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Abstract
Objective To test the hypothesis that periodontal disease would be associated with increased risk for dementia and mild cognitive impairment (MCI) by assessing dementia/MCI outcomes after a baseline periodontal examination.
Methods Participants enrolled in the Atherosclerosis Risk in Communities study with a clinical periodontal examination (or edentulous participants) at visit 4 (1996–1998; mean ± SD age 63 ± 6 years, 55% female, 21% black) and adjudicated dementia outcomes through 2016 were included (n = 8,275). A subgroup of 4,559 participants had adjudicated dementia and MCI assessments at visit 5 (2011–2013). Participants received a full-mouth periodontal examination and were classified into periodontal profile classes (PPCs) based on the severity and extent of gingival inflammation and attachment loss. MCI and dementia were determined via neurocognitive testing, neurological examination and history, informant interviews, and brain MRI in a subset. Cox proportional hazards models regressed incident dementia on PPCs. Relative risk regression models were used for the composite of MCI/dementia.
Results The cumulative incidence and incidence density of dementia during follow-up (average 18.4 years) were 19% (n = 1,569) and 11.8 cases per 1,000 person-years. Multivariable adjusted hazard ratios for incident dementia among participants with severe PPC or edentulism (vs periodontal healthy) were 1.22 (95% confidence interval [CI] 1.01–1.47) and 1.21 (95% CI 0.99–1.48), respectively. For the combined dementia/MCI outcome, adjusted risk ratios among participants with mild/intermediate PPC, severe PPC, or edentulism (vs periodontal healthy) were 1.22 (95% CI 1.00–1.48), 1.15 (95% CI 0.88–1.51), and 1.90 (95% CI 1.40–2.58). Results were stronger among younger (≤62 years) participants (p for interaction = 0.02).
Conclusion Periodontal disease was modestly associated with incident MCI and dementia in a community-based cohort of black and white participants.
Glossary
- ARIC=
- Atherosclerosis Risk in Communities;
- BMI=
- body mass index;
- CDC-AAP=
- Centers for Disease Control and Prevention/American Academy of Periodontology;
- CI=
- confidence interval;
- DSM-V=
- Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition;
- HDL=
- high-density lipoprotein;
- HF=
- heart failure;
- HR=
- hazard ratio;
- ICD-9-CM=
- International Classification of Diseases, 9th revision, clinical modification;
- LDL=
- low-density lipoprotein;
- MCI=
- mild cognitive impairment;
- PISA=
- periodontal inflamed surface area;
- PPC=
- periodontal profile class
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- Received August 23, 2019.
- Accepted in final form April 6, 2020.
- © 2020 American Academy of Neurology
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