impairment in older adults. The more missing teeth in older adults, the higher risk of developing cognitive impairment, with edentulous individuals particularly susceptible to cognitive impairment. While a certain degree of increased risk of Alzheimer’s disease was observed, no significant association was found between tooth loss and the risk of developing Alzheimer’s disease. Enhancing periodontal health management and delivering high-quality oral health care services to older adults can help prevent cognitive impairment.

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References

  1. World Health Organization. Ageing and health. 2022. https://www.who.int/zh/news-room/fact-sheets/detail/ageing-and-health. Accessed1 October 2022

  2. United Nations. World Social Report 2023: Leaving No One Behind In An Ageing World. 2023. https://news.un.org/zh/story/2023/01/1114127. Accessed 12 January 2023

  3. Expert Consensus Group on the Prevention and Treatment of Cognitive Impairment in China. Expert Consensus on the Prevention and Treatment of Cognitive Impairment in China. Chin J Intern Med. 2006;45(2):171–173. doi:https://doi.org/10.3760/j.issn:0578-1426.2006.02.029

    Google Scholar 

  4. Jia L, Du Y, Chu L, et al. Prevalence, risk factors, and management of dementia and mild cognitive impairment in adults aged 60 years or older in China: a cross-sectional study. Lancet Public Health. 2020;5(12):e661–e671. doi:https://doi.org/10.1016/S2468-2667(20)30185-7.

    Article  PubMed  Google Scholar 

  5. Livingston G, Huntley J, Sommerlad A, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020;396(10248):413–446. doi:https://doi.org/10.1016/S0140-6736(20)30367-6

    Article  PubMed  PubMed Central  Google Scholar 

  6. Chinese Stomatological Association, Yu GY, Wang QT, et al. Consensus of Chinese stomatological multidisciplinary experts on maintaining periodontal Health (First Edition). Chin J Stomatol. 2021;56(2):9. doi:https://doi.org/10.3760/cma.j.cn112144-20210112-00013

    Google Scholar 

  7. Kinane DF, Stathopoulou PG, Papapanou PN. Periodontol diseases. Nat Rev Dis Primers. 2017;3:17038. doi:https://doi.org/10.1038/nrdp.2017.38

    Article  PubMed  Google Scholar 

  8. Lang NP, Bartold PM. Periodontol health. J Periodontol. 2018;89 Suppl 1:S9–S16. doi:https://doi.org/10.1002/JPER.16-0517

    PubMed  Google Scholar 

  9. Raphael C. Oral Health and Aging. Am J Public Health. 2017;107(S1):S44–S45. doi:https://doi.org/10.2105/AJPH.2017.303835

    Article  PubMed  PubMed Central  Google Scholar 

  10. Northridge ME, Kumar A, Kaur R. Disparities in Access to Oral Health Care. Annu Rev Public Health. 2020;41:513–535. doi:https://doi.org/10.1146/annurev-publhealth-040119-094318

    Article  PubMed  PubMed Central  Google Scholar 

  11. Wang X. The Fourth National Oral Health Epidemiological Survey Report. 2018. Beijing, People’s Medical Publishing House.

    Google Scholar 

  12. Peres MA, Macpherson LMD, Weyant RJ, et al. Oral diseases: a global public health challenge. Lancet. 2019;394(10194):249–260. doi:https://doi.org/10.1016/S0140-6736(19)31146-8

    Article  PubMed  Google Scholar 

  13. Wells G. The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Non-Randomised Studies in Meta-Analyses[C]//Symposium on Systematic Reviews: Beyond the Basics. 2014. doi:https://doi.org/10.1006/bioe.2002.0137

  14. Iwasaki M, Yoshihara A, Kimura Y, et al. Longitudinal relationship of severe periodontitis with cognitive decline in older Japanese. J Periodontol Res. 2016;51(5):681–688.doi:https://doi.org/10.1111/jre.12348

    Article  CAS  Google Scholar 

  15. Suzuki H, Furuya J, Hidaka R, et al. Patients with mild cognitive impairment diagnosed at dementia clinic display decreased maximum occlusal force: a cross-sectional study. BMC Oral Health. 2021;21(1):665.doi:https://doi.org/10.1186/s12903-021-02027-8

    Article  PubMed  PubMed Central  Google Scholar 

  16. Bumb, S. S., Govindan, C. C., Kadtane, S. S., et al. Association between cognitive decline and oral health status in the aging population: A 5-year observational study. GeroPsych: The Journal of Gerontopsychology and Geriatric Psychiatry, 2022, 35(4), 189–195. https://doi.org/10.1024/1662-9647/a000271

    Article  Google Scholar 

  17. Marruganti C, Baima G, Aimetti M, et al. Periodontitis and low cognitive performance: A population-based study. J Clin Periodontol. 2023;50(4):418–429. doi:https://doi.org/10.1111/jcpe.13779

    Article  PubMed  Google Scholar 

  18. Nilsson H, Berglund JS, Renvert S. Periodontitis, tooth loss and cognitive functions among older adults. Clin Oral Investig. 2018;22(5):2103–2109. doi:https://doi.org/10.1007/s00784-017-2307-8

    Article  PubMed  Google Scholar 

  19. Hatta K, Ikebe K, Gondo Y, et al. Influence of lack of posterior occlusal support on cognitive decline among 80-year-old Japanese people in a 3-year prospective study. GeriatrGerontol Int. 2018;18(10):1439–1446.doi:https://doi.org/10.1111/ggi.13508

    Google Scholar 

  20. Nilsson H, Berglund J, Renvert S. Tooth loss and cognitive functions among older adults. Acta Odontol Scand. 2014;72(8):639–644.doi:https://doi.org/10.3109/00016357.2014.882983

    Article  PubMed  Google Scholar 

  21. Lopez-Jornet P, Zamora Lavella C, Pons-Fuster Lopez E, Tvarijonaviciute A. Oral Health Status in Older People with Dementia: A Case-Control Study. J Clin Med. 2021;10(3):477.doi:https://doi.org/10.3390/jcm10030477

    Article  PubMed  PubMed Central  Google Scholar 

  22. Tsuneishi M, Yamamoto T, Yamaguchi T, et al. Association between number of teeth and Alzheimer’s disease using the National Database of Health Insurance Claims and Specific Health Checkups of Japan. PLoS One. 2021;16(4):e0251056.doi:https://doi.org/10.1371/journal.pone.0251056

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Takehara S, Wright FAC, Waite LM, et al. Oral health and cognitive status in the Concord Health and Ageing in Men Project: A cross-sectional study in community-dwelling older Australian men. Gerodontology. 2020;37(4):353–360.doi:https://doi.org/10.1111/ger.12469

    Article  PubMed  Google Scholar 

  24. Saito S, Ohi T, Murakami T, Komiyama T, et al. Association between tooth loss and cognitive impairment in community-dwelling older Japanese adults: a 4-year prospective cohort study from the Ohasama study. BMC Oral Health. 2018;18(1):142.doi:https://doi.org/10.1186/s12903-018-0602-7

    Article  PubMed  PubMed Central  Google Scholar 

  25. Saito Y, Sugawara N, Yasui-Furukori N, Takahashi I, Nakaji S, Kimura H. Cognitive function and number of teeth in a community-dwelling population in Japan. Ann Gen Psychiatry. 2013;12(1):20.doi:https://doi.org/10.1186/1744-859X-12-20

    Article  PubMed  PubMed Central  Google Scholar 

  26. Stein PS, Desrosiers M, Donegan SJ, et al. Tooth loss, dementia and neuropathology in the Nun study. J Am Dent Assoc. 2007;138(10):1314–1382. doi:https://doi.org/10.14219/jada.archive.2007.0046

    Article  PubMed  Google Scholar 

  27. Okamoto N, Morikawa M, Okamoto K, et al. Relationship of tooth loss to mild memory impairment and cognitive impairment: findings from the Fujiwarakyo study. Behav Brain Funct. 2010;6:77.doi:https://doi.org/10.1186/1744-9081-6-77

    Article  PubMed  PubMed Central  Google Scholar 

  28. Iwasaki M, Kimura Y, Yoshihara A, et al. Oral health status in relation to cognitive function among older Japanese. Clin Exp Dent Res. 2015;1(1):3–9. doi:https://doi.org/10.1002/cre2.2

    Article  PubMed  PubMed Central  Google Scholar 

  29. Lexomboon D, Trulsson M, Wårdh I, Parker MG. Chewing ability and tooth loss: association with cognitive impairment in an elderly population study. J Am Geriatr Soc. 2012;60(10):1951–1956.doi:https://doi.org/10.1111/j.1532-5415.2012.04154.x

    Article  PubMed  Google Scholar 

  30. Shin MS, Shin YJ, Karna S, Kim HD. Rehabilitation of lost teeth related to maintenance of cognitive function. Oral Dis. 2019;25(1):290–299.doi:https://doi.org/10.1111/odi.12960

    Article  PubMed  Google Scholar 

  31. Turnbull N, Cherdsakul P, Chanaboon S, et al. Tooth Loss, Cognitive Impairment and Fall Risk: A Cross-Sectional Study of Older Adults in Rural Thailand. Int J Environ Res Public Health. 2022;19(23):16015.doi:https://doi.org/10.3390/ijerph192316015

    Article  PubMed  PubMed Central  Google Scholar 

  32. Xu S, Huang X, Gong Y, Sun J. Association between tooth loss rate and risk of mild cognitive impairment in older adults: a population-based longitudinal study. Aging (Albany NY). 2021;13(17):21599–21609. doi:https://doi.org/10.18632/aging.203504

    Article  PubMed  Google Scholar 

  33. Jiang Z, Liu X, Lü Y. Unhealthy oral status contributes to the older patients with cognitive frailty: an analysis based on a 5-year database. BMC Geriatr. 2022;22(1):980.doi:https://doi.org/10.1186/s12877-022-03673-5

    Article  PubMed  PubMed Central  Google Scholar 

  34. Luo J, Wu B, Zhao Q, et al. Association between tooth loss and cognitive function among 3063 Chinese older adults: a community-based study. PLoS One. 2015;10(3):e0120986.doi:https://doi.org/10.1371/journal.pone.0120986

    Article  PubMed  PubMed Central  Google Scholar 

  35. Yoo JJ, Yoon JH, Kang MJ, et al. The effect of missing teeth on dementia in older people: a nationwide population-based cohort study in South Korea. BMC Oral Health. 2019;19(1):61.doi:https://doi.org/10.1186/s12903-019-0750-4

    Article  PubMed  PubMed Central  Google Scholar 

  36. Wu B, Fillenbaum GG, Plassman BL, Guo L. Association Between Oral Health and Cognitive Status: A Systematic Review. J Am Geriatr Soc. 2016;64(4):739–751. doi:https://doi.org/10.1111/jgs.14036

    Article  PubMed  PubMed Central  Google Scholar 

  37. Arimatsu K, Yamada H, Miyazawa H, et al. Oral pathobiont induces systemic inflammation and metabolic changes associated with alteration of gut microbiota. Sci Rep. 2014;4:4828. doi:https://doi.org/10.1038/srep04828

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Lam GA, Albarrak H, McColl CJ, et al. The Oral-Gut Axis: Periodontol Diseases and Gastrointestinal Disorders. Inflamm Bowel Dis. 2023;29(7):1153–1164. doi:https://doi.org/10.1093/ibd/izac241

    Article  PubMed  Google Scholar 

  39. Baumgart M, Snyder HM, Carrillo MC, Fazio S, Kim H, Johns H. Summary of the evidence on modifiable risk factors for cognitive decline and dementia: A population-based perspective. Alzheimers Dement. 2015;11(6):718–726. doi:https://doi.org/10.1016/j.jalz.2015.05.016

    Article  PubMed  Google Scholar 

  40. Bao H, Liu Y, Zhang M, et al. Increased β-site APP cleaving enzyme 1-mediated insulin receptor cleavage in type 2 diabetes mellitus with cognitive impairment. Alzheimers Dement. 2021;17(7):1097–1108. doi:https://doi.org/10.1002/alz.12276

    Article  CAS  PubMed  Google Scholar 

  41. Chinese Society of Geriatrics, Chinese Society of Geriatrics Hypertension Branch, Chinese Society of Geriatrics Cognitive Impairment Branch, et al. Chinese expert consensus on the diagnosis and treatment of hypertension and cognitive impairment in the elderly(2021). Chin. J. Clin. Healthcare. 2021;24(2):145–159.doi:https://doi.org/10.11915/j.issn.1671-5403.2021.04.052

    Google Scholar 

  42. Ungvari Z, Toth P, Tarantini S, et al. Hypertension-induced cognitive impairment: from pathophysiology to public health. Nat Rev Nephrol. 2021;17(10):639–654. doi:https://doi.org/10.1038/s41581-021-00430-6

    Article  PubMed  PubMed Central  Google Scholar 

  43. Qi X, Zhu Z, Plassman BL, Wu B. Dose-Response Meta-Analysis on Tooth Loss With the Risk of Cognitive Impairment and Dementia. J Am Med Dir Assoc. 2021;22(10):2039–2045. doi:https://doi.org/10.1016/j.jamda.2021.05.009

    Article  PubMed  PubMed Central  Google Scholar 

  44. Yoo JJ, Yoon JH, Kang MJ, Kim M, Oh N. The effect of missing teeth on dementia in older people: a nationwide population-based cohort study in South Korea. BMC Oral Health. 2019;19(1):61. doi:https://doi.org/10.1186/s12903-019-0750-4

    Article  PubMed  PubMed Central  Google Scholar 

  45. Gil Martínez V, Avedillo Salas A, Santander Ballestín S. Vitamin Supplementation and Dementia: A Systematic Review. Nutrients. 2022;14(5):1033.doi:https://doi.org/10.3390/nu14051033

    Article  Google Scholar 

  46. Suh SW, Kim HS, Han JH, et al. Efficacy of Vitamins on Cognitive Function of Non-Demented People: A Systematic Review and Meta-Analysis. Nutrients. 2020;12(4):1168. doi:https://doi.org/10.3390/nu12041168

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Forbes SC, Holroyd-Leduc JM, Poulin MJ, Hogan DB. Effect of Nutrients, Dietary Supplements and Vitamins on Cognition: a Systematic Review and Meta-Analysis of Randomized Controlled Trials. Can Geriatr J. 2015;18(4):231–245. doi:https://doi.org/10.5770/cgj.18.189

    Article  PubMed  PubMed Central  Google Scholar 

  48. Huang DZ, Zhang Q, Jiang H. Research progress on correlation between mastication and memory. J Prosthodont. 2019;20(06):357–362.doi:https://doi.org/10.19748/j.cn.kqxf.1009-3761.2019.06.008

    Google Scholar 

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Acknowledgments

The authors would like to thank all the authors of the included trails and their participants.

Funding

Funding: This work was supported financially by grants from National Natural Science Foundation of China (72174159).

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Authors and Affiliations

  1. Geriatric Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China

    Y.-D. Fu, C.-L. Li, C.-L. Hu, M.-D. Pei, W.-Y. Cai, Y.-Q. Li, Lang Xu & Yan Zeng

  2. Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, West Huangjiahu Road, Hongshan District, Wuhan, 430065, China

    Y.-D. Fu, C.-L. Li, C.-L. Hu, M.-D. Pei, W.-Y. Cai, Y.-Q. Li, Lang Xu & Yan Zeng

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  1. Y.-D. Fu
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  2. C.-L. Li
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  3. C.-L. Hu
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  4. M.-D. Pei
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Correspondence to Lang Xu or Yan Zeng.

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Conflict of interest: The authors declare no competing financial interest.

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Fu, YD., Li, CL., Hu, CL. et al. Meta Analysis of the Correlation between Periodontal Health and Cognitive Impairment in the Older Population. J Prev Alzheimers Dis (2024). https://doi.org/10.14283/jpad.2024.87

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