Effects of the Co-occurrence of Diabetes Mellitus and Tooth Loss on Cognitive Function

Abstract

Objective: Both diabetes mellitus (DM) and poor oral health are common chronic conditions and risk factors of Alzheimer’s disease and related dementia among older adults. This study assessed the effects of DM and complete tooth loss (TL) on cognitive function, accounting for their interactions. Methods: Longitudinal data were obtained from the 2006, 2012, and 2018 waves of the Health and Retirement Study. This cohort study included 7,805 respondents aged 65 years or older with 18,331 person-year observations. DM and complete TL were self-reported. Cognitive function was measured by the Telephone Interview for Cognitive Status. Random-effect regressions were used to test the associations, overall and stratified by sex. Results: Compared with older adults without neither DM nor complete TL, those with both conditions (b = -1.35, 95% confidence interval [CI]: -1.68, -1.02), with complete TL alone (b = -0.67, 95% CI: -0.88, -0.45), or with DM alone (b = -0.40, 95% CI: -0.59, -0.22), had lower cognitive scores. The impact of having both conditions was significantly greater than that of having DM alone (p < .001) or complete TL alone (p = 0.001). Sex-stratified analyses showed the effects were similar in males and females, except having DM alone was not significant in males. Conclusion: The co-occurrence of DM and complete TL poses an additive risk for cognition. Healthcare and family-care providers should pay attention to the cognitive health of patients with both DM and complete TL. Continued efforts are needed to improve older adults’ access to dental care, especially for individuals with DM.

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).…”