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Periodontitis, periodontal inflammation, and mild cognitive impairment: A 5-year cohort study
Masanori Iwasaki1,2, Yumi Kimura3, Hiroshi Ogawa1
1Division of Preventive Dentistry, Department of Oral Health Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Background And Objectives:
Identification of modifiable factors for mild cognitive impairment (MCI) is important since individuals with MCI are at a high risk of dementia and disability. Previous studies have suggested a potential association between periodontitis and cognitive impairment, but the results remain inconclusive. We designed a 5-year longitudinal study to explore the association between MCI and periodontitis and periodontal inflammation in older adults.
Methods:
This study included 179 community-dwelling dentate individuals (62 men and 117 women, average age: 80.1 years). A full-mouth periodontal examination at six sites per tooth was performed at baseline. Case definitions provided by the European Workshop in Periodontology Group C (EWP definition) and the Centers for Disease Control/American Academy of Periodontology (CDC/AAP definition) were used to define severe periodontitis. Additionally, the periodontal inflamed surface area (PISA), reflecting the amount of inflamed periodontal tissue, was calculated using clinical periodontal parameters. Follow-up cognitive examinations for MCI diagnosis were performed by neurologists 1, 2, 3, and 5 years after baseline. Odds ratios (ORs) for MCI according to the presence of periodontitis and periodontal inflammation at baseline were calculated using multilevel mixed-effects logistic regression.
Results:
At baseline, 56.4% and 27.4% of the participants had severe periodontitis by the EWP and CDC/AAP definitions, respectively. After adjusting for follow-up period and other baseline health characteristics (age, sex, smoking status, educational level, physical activity level, obesity, depression, and diabetes), severe periodontitis by either definition was significantly associated with MCI (for the EWP definition: adjusted OR = 3.58, 95% confidence interval [CI] = 1.45-8.87; for the CDC/AAP definition: adjusted OR = 2.61, 95% CI = 1.08-6.28). Periodontal inflammation assessed by PISA was also significantly associated with a higher OR for MCI (adjusted OR = 1.05, 95% CI = 1.01-1.10, per 10-mm2 increase in PISA).
Conclusion:
Severe periodontitis and periodontal inflammation were associated with incident MCI among older community-dwelling men and women.
Insights
Severe periodontitis and periodontal inflammation are linked to a higher risk of developing mild cognitive impairment (MCI) in older adults. This 5-year study highlights potential modifiable factors for cognitive decline.
Area of Science:
- Gerontology
- Neurology
- Periodontology
Background:
- Mild cognitive impairment (MCI) poses a significant risk for dementia and disability in older adults.
- Previous research on the association between periodontitis and cognitive impairment has yielded inconclusive results.
- Identifying modifiable risk factors for MCI is crucial for public health interventions.
Purpose of the Study:
- To investigate the longitudinal association between severe periodontitis and incident mild cognitive impairment (MCI) in older adults.
- To explore the relationship between periodontal inflammation, quantified by the periodontal inflamed surface area (PISA), and MCI development.
- To determine if periodontitis is a modifiable risk factor for cognitive decline in the elderly.
Main Methods:
- A 5-year longitudinal study involving 179 community-dwelling older adults (mean age 80.1 years).
- Severe periodontitis was diagnosed using European Workshop in Periodontology (EWP) and CDC/American Academy of Periodontology (CDC/AAP) criteria.
- Periodontal inflammation was assessed using the periodontal inflamed surface area (PISA). Cognitive function was evaluated by neurologists annually for 5 years.
- Multilevel mixed-effects logistic regression was used to calculate adjusted odds ratios (ORs) for MCI.
Main Results:
- At baseline, 56.4% (EWP) and 27.4% (CDC/AAP) of participants had severe periodontitis.
- Severe periodontitis was significantly associated with an increased risk of MCI (adjusted ORs 3.58 and 2.61, respectively).
- Increased periodontal inflammation (PISA) was also significantly associated with a higher risk of MCI (adjusted OR 1.05 per 10-mm² increase).
Conclusions:
- Severe periodontitis, defined by established criteria, is a significant risk factor for incident MCI in older adults.
- The extent of periodontal inflammation, as measured by PISA, is independently associated with an elevated risk of developing MCI.
- These findings suggest that managing severe periodontitis and reducing periodontal inflammation may be important strategies for preserving cognitive health in aging populations.
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