Periodontal Disease & Cognitive Decline

[Dean Pomerleau]

All,

 

There seems to be growing evidence that systemic inflammation is involved in many diseases of aging, including cardiovascular disease, diabetes and cognitive impairment / Alzheimer's disease. This new study [1] speaks to the latter. It found the rate of cognitive decline in people suffering from mild cognitive impairment or early-stage Alzheimer's disease was 6x higher in those people who also suffered from periodontal disease, likely as a result of the systemic inflammatory effects of the subjects' infected gums. 

 

So take care of those teeth and gums!

 

--Dean

 

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[1] PLoS One. 2016 Mar 10;11(3):e0151081. doi: 10.1371/journal.pone.0151081.

eCollection 2016.

Periodontitis and Cognitive Decline in Alzheimer's Disease.

Ide M(1), Harris M(2), Stevens A(3), Sussams R(2,)(3), Hopkins V(3), Culliford
D(4), Fuller J(5), Ibbett P(5), Raybould R(6), Thomas R(6), Puenter U(5), Teeling
J(5), Perry VH(5), Holmes C(2,)(3).

Author information:
(1)Dental Institute, Kings College London, Guy's Hospital, London, United
Kingdom. (2)University of Southampton, Faculty of Medicine, Clinical Experimental
Science, Southampton, United Kingdom. (3)Memory Assessment and Research Centre,
Moorgreen Hospital, Southampton, United Kingdom. (4)University of Southampton,
Faculty of Health Sciences, NIHR CLAHRC Wessex Methodological Hub, Southampton,
United Kingdom. (5)University of Southampton, Faculty of Natural and
Environmental Science, Centre for Biological Sciences, Southampton, United
Kingdom. (6)Medical Research Council Centre for Neuropsychiatric Genetics and
Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff
University, Cardiff, United Kingdom.

 

Free full text: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4786266/

Periodontitis is common in the elderly and may become more common in Alzheimer's
disease because of a reduced ability to take care of oral hygiene as the disease
progresses. Elevated antibodies to periodontal bacteria are associated with an
increased systemic pro-inflammatory state. Elsewhere raised serum
pro-inflammatory cytokines have been associated with an increased rate of
cognitive decline in Alzheimer's disease. We hypothesized that periodontitis
would be associated with increased dementia severity and a more rapid cognitive
decline in Alzheimer's disease. We aimed to determine if periodontitis in
Alzheimer's disease is associated with both increased dementia severity and
cognitive decline, and an increased systemic pro inflammatory state. In a six
month observational cohort study 60 community dwelling participants with mild to
moderate Alzheimer's Disease were cognitively assessed and a blood sample taken
for systemic inflammatory markers. Dental health was assessed by a dental
hygienist, blind to cognitive outcomes. All assessments were repeated at six
months. The presence of periodontitis at baseline was not related to baseline
cognitive state but was associated with a six fold increase in the rate of
cognitive decline as assessed by the ADAS-cog over a six month follow up period.
Periodontitis at baseline was associated with a relative increase in the
pro-inflammatory state over the six month follow up period. Our data showed that
periodontitis is associated with an increase in cognitive decline in Alzheimer's
Disease, independent to baseline cognitive state, which may be mediated through
effects on systemic inflammation.

PMCID: PMC4786266
PMID: 26963387

[AlPater]

The below paper is pdf-availed.

 

http://www.reuters.com/article/us-health-dementia-oral-idUSKCN0WY5I2

 

Apr 1, 2016 3:41pm EDT Related: HEALTH
Link between gum disease and dementia is uncertain
BY ANDREW M. SEAMAN
(Reuters Health) -

 

Will better oral health protect an aging brain? The answer isn't clear.

 

Over the past two decades, an increasing number of studies have been looking for relationships between oral health and cognitive problems in older adults.

 

A study earlier this year, for example, linked gum disease with faster cognitive decline in people with Alzheimer's disease (see Reuters Health story of March 15, 2016 here: reut.rs/1UIy5TT).

 

The authors of a more recent review of the evidence say any such link would be important, because many older adults keep their natural teeth and over one third of people over age are cognitively impaired.

 

"We thought it would be interesting to look at the current state of the findings," lead author Bei Wu, of Duke University's School of Nursing in Durham, North Carolina, told Reuters Health.

 

As reported in the Journal of the American Geriatrics Society, Wu's team analyzed 16 studies that had tracked participants over time, plus another 40 studies that only looked at people at one point in time.

 

Some studies found that markers of oral health, like number of teeth and presence of gum disease, were tied to rate of cognitive decline or dementia risk. But the links weren't stable in every study.

 

Other studies found no link between oral and brain health.

 

Also, the idea that both conditions are linked by underlying inflammation was only examined by one study that the researchers found "to be only marginally relevant."

 

"This field is promising, but we really need to have a more rigorous studies to look into the relationship," said Wu.

 

Wu said the idea that oral health could affect cognition is appealing, because it's something that people can modify on their own.

 

"Having this kind of systematic review is extremely helpful for us to know what are the strengths and weaknesses of this area of research and what direction we should go in," she said.

 

SOURCE:

 

Association Between Oral Health and Cognitive Status: A Systematic Review.
Wu B, Fillenbaum GG, Plassman BL, Guo L.
J Am Geriatr Soc. 2016 Apr 1. doi: 10.1111/jgs.14036. [Epub ahead of print]
PMID: 27037761

 

Keywords:

 

oral health;dementia;cognitive decline

 

Abstract

 

Objectives

 

To systematically review longitudinal studies examining the association between oral health and cognitive decline.

 

Design

 

Studies published between January 1993 and March 2013 were identified by search of English language publications in PubMed/Medline using relevant Medical Subject Heading terms and title and abstract keywords and from CINAHL using relevant subject headings. After applying eligibility criteria and adding four studies identified from article references, 56 of the 1,412 articles identified remained; 40 were cross-sectional, and 16 were longitudinal; 11 of the latter examined the effect of oral health on change in cognitive health or dementia incidence, five examined the reverse.

 

Setting

 

Sources of information included administrative data, subject evaluations in parent studies, medical and dental records, self-reports, and in-person evaluations.

 

Participants

 

Older adults.

 

Measurements

 

Most studies used subjects whose oral or cognitive status was known, using standard approaches to impute for missing information. The oral health information most frequently studied included number of teeth, periodontal and caries problems, and denture use. Cognition was most frequently evaluated using the Mini-Mental State Examination or according to a diagnosis of dementia.

 

Results

 

Some studies found that oral health measures such as number of teeth and periodontal disease were associated with risk of cognitive decline or incident dementia, whereas others did not find an association. Similarly, cognitive decline was not consistently associated with greater loss of teeth or number of decayed teeth. It is likely that methodological limitations play a major role in explaining the inconsistent findings.

 

Conclusion

 

It is unclear how or whether oral health and cognitive status are related. Additional research is needed in which there is greater agreement on how oral health and cognitive states are assessed to better examine the linkages between these two health outcomes.

-- Al Pater, alpater@SHAW.ca

[TomBAvoider]

In keeping with the hypothesis that it is tooth loss per se that is causative in cognitive decline, it would not be surprising to find that mere presence of periodontal disease is not dispositive wrt. mental decline. It stands to reason that if more periodontal disease leads to more tooth loss, you'd have cognitive decline based on the tooth loss, but not based on the periodontal disease. Therefore there should be some way to disentangle the effect of (1) tooth loss alone (2) periodontal disease as it relates to cognitive decline. The difficulty is of course in that tooth loss is overwhelmingly the result of periodontal disease, so getting at the disparate effects seems hard.