This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
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
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
Letters: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
You May Also be Interested in
Topics Discussed
Alert Me
Recommended articles
Dementia in late-onset epilepsy
Quantity and quality of mental activities and the risk of incident mild cognitive impairment
Recurrent depressive symptoms and the incidence of dementia and mild cognitive impairment
APOE ε2ε4 genotype, incident AD and MCI, cognitive decline, and AD pathology in older adults