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Comparative Study
. 2013 Feb;61(2):177-84.
doi: 10.1111/jgs.12094.

Adverse oral health and cognitive decline: the health, aging and body composition study

Robert Stewart  1 , Robert J Weyant, Melissa E Garcia, Tamara Harris, Lenore J Launer, Suzanne Satterfield, Eleanor M Simonsick, Kristine Yaffe, Anne B Newman
Affiliations
Comparative Study

Adverse oral health and cognitive decline: the health, aging and body composition study

Robert Stewart et al. J Am Geriatr Soc. 2013 Feb.

Abstract

Objectives: To investigate the relationship between periodontal disease and cognitive decline.

Design: Analysis of a prospective cohort study.

Setting: The Health, Aging and Body Composition (Health ABC) Study.

Participants: One thousand fifty-three participants who were administered the Modified Mini-Mental State Examination (3MS) at Year 1 (baseline) and Year 3 and had participated in a comprehensive periodontal examination at Year 2.

Measurements: The prospective association between a range of oral health parameters and cognitive function was examined. Decline in 3MS score from Year 3 to 5 was investigated in 947 (89.9%) participants. Covariates included age, sex, education, race, cardiovascular disease and risk, and depressive symptoms.

Results: Most indicators of adverse oral health at Year 2 were associated with cognitive impairment based on averaged 3MS scores less than 80 for Years 1 and 3, but education and race substantially confounded these associations. Higher gingival index, a measure of gingival inflammation, at Year 2 remained independently associated with this definition of cognitive impairment and, in fully adjusted analyses, was also an independent predictor of a more-than-5-point cognitive decline from Year 3 to 5.

Conclusion: Periodontitis may be a risk factor for cognitive decline. Gingivitis is reversible, and periodontitis to some degree is preventable and controllable when manifest. Therefore, further research is needed to clarify potential underlying mechanisms and oral health interventions that might ameliorate cognitive decline.

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Conflict of interest statement

Conflict of interest: Robert Stewart has received research funding in the last 2 years from the Wellcome Trust and the National Institute for Health Research, is funded by the NIHR Specialist Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King’s College London, and wishes to declare research support, travel support and honoraria from several pharmaceutical companies (Pfizer, Eisai, Lunbeck, J&J, Roche). Robert Weyant receives an honorarium as Editor-in-Chief of the Journal of Public Health Dentistry and has received research funding from NIH/National Institute for Drug Abuse, NIH/National Institute for Dental and Craniofacial Research, and US Health Resources and Services Administration. Melissa Garcia has no financial relationships to declare. Tamara Harris is a US government employee and declares that all funding sources have been from US Federal Government and academic centres, that travel support has been received from University of Padua, University of Verona, and Imperial College London, spouse consultancy fees from Imperial College London and children’s stock holding in Web MD. Lenore Launer is a US government employee and has no financial relationships to disclose. Suzanne Satterfield declares that the Memphis Clinical Site for Health ABC received support from USPHS Cont N01-AG-6-2103, 1R01AG028050, and N01-AG-6-2106. EMS is a full-time employee of the US Federal Government with all funding from NIH and has no financial relationships to declare. Kristine Yaffe has served as a consultant to Novartis and serves on data and safety monitoring boards for the National Institute of Mental Health and Institute, Pfizer and Medivation as well as the NIA/Beeson Scientific Advisory Committee. ABN declares a consultancy with Merck in 2008.

Comment in

  • Response to Thomas Finucane.
    Stewart R, Weyant R, Newman A. Stewart R, et al. J Am Geriatr Soc. 2013 Nov;61(11):2060. doi: 10.1111/jgs.12526. J Am Geriatr Soc. 2013. PMID: 24219221 No abstract available.
  • Periodontitis, edentulism, and dementia.
    Finucane TE. Finucane TE. J Am Geriatr Soc. 2013 Nov;61(11):2060. doi: 10.1111/jgs.12518. J Am Geriatr Soc. 2013. PMID: 24219222 No abstract available.

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