Skip to main content
Search
Search
    Quick Search anywhere
    Quick search in Citations
Advanced Search
Skip main navigationClose Drawer MenuOpen Drawer Menu
Previous article
Next article
Full-Length Research Report

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

A 5-year Observational Study

Published Online:July 29, 2021https://doi.org/10.1024/1662-9647/a000271

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.

References

  • Aida, J., Ando, Y., Akhter, R., Aoyama, H., Masui, M., & Morita, M. (2006). Reasons for permanent tooth extractions in Japan. Journal of Epidemiology, 16(5), 214–219. First citation in articleCrossref, Google Scholar

  • Arrivé, E., Letenneur, L., Matharan, F., Laporte, C., Helmer, C., Barberger-Gateau, P., & Dartigues, J. F. (2012). Oral health condition of French elderly and risk of dementia: A longitudinal cohort study. Community Dentistry and Oral Epidemiology, 40(3), 230–238. First citation in articleCrossref, Google Scholar

  • Batty, G. D., Li, Q., Huxley, R., Zoungas, S., Taylor, B. A., Neal, B., & ADVANCE Collaborative Group. (2013). Oral disease in relation to future risk of dementia and cognitive decline: Prospective cohort study based on the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation (ADVANCE) trial. European Psychiatry, 28(1), 49–52. First citation in articleCrossref, Google Scholar

  • Committee of the Japan Diabetes Society on the Diagnostic Criteria of Diabetes Mellitus, Seino, Y., Nanjo, K., Tajima, N., Kadowaki, T., Kashiwagi, A., Araki, E., Ito, C., Inagaki, N., Iwamoto, Y., Kasuga, M., Hanafusa, T., Haneda, M., & Ueki, K. (2010). Report of the committee on the classification and diagnostic criteria of diabetes mellitus. Journal of Diabetes Investigations, 1, 212–228. First citation in articleCrossref, Google Scholar

  • Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189–198. First citation in articleCrossref, Google Scholar

  • Gil-Montoya, J. A., Sanchez-Lara, I., Carnero-Pardo, C., Fornieles, F., Montes, J., Vilchez, R., & Bravo, M. (2015). Is periodontitis a risk factor for cognitive impairment and dementia? A case-control study. Journal of Periodontology, 86(2), 244–253. First citation in articleCrossref, Google Scholar

  • Hansson, P., Eriksson Sörman, D., Bergdahl, J., Bergdahl, M., Nyberg, L., Adolfsson, R., & Nilsson, L. G. (2014). Dental status is unrelated to risk of dementia: A 20-year prospective study. Journal of the American Geriatrics Society, 62(5), 979–981. First citation in articleCrossref, Google Scholar

  • Harrison, F. E. (2012). A critical review of vitamin C for the prevention of age-related cognitive decline and Alzheimer’s disease. Journal of Alzheimer’s Disease, 29(4), 711–726. First citation in articleCrossref, Google Scholar

  • Holmes, C., Cunningham, C., Zotova, E., Woolford, J., Dean, C., Kerr, S. U., & Perry, V. H. (2009). Systemic inflammation and disease progression in Alzheimer disease. Neurology, 73(10), 768–774. First citation in articleCrossref, Google Scholar

  • Japanese Ministry of Health, Labour and Welfare. (2018, August 7). The survey of dental disease in 2011. http://www.mhlw.go.jp/toukei/list/dl/62-23-02.pdf First citation in articleGoogle Scholar

  • Kato, T., Usami, T., Noda, Y., Hasegawa, M., Ueda, M., & Nabeshima, T. (1997). The effect of the loss of molar teeth on spatial memory and acetylcholine release from the parietal cortex in aged rats. Behavioural Brain Research, 83(1–2), 239–242. First citation in articleCrossref, Google Scholar

  • Kaye, E. K., Valencia, A., Baba, N., Spiro, A. III, Dietrich, T., & Garcia, R. I. (2010). Tooth loss and periodontal disease predict poor cognitive function in older men. Journal of the American Geriatrics Society, 58(4), 713–718. First citation in articleCrossref, Google Scholar

  • Kushida, S., Kimoto, K., Hori, N., Toyoda, M., Karasawa, N., Yamamoto, T., & Onozuka, M. (2008). Soft-diet feeding decreases dopamine release and impairs aversion learning in Alzheimer model rats. Neuroscience Letters, 439(2), 208–211. First citation in articleCrossref, Google Scholar

  • Larrieu, S., Letenneur, L., Helmer, C., Dartigues, J. F., & Barberger-Gateau, P. (2004). Nutritional factors and risk of incident dementia in the PAQUID longitudinal cohort. Journal of Nutrition, Health & Aging, 8, 150–154. First citation in articleGoogle Scholar

  • Martande, S. S., Pradeep, A. R., Singh, S. P., Kumari, M., Suke, D. K., Raju, A. P., Naik, S. B., Singh, P., Guruprasad, C. N., & Chatterji, A. (2014). Periodontal health condition in patients with Alzheimer’s disease. American Journal of Alzheimer’s Disease and Other Dementias, 29(6), 498–502. https://doi.org/10.1177/1533317514549650. PMID: 25214647 First citation in articleCrossref, Google Scholar

  • Miller, J. W., Harvey, D. J., Beckett, L. A., Green, R., Farias, S. T., Reed, B. R., Olichney, J. M., Mungas, D. M., & DeCarli, C. (2015). Vitamin D status and rates of cognitive decline in a multiethnic cohort of older adults. JAMA Neurology, 72(11), 1295–1303. First citation in articleCrossref, Google Scholar

  • Momose, T., Nishikawa, J., Watanabe, T., Sasaki, Y., Senda, M., Kubota, K., & Minakuchi, S. (1997). Effect of mastication on regional cerebral blood flow in humans examined by positron-emission tomography with 15O-labelled water and magnetic resonance imaging. Archives of Oral Biology, 42(1), 57–61. First citation in articleCrossref, Google Scholar

  • Mori, E., Mitani, Y., & Yamadori, A. (1985). Usefulness of a Japanese version of the Mini-mental State Test in neurological patients (in Japanese). Shinnkei Shinrigaku, 1, 2–10. First citation in articleGoogle Scholar

  • Naorungroj, S., Schoenbach, V. J., Wruck, L., Mosley, T. H., Gottesman, R. F., Alonso, A., & Slade, G. D. (2015). Tooth loss, periodontal disease, and cognitive decline in the Atherosclerosis Risk in Communities (ARIC) study. Community Dentistry and Oral Epidemiology, 43(1), 47–57. First citation in articleCrossref, Google Scholar

  • Naorungroj, S., Slade, G. D., Beck, J. D., Mosley, T. H., Gottesman, R. F., Alonso, A., & Heiss, G. (2013). Cognitive decline and oral health in middle-aged adults in the ARIC study. Journal of Dental Research, 92(9), 795–801. First citation in articleCrossref, Google Scholar

  • Nowjack-Raymer, R. E., & Sheiham, A. (2007). Numbers of natural teeth, diet, and nutritional status in US adults. Journal of Dental Research, 86(12), 1171–1175. First citation in articleCrossref, Google Scholar

  • Okamoto, N., Morikawa, M., Tomioka, K., Yanagi, M., Amano, N., & Kurumatani, N. (2015). Association between tooth loss and the development of mild memory impairment in the elderly: The Fujiwara-kyo Study. Journal of Alzheimer’s Disease, 44(3), 777–786. First citation in articleCrossref, Google Scholar

  • Onozuka, M., Fujita, M., Watanabe, K., Hirano, Y., Niwa, M., Nishiyama, K., & Saito, S. (2002). Mapping brain region activity during chewing: A functional magnetic resonance imaging study. Journal of Dental Research, 81(11), 743–746. First citation in articleCrossref, Google Scholar

  • Paganini-Hill, A., White, S. C., & Atchison, K. A. (2012). Dentition, dental health habits, and dementia: The leisure world cohort study. Journal of the American Geriatrics Society, 60(8), 1556–1563. First citation in articleCrossref, Google Scholar

  • Patil, S., Patel, S., Shivakumar, K. M., & Hathiwala, S. (2018). Relationship of tooth loss, impaired chewing ability, and cognitive impairment among the elderly of Western Maharashtra, India. Journal of International Oral Health, 10(4), 172–175. First citation in articleCrossref, Google Scholar

  • Popat, R. P., Bhavsar, N. V., & Popat, P. R. (2016). Association between periodontitis and Alzheimer’s disease: Does the link exist? Indian Journal of Oral Sciences, 7(2), 74–78. First citation in articleCrossref, Google Scholar

  • Ranjan, R., Rout, M., Mishra, M., & Kore, S. A. (2019). Tooth loss and dementia: An oro-neural connection. A cross-sectional study. Journal of Indian Society of Periodontology, 23(2), 158–162. First citation in articleCrossref, Google Scholar

  • Reyes-Ortiz, C. A., Luque, J. S., Eriksson, C. K., & Soto, L. (2013). Self-reported tooth loss and cognitive function: Data from the Hispanic established populations for epidemiologic studies of the elderly (Hispanic EPESE). Colombia Medica, 44(3), 139–145. First citation in articleCrossref, Google Scholar

  • Shimazaki, Y., Soh, I., Saito, T., Yamashita, Y., Koga, T., Miyazaki, H., & Takehara, T. (2001). Influence of dentition status on physical disability, mental impairment, and mortality in institutionalized elderly people. Journal of Dental Research, 80(1), 340–345. First citation in articleCrossref, Google Scholar

  • Shin, H. S., Shin, M. S., Ahn, Y. B., Choi, B. Y., Nam, J. H., & Kim, H. D. (2016). Periodontitis is associated with cognitive impairment in elderly Koreans: Results from the Yangpyeong Cohort Study. Journal of the American Geriatrics Society, 64(1), 162–167. First citation in articleCrossref, Google Scholar

  • Stein, P. S., Desrosiers, M., Donegan, S. J., Yepes, J. F., & Kryscio, R. J. (2007). Tooth loss, dementia and neuropathology in the Nun Study. The Journal of the American Dental Association, 138(10), 1314–1322. First citation in articleCrossref, Google Scholar

  • Stein, P. S., Kryscio, R. J., Desrosiers, M., Donegan, S. J., & Gibbs, M. B. (2010). Tooth loss, apolipoprotein E, and decline in delayed word recall. Journal of Dental Research, 89(5), 473–477. First citation in articleCrossref, Google Scholar

  • Stein, P. S., Steffen, M. J., Smith, C., Jicha, G., Ebersole, J. L., Abner, E., & Dawson, D. III (2012). Serum antibodies to periodontal pathogens are a risk factor for Alzheimer’s disease. Alzheimer’s & Dementia, 8(3), 196–203. First citation in articleCrossref, Google Scholar

  • Stewart, R., Stenman, U., Hakeberg, M., Hägglin, C., Gustafson, D., & Skoog, I. (2015). Associations between oral health and risk of dementia in a 37-year follow-up study: The prospective population study of women in Gothenburg. Journal of the American Geriatrics Society, 63(1), 100–105. First citation in articleCrossref, Google Scholar

  • Takeuchi, K., Ohara, T., Furuta, M., Takeshita, T., Shibata, Y., Hata, J., & Ninomiya, T. (2017). Tooth loss and risk of dementia in the community: The Hisayama Study. Journal of the American Geriatrics Society, 65(5), e95–e100. First citation in articleCrossref, Google Scholar

  • Tonsekar, P. P., Jiang, S. S., & Yue, G. (2017). Periodontal disease, tooth loss and dementia: Is there a link? A systematic review. Gerodontology, 34(2), 151–163. First citation in articleCrossref, Google Scholar

  • Trovik, T. A., Klock, K. S., & Haugejorden, O. (2000). Trends in reasons for tooth extractions in Norway from 1968 to 1998. Acta Odontologica Scandinavica, 58(2), 89–96. First citation in articleCrossref, Google Scholar

  • Tsuji, I., Imai, Y., Nagai, K., Ohkubo, T., Watanabe, N., Minami, N., & Abe, K. (1997). Proposal of reference values for home blood pressure measurement: Prognostic criteria based on a prospective observation of the general population in Ohasama, Japan. American Journal of Hypertension, 10(4), 409–418. First citation in articleGoogle Scholar

  • Watts, A., Crimmins, E. M., & Gatz, M. (2008). Inflammation as a potential mediator for the association between periodontal disease and Alzheimer’s disease. Neuropsychiatric Disease and Treatment, 4(5), 865–876. First citation in articleCrossref, Google Scholar

  • World Health Organization. (2018, August 7). Dementia fact sheet 2017. http://www.who.int/mediacentre/factsheets/fs362/en First citation in articleGoogle Scholar

  • Yamamoto, T., Kondo, K., Hirai, H., Nakade, M., Aida, J., & Hirata, Y. (2012). Association between self-reported dental health status and onset of dementia: A 4-year prospective cohort study of older Japanese adults from the Aichi Gerontological Evaluation Study (AGES) Project. Psychosomatic Medicine, 74(3), 241–248. First citation in articleCrossref, Google Scholar

  • Yoshihara, A., Watanabe, R., Nishimuta, M., Hanada, N., & Miyazaki, H. (2005). The relationship between dietary intake and the number of teeth in elderly Japanese subjects. Gerodontology, 22(4), 211–218. First citation in articleCrossref, Google Scholar

  • Zhu, J., Li, X., Zhu, F., Chen, L., Zhang, C., McGrath, C., & Jin, L. (2015). Multiple tooth loss is associated with vascular cognitive impairment in subjects with acute ischemic stroke. Journal of Periodontal Research, 50(5), 683–688. First citation in articleCrossref, Google Scholar

  • Zung, W. W. K. (1967). Depression in the normal aged. Psychosomatics, 8, 287–292. First citation in articleCrossref, Google Scholar