Periodontitis Linked to Increased Dementia Risk

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Women aged 75 and older with a history of hypertension, stroke, and periodontitis were at a significantly greater risk of dementia.
Women aged 75 and older with a history of hypertension, stroke, and periodontitis were at a significantly greater risk of dementia.

Periodontitis is associated with a significant risk of dementia and should be considered a modifiable risk factor in preventive strategies, results from a large prospective study indicate.1

Research increasingly supports the role of inflammation, both central and peripheral, in the pathogenesis and exacerbation of Alzheimer's dementia (AD).2-4 In periodontal disease, the interaction of the infection with the immune response may contribute to AD pathogenesis in people who are at risk for dementia.5

In order to better understand how periodontitis may impact risk for dementia, Yao-Tung Lee, MD, of Shuang Ho Hospital New Taipei City, Taiwan, and colleagues compared the incidence of dementia in 3028 patients aged 65 and older (54% male) with periodontitis with 3028 age- and sex-matched controls.

Only patients who received concurrent antibiotic treatment, periodontal treatment besides scaling, or scaling more than 2 times per year performed by a dentist were included in the group. Diagnoses for periodontitis and dementia were based off ICD-9-CM codes. The researchers controlled for  several comorbidities, including hypertension; diabetes mellitus; cardiovascular disease; peripheral arterial disease; congestive heart failure;  atrial fibrillation; stroke (hemorrhagic stroke, transient ischemic accident, ischemic stroke); and chronic renal disease. Notably, hypertension was more prevalent than other comorbidities. Participants were followed until diagnosis of dementia, death, withdrawal from the National Health Insurance program, or December 31, 2012.

Following Cox proportional analysis, the researchers found that participants with periodontitis were 1.16 times more likely to develop dementia compared with controls (HR = 1.16, 95% confidence interval (CI), 1.02–1.32). Risk increased slightly after adjusting for comorbidities and sociodemographic factors (HR = 1.16, 95% CI, 1.01–1.32). Notably, women who were aged 75 years or older, and who had periodontitis, hypertension (HR = 1.22, 95% CI, 1.07-1.39), and a history of stroke (HR = 1.53, 95% CI, 1.20-1.94) were at a significantly greater risk of developing dementia.

“The current study findings provide new evidence that individuals with periodontitis have a higher risk of developing dementia than those without,” the authors concluded, emphasizing that the current study was meant to examine empirical data with more stringent diagnostic criteria compared to previous research on the association between periodontitis and dementia.

However, the researchers pointed out several limitations to their study that could have influenced the results. Among them were the ICD-9 code-based criteria used to establish diagnostic validity, lack of data on severity of periodontitis, and lack of data on remaining teeth in both cohorts.

Due to its treatability, periodontitis should be considered a modifiable risk factor for dementia, the researchers concluded. They added that further research on the role of the oral microbiome in the pathogenesis of cognitive decline will help to develop new treatment and preventive strategies.

The authors report no relevant disclosures.

References

  1. Lee YT, Lee HC, Hu CJ, et al. Periodontitis as a modifiable risk factor for dementia: A nationwide population-based cohort study. J Am Geriatr Soc. 2016 Sept 29; doi:10.1111/jgs.14449 [Epub ahead of print].
  2. McGeer PL, McGeer EG. Inflammation, autotoxicity and alzheimer disease. Neurobiol Aging. 2001;22:799–809.
  3. Barnes DE, Yaffe K. The projected effect of risk factor reduction on Alzheimer's disease prevalence. Lancet Neurol. 2011;10:819–828.
  4. Rogers J. The inflammatory response in Alzheimer's disease. J Periodontol. 2008;79:1535–1543.
  5. Craig RG, Yip JK, So MK et al. Relationship of destructive periodontal disease to the acute-phase response. J Periodontol. 2003;74:1007–1016.
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