The Effect of Periodontitis on Dementia and Cognitive Impairment: A Meta-Analysis

Guo, Haiying; Chang, Shuli; Pi, Xiaoqin; Hua, Fang; Jiang, Han; Liu, Chang; Du, Minquan

doi:10.3390/ijerph18136823

Cited by 43 publications

(27 citation statements)

References 75 publications

(186 reference statements)

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“…Accordingly, the results of this study are in line with the most recent comparative subgroup analysis of twenty observational studies, carried out by Guo et al [ 7 ], who found a strong relationship between periodontitis and cognitive decline (OR = 1.77, 95% CI: 1.31–2.38). The analysis of subgroups (severity of PDS) showed that moderate/severe periodontitis was associated with dementia (OR = 2.13).…”

Section: Discussionsupporting

confidence: 92%

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Is Periodontitis Associated with Age-Related Cognitive Impairment? The Systematic Review, Confounders Assessment and Meta-Analysis of Clinical Studies

Dziedzic

2022

IJMS

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It has been suggested that molecular pathological mechanisms responsible for periodontitis can be linked with biochemical alterations in neurodegenerative disorders. Hypothetically, chronic systemic inflammation as a response to periodontitis plays a role in the etiology of cognitive impairment. This study aimed to determine whether periodontitis (PDS) is a risk factor for age-related cognitive impairment (ACI) based on evidence of clinical studies. A comprehensive, structured systematic review of existing data adhering to the Preferred Reporting Items for Systematic Review and Meta Analyses (PRISMA) guidelines was carried out. Five electronic databases, PubMed, Embase, Scopus, Web of Science, and Cochrane, were searched for key terms published in peer-reviewed journals until January 2021. The Newcastle–Ottawa scale was used to assess the quality of studies and risk of bias. The primary and residual confounders were explored and evaluated. A meta-analysis synthesizing quantitative data was carried out using a random-effects model. Seventeen clinical studies were identified, including 14 cohort, one cross-sectional, and two case-control studies. Study samples ranged from 85 to 262,349 subjects, with follow-up between 2 and 32 years, and age above 45 years, except for two studies. The findings of studies suggesting the PDS-ACI relationship revealed substantial differences in design and methods. A noticeable variation related to the treatment of confounders was observed. Quality assessment unveiled a moderate quality of evidence and risk of bias. The subgroups meta-analysis and pooled sensitivity analysis of results from seven eligible studies demonstrated overall that the presence of PDS is associated with an increased risk of incidence of cognitive impairment (OR = 1.36, 95% CI 1.03–1.79), particularly dementia (OR = 1.39, 95% CI 1.02–1.88) and Alzheimer’s disease (OR = 1.03 95% CI 0.98–1.07)). However, a considerable heterogeneity of synthesized data (I2 = 96%) and potential publication bias might affect obtained results. While there is a moderate statistical association between periodontitis and dementia, as well as Alzheimer’s disease, the risk of bias in the evidence prevents conclusions being drawn about the role of periodontitis as a risk factor for age-related cognitive impairment.

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Section: Discussionsupporting

confidence: 92%

“…There is therefore a need for critical data analysis of the presence and magnitude of association between these two conditions. The hypothetical relationship between the status of periodontium and cognitive state has been thoroughly investigated over the last two decades using systematic reviews [ 7 , 8 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Is Periodontitis Associated with Age-Related Cognitive Impairment? The Systematic Review, Confounders Assessment and Meta-Analysis of Clinical Studies

Dziedzic

2022

IJMS

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“…Their findings also revealed that periodontal disease was associated with dementia events (34). Additionally, a recent meta-analysis by Guo et al disclosed that there is a correlation between periodontitis and cognitive impairment, and moderate or severe periodontitis is a risk factor for dementia, consistent with our findings (93). The exact molecular mechanism of the involvement of periodontitis in the pathogenicity of dementia remains ambiguous, and the possible explanations are detailed as follows.…”

Section: Comparison With Other Studies and Possible Explanationssupporting

confidence: 91%

Association between microbiological risk factors and neurodegenerative disorders: An umbrella review of systematic reviews and meta-analyses

Wang¹,

Jiang

et al. 2022

Front. Psychiatry

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The role of microbiological factors in the development of neurodegenerative diseases is attracting increasing attention, while the relationship remains debated. This study aimed to comprehensively summarize and evaluate the associations between microbiological factors and the risk of neurodegenerative disorders with an umbrella review. PubMed, Embase, and the Cochrane library were used to search for papers from the earliest to March 2021 for identifying meta-analyses and systematic reviews that examined associations between microbiological factors and neurodegenerative diseases. AMSTAR2 tool was employed to evaluate the methodical quality of systematic reviews and meta-analyses. The effect size and 95% confidence interval (95% CI) were recalculated with a random effect model after the overlap was recognized by the corrected covered area (CCA) method. The heterogeneity of each meta-analysis was measured by the I2 statistic and 95% prediction interval (95% PI). Additionally, publication bias and the quality of evidence were evaluated for all 37 unique associations. Only 4 associations had above the medium level of evidence, and the rest associations presented a low level of evidence. Among them, helicobacter pylori (HP), infection, and bacteria are associated with Parkinson's disease (PD), and the other one verifies that periodontal disease is a risk factor for all types of dementia. Following the evidence of our study, eradication of HP and aggressive treatment of periodontitis are beneficial for the prevention of PD and dementia, respectively. This umbrella review provides comprehensive quality-grade evidence on the relationship between microbial factors and neurodegenerative disease. Regardless of much evidence linking microbial factors to neurodegenerative diseases, these associations are not necessarily causal, and the evidence level is generally low. Thus, more effective studies are required.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/#searchadvanced, PROSPERO, identifier: CRD42021239512.

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“…Previous studies have suggested that chronic inflammatory stimulation is involved in the pathophysiological mechanism of cognitive frailty [ 27 ]. In addition, the most important reason for tooth loss in older individuals is the long-term cumulative effects of periodontitis [ 28 ]. Oral pathogens and their toxic molecules, after disseminating into the bloodstream, may induce a low-grade systemic inflammation through upregulating the release of cytokines and inflammatory mediators, which can trigger neuroinflammation and cause neuronal degeneration.…”

Section: Discussionmentioning

confidence: 99%

Unhealthy oral status contributes to the older patients with cognitive frailty: an analysis based on a 5-year database

Jiang

Liu

2022

BMC Geriatr

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Background Oral health is associated with the onset and deterioration of cognitive function and physical frailty, which can be improved with appropriate interventions. However, far too little attention has been paid to oral health status of elderly with cognitive frailty. The objective of this study was to investigate the oral health status and potential risk factors of elderly hospitalized patients aged 60 years or older with cognitive frailty. Methods The participants’ assessment data derived from the Comprehensive Geriatric Assessment Database of hospitalized patients from The First Affiliated Hospital of Chongqing Medical University. Data were collected from April 2016 to December 2021. All participants underwent a face-to-face assessment conducted by professional evaluators. Physical frailty was defined by Fried’s criteria. Cognitive function was assessed by Mini Mental State Examination (MMSE). The cognitive frailty is characterized by the simultaneous presence of at least 1 Fried’s criteria and mild cognitive impairment according to Diagnostic and Statistical Manual of Mental Disorders 5th edition. The oral health was assessed according to 10-item Brief Oral Health Status Examination (BOHSE). The general demographic characteristics, BOHSE scores were compared between the cognitive frailty and non-cognitive frailty (control group). The score of BOHSE and ten items were included in the binary logistic regression analysis. The covariate characteristics were adjusted for a final model with a multivariate analysis. Results A total of 425 patients (245 females) with cognitive frailty and 491 patients (283 females) with non-cognitive frailty were enrolled in this retrospective study. Univariate analysis showed statistically significant differences in age, education level, living arrangement, diabetes, Body Mass Index (BMI), Pittsburgh Sleep Quality Index (PSQI), depression between the two groups. The total BOHSE score of cognitive frailty was higher than that of the control group (4.35 ± 2.68 vs. 3.64 ± 2.60, Z = 4.07, P < 0.001). The average scores and the proportions of health changes and unhealthy states of tongue, mucosa tissue, gums, natural teeth, dentures, masticatory teeth and oral hygiene in cognitive frailty were greater than those of the control group (all P < 0.05). The binary logistical regression analysis showed that four or more natural teeth decayed or broken was independently associated with cognitive frailty after adjusting the age, gender, education level, living arrangement and BMI, PSQI, diabetes and depression (OR = 1.91, 95%CI: 1.20–3.07, P = 0.007). Additionally, while in the chewing position, those cases with a normal-occlusal-relationship number of less than 11 pairs had a higher risk of cognitive frailty than those with 12 pairs or more. Conclusions The oral health status of older hospitalized patients over 60 years with cognitive frailty was worse than that of patients with non-cognitive frailty. But only four or more natural teeth decayed or broken and a reduction in chewing pairs were independent risk factors for cognitive frailty.

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The Effect of Periodontitis on Dementia and Cognitive Impairment: A Meta-Analysis

Cited by 43 publications

References 75 publications

Is Periodontitis Associated with Age-Related Cognitive Impairment? The Systematic Review, Confounders Assessment and Meta-Analysis of Clinical Studies

Is Periodontitis Associated with Age-Related Cognitive Impairment? The Systematic Review, Confounders Assessment and Meta-Analysis of Clinical Studies

Association between microbiological risk factors and neurodegenerative disorders: An umbrella review of systematic reviews and meta-analyses

Unhealthy oral status contributes to the older patients with cognitive frailty: an analysis based on a 5-year database

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