Determinants of post-stroke cognitive impairment in patients with periodontal disease

Abstract

Introduction: Periodontal disease (PD) is a risk factor for stroke and cardiovascular disease. The effect of PD on post-stroke cognitive impairment (PSCI) remains underexplored.

Methods: A cross-sectional analysis of the Periodontal tReatment to Eliminate Minority InEquality and Rural disparities in Stroke (PREMIERS) study participants was conducted. Baseline cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) within 90 days of the index event. MoCA score ≤21 indicated severe PSCI. White matter hyperintensity, indicating cerebral small vessel disease (cSVD), was evaluated using the Fazekas scale on MRI. Due to non-normal MoCA distribution, two analytical approaches were employed: 1) logistic regression using dichotomized MoCA scores based on clinically relevant cutoffs and 2) generalized linear mixed modeling after bootstrap normalization that examined MoCA scores continuously.

Results: Among 280 participants with PD, 48% exhibited severe PSCI. Both analytical approaches demonstrated that severe PD, African American (AA) race, and greater stroke severity significantly and independently predicted severe PSCI, while advanced education was protective. Fazekas' scale showed no significant associations with PSCI.

Conclusions: This study identifies PD severity as a novel and independent contributor to early PSCI. Traditional predictors like AA race, educational attainment, and stroke severity remained significant.

Clinical trial registration information: https://www.

Clinicaltrials: gov; Unique identifier: NCT02541032.

Keywords: Cognition; Periodontal disease; Race; Stroke.

Fig. 1.

Summary of the enrollment of the PREMIERS trial population studied for baseline cognitive status, Fazekas Scale for white matter hyperintensity, and other clinical characteristics. Within 90 days of ischemic stroke/TIA, patients were assessed for eligibility, then screened by dental examiners before their baseline visit. At this visit, cognitive function was assessed using the MoCA.