Dementia and the Risk of Periodontitis: A Population-Based Cohort Study

Abstract

Dementia and Alzheimer's disease (AD) are proposed to be comorbid with periodontitis (PD). It is unclear whether PD is associated with dementia and AD independent of confounding factors. We aimed at identifying the relationship between the longitudinal risk of developing PD in a cohort of patients with dementia and AD who did not show any signs of PD at baseline. In this retrospective cohort study, 8,640 patients with dementia without prior PD were recruited, and 8,640 individuals without dementia history were selected as propensity score-matched controls. A Cox proportional hazard model was developed to estimate the risk of developing PD over 10 y. Cumulative probability was derived to assess the time-dependent effect of dementia on PD. Of the 8,640 patients, a sensitivity test was conducted on 606 patients with AD-associated dementia and 606 non-AD propensity score-matched controls to identify the impact of AD-associated dementia on the risk for PD. Subgroup analyses on age stratification were included. Overall 2,670 patients with dementia developed PD. The relative risk of PD in these patients was significantly higher than in the nondementia group (1.825, 95% CI = 1.715 to 1.942). Cox proportional hazard models showed that patients with dementia were more likely to have PD than individuals without dementia (adjusted hazard ratio = 1.915, 95% CI = 1.766 to 2.077, P < 0.0001, log-rank test P < 0.0001). The risk of PD in patients with dementia was age dependent (P values for all ages <0.0001); younger patients with dementia were more likely to develop PD. The findings persisted for patients with AD: the relative risk (1.531, 95% CI = 1.209 to 1.939) and adjusted hazard ratio (1.667, 95% CI = 1.244 to 2.232; log-rank test P = 0.0004) of PD in patients with AD were significantly higher than the non-AD cohort. Our findings demonstrated that dementia and AD were associated with a higher risk of PD dependent of age and independent of systemic confounding factors.

Keywords: Alzheimer’s disease; aged; inflammatory response; neurodegenerative diseases; periodontal diseases; periodontal pocket.

Figure.

Kaplan-Meier survival curves of cumulative probability for developing periodontitis (PD) in the dementia cohort and the Alzheimer’s disease (AD) cohort after propensity score matching (PSM). (A) PD risks in the dementia cohort. The survival curve suggests that patients with dementia have higher risks of developing PD after PSM. Subgroup analysis based on age stratification demonstrates PD risks in patients with dementia aged (B) <61 y, (C) 61 to 70 y, (D) 71 to 80 y, and (E) >80 y, which indicates that the risk of developing PD after dementia onset is age dependent. The younger these patients were, the more likely that they would develop PD after dementia onset. (F) PD risks in the AD cohort, in which patients with AD have higher risks of developing PD after PSM.