Meta Analysis of the Correlation between Periodontal Health and Cognitive Impairment in the Older Population

Y.-D. Fu, C.-L. Li, C.-L. Hu, M.-D. Pei, W.-Y. Cai, Y.-Q. Li, Lang Xu, Yan Zeng
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Abstract

Objective

To explore the correlation between periodontal health and cognitive impairment in the older population to provide the evidence for preventing cognitive impairment from the perspective of oral health care in older adults.

Methods

A comprehensive search was conducted in PubMed, Embase, the Cochrane Library, the Web of Science, the China National Knowledge Infrastructure, Wanfang Data, the China Science and Technology Journal Database, and the China Biomedical Literature Database, to include both cross-sectional and longitudinal cohort studies on the association between periodontal health and cognitive impairment in older adults. The search was completed in April 2023. Following quality assessment and data organization of the included studies, meta-analysis was performed using Review Manager 5.4.

Results

Twenty-two studies involving a total of 4,246,608 patients were included to comprehensively assess periodontal health from four dimensions (periodontitis, tooth loss, occlusal support, and masticatory ability), with the outcome variable of cognitive impairment (including mild cognitive impairment, Alzheimer’s disease and all-cause dementia). Meta-analysis showed that, compared to those of periodontally healthy older adults, the risk of cognitive impairment in older adults with poor periodontal health, after adjusting for confounders, was significantly greater for those with periodontitis (OR=1.45, 95% CI: 1.20–1.76, P<0.001), tooth loss (OR=1.80, 95% CI: 1.50–2.15, P<0.001), compromised occlusal support (OR=1.87, 95% CI: 1.29–2.70, P=0.001), and reduced masticatory ability (OR=1.39, 95% CI: 1.11–1.75, P=0.005). The risk of cognitive impairment was higher in older adults with low-dentition than in those with high-dentition. Subgroup analysis revealed older individuals with fewer remaining teeth were at a higher risk of developing cognitive impairment compared to those with more remaining teeth, as shown by the comparison of number of teeth lost (7–17 teeth compared to 0–6 teeth) (OR=1.64, 95% CI: 1.13–2.39, P=0.01), (9–28 teeth compared to 0–8 teeth) (OR=1.13, 95% CI: 1.06–1.20, P<0.001), (19–28 teeth compared to 0–18 teeth) (OR=2.52, 95% CI: 1.32–4.80, P=0.005), and (28 teeth compared to 0–27 teeth) (OR=2.07, 95% CI: 1.54–2.77, P<0.001). In addition, tooth loss in older adults led to a significantly increased risk of mild cognitive impairment (OR=1.66, 95% CI: 1.43–1.91, P<0.001) and all-cause dementia (OR=1.35, 95% CI: 1.11–1.65, P=0.003), although the correlation between tooth loss and the risk of Alzheimer’s disease was not significant (OR=3.89, 95% CI: 0.68–22.31, P=0.13).

Conclusion

Poor periodontal health, assessed across four dimensions (periodontitis, tooth loss, occlusal support, and masticatory ability), represents a significant risk factor for cognitive impairment in older adults. The more missing teeth in older adults, the higher risk of developing cognitive impairment, with edentulous individuals particularly susceptible to cognitive impairment. While a certain degree of increased risk of Alzheimer’s disease was observed, no significant association was found between tooth loss and the risk of developing Alzheimer’s disease. Enhancing periodontal health management and delivering high-quality oral health care services to older adults can help prevent cognitive impairment.

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老年人牙周健康与认知障碍之间的相关性元分析
方法 在PubMed、Embase、Cochrane图书馆、Web of Science、中国国家知识基础设施、万方数据、中国科技期刊数据库和中国生物医学文献数据库中进行了全面检索,纳入了有关老年人牙周健康与认知障碍之间关系的横断面和纵向队列研究。检索工作于 2023 年 4 月完成。结果共纳入22项研究,涉及4246608名患者,从四个维度(牙周炎、牙齿脱落、咬合支持和咀嚼能力)全面评估牙周健康状况,结果变量为认知障碍(包括轻度认知障碍、阿尔茨海默病和全因痴呆)。元分析表明,与牙周健康的老年人相比,在调整了混杂因素后,牙周健康不良的老年人出现认知障碍的风险明显高于有牙周炎的老年人(OR=1.45,95% CI:1.20-1.76,P<0.001)、牙齿脱落(OR=1.80,95% CI:1.50-2.15,P<0.001)、咬合支持受损(OR=1.87,95% CI:1.29-2.70,P=0.001)和咀嚼能力下降(OR=1.39,95% CI:1.11-1.75,P=0.005)。低牙列老年人发生认知障碍的风险高于高牙列老年人。亚组分析显示,与剩余牙齿较多的老年人相比,剩余牙齿较少的老年人患认知障碍的风险更高,这一点可以从牙齿脱落数量(7-17 颗牙齿与 0-6 颗牙齿相比)的比较中看出(OR=1.64,95% CI:1.13-2.39,P=0.01)、(9-28颗牙齿与0-8颗牙齿相比)(OR=1.13,95% CI:1.06-1.20,P<0.001)、(19-28颗牙齿与0-18颗牙齿相比)(OR=2.52,95% CI:1.32-4.80,P=0.005)和(28颗牙齿与0-27颗牙齿相比)(OR=2.07,95% CI:1.54-2.77,P<0.001)。此外,老年人牙齿缺失导致轻度认知障碍(OR=1.66,95% CI:1.43-1.91,P<0.001)和全因痴呆(OR=1.35,95% CI:1.11-1.65,P=0.003)的风险显著增加,尽管牙齿缺失与阿尔茨海默病风险之间的相关性不显著(OR=3.结论从四个方面(牙周炎、牙齿缺失、咬合支持和咀嚼能力)评估牙周健康状况不佳是导致老年人认知障碍的重要风险因素。老年人缺牙越多,患认知障碍的风险就越高,无牙者尤其容易患认知障碍。虽然观察到阿尔茨海默病的风险有一定程度的增加,但并没有发现牙齿缺失与阿尔茨海默病的发病风险之间有明显的关联。加强牙周健康管理和为老年人提供高质量的口腔保健服务有助于预防认知障碍。
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来源期刊
The Journal of Prevention of Alzheimer's Disease
The Journal of Prevention of Alzheimer's Disease Medicine-Psychiatry and Mental Health
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期刊介绍: The JPAD Journal of Prevention of Alzheimer’Disease will publish reviews, original research articles and short reports to improve our knowledge in the field of Alzheimer prevention including: neurosciences, biomarkers, imaging, epidemiology, public health, physical cognitive exercise, nutrition, risk and protective factors, drug development, trials design, and heath economic outcomes.JPAD will publish also the meeting abstracts from Clinical Trial on Alzheimer Disease (CTAD) and will be distributed both in paper and online version worldwide.We hope that JPAD with your contribution will play a role in the development of Alzheimer prevention.
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