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Population-Based Structural Evidence: Triadic Effects of Periodontitis, Depression, and Biological Aging on Cognitive
Dawei Zhang1, Shijie Zhu2,3, Zhaobiao Zong4
1Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong, China.
Gerontology
|February 24, 2026
Summary
Periodontitis and depression significantly impact cognition, with biological aging acting as a partial mediator. Addressing these factors may help reduce cognitive decline in aging populations.
Area of Science:
- Gerontology
- Neuroscience
- Public Health
Background:
- Cognitive impairment is a major public health concern in aging societies.
- Periodontitis and depression are prevalent conditions associated with aging.
- Understanding the interplay of these factors is crucial for public health strategies.
Purpose of the Study:
- To investigate the triadic effects of periodontitis, depression, and biological aging on cognitive function.
- To examine the mediating role of biological aging in the relationship between periodontitis/depression and cognition.
Main Methods:
- Utilized Structural Equation Modeling (SEM) and Relative Weight Analysis (RWA).
- Analyzed data from the National Health and Nutrition Examination Survey (NHANES) (N=1,816).
- Assessed cognitive function, periodontitis, depression, and biological age (PhenoAge) with covariate adjustment.
Main Results:
- Periodontitis severity, depressive symptoms, and advanced PhenoAge were directly associated with lower cognitive performance.
- Biological aging partially mediated the effects of depression and periodontitis on cognitive outcomes.
- Periodontitis, depression, and PhenoAge significantly contributed to cognitive variance.
Conclusions:
- Confirmed triadic interdependencies between periodontitis, depression, biological aging, and cognition.
- Biological aging partially mediates the impact of periodontitis and depression on cognitive function.
- Prioritizing periodontal care and mental health interventions may mitigate cognitive decline.
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