Association Between Cognitive Decline and Oral Health Status in the Aging Population

Abstract

Abstract. Background: To date, no longitudinal prospective study has investigated the association between oral health status and cognitive decline in the geriatric Indian population, possibly because past studies differed in their target groups and methodologies. We investigated the association between tooth loss, as evaluated through clinical oral examinations, and the development of cognitive decline in older adults while considering baseline cognitive function. Objectives: This study served to find an association between oral health status and the subsequent development of cognitive decline in older adults of Maharashtra state while considering baseline cognitive function. Material and Methods: This 5-year prospective cohort study followed 140 participants without cognitive impairment aged ≥ 65 years (mean age: 70.9 ± 4.3 years) living in the Dhule region of Maharashtra, India. Cognitive function was evaluated with the Mini-Mental State Examination (MMSE) in baseline and follow-up surveys, while oral health examination was carried out using Oral Hygiene Index. To investigate the association between oral health status and cognitive decline, we applied a multiple logistic regression analysis adjusted for age, sex, hypertension, diabetes, cerebrovascular/cardiovascular disease, hypercholesterolemia, depressive symptoms, body mass index, smoking status, drinking status, duration of education, and baseline MMSE score. Results: In the 5 years after the baseline survey, we obtained an overall incidence of 20.71% in the population that developed cognitive decline (i.e., MMSE scores of ≤ 24). A multivariable logistic regression analysis indicated that participants with compromised oral health were more likely to develop cognitive decline than those with mild to moderate oral health were (odds ratio: 3.31; 95% confidence interval: 1.07–10.2). Age, male sex, and baseline MMSE scores were also significantly associated with cognitive decline. Conclusion: Among the geriatric population of India, poor oral health status was independently associated with the development of cognitive decline within 5 years. This finding corroborates the hypothesis that oral health may be a predictor or risk factor for cognitive decline.

Periodontal health, cognitive decline, and dementia: A systematic review and meta‐analysis of longitudinal studies

“…Forty seven studies were included in this review: 24 for cognitive decline 8 , 9 , 15 , 16 , 17 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 and 23 for dementia 10 , 11 , 12 , 13 , 14 , 47 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 (Figure 1 ). Characteristics of included studies are summarized in Table S1 .…”

“…Quality assessment of included studies is summarized in Table S2 and Supplementary Text S2 . For cognitive decline, the overall risk of bias was high; 1 study received “moderate” 56 and 23 “low” 8 , 9 , 15 , 16 , 17 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 57 , 58 , 59 , 60 for overall quality. For dementia, overall risk of bias was moderate; 2 studies receiving “good,” 67 , 70 9 “moderate” 10 , 13 , 14 , 64 , 68 , 71 , 72 , 74 , 77 and 12 “low” 11 , 12 , 47 , 61 , 62 , 63 , 65 , 66 , 69 , 73 , 75 , 76 for overall quality.…”

“… 5 , 6 , 7 Among the many risk factors for dementia and cognitive decline, oral health measures (e.g., periodontitis, tooth loss) have only started to be recently explored. 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 …”

“…19 The available evidence on periodontal health and cognitive deterioration is insufficient and subject to limitations. 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 Most individual studies lack comprehensive exposure and outcome assessments and have a shorter duration. Also, in the past two years, several studies have been published 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 which warrant synthesis and evaluation.…”

“… 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 Most individual studies lack comprehensive exposure and outcome assessments and have a shorter duration. Also, in the past two years, several studies have been published 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 which warrant synthesis and evaluation. Previous literature reviews restricted their analysis by either exposure, outcome, or both, that is, they explored either periodontitis or tooth loss in relation to either cognitive impairment or dementia (but not all simultaneously).…”