Edentulism and cognitive transitions: A multi-state analysis

BackgroundEdentulism has been linked to cognitive decline, yet its effects on the transitions from normal cognition to dementia and ultimately death remain unclear.ObjectiveThis study aimed to evaluate how edentulism influences cognitive state transitions across the aging continuum.MethodsWe conducted a prospective cohort analysis of 22,205 adults aged 50 years or older from China, the USA, and England, with cognitive states assessed over a median follow-up of 12.3 years. Multi-state Markov models were used to estimate transition-specific hazard ratios (HR) and population attributable fractions (PAFs) for edentulism after adjusting for sociodemographic, behavioral, and health covariates. A Cox regression model was used to estimate edentulism associated with the risk of cognitive status and death.ResultsAt baseline, 7.41% of Chinese, 21.64% of US, and 14.24% of English participants were edentulous. During follow-up, 60.1% developed mild cognitive impairment (MCI), 13.6% of those progressed to dementia, and 36.0% died after dementia. Edentulism significantly increased the risk of transition from baseline to death (HR = 1.27, 95% CI:1.13, 1.42) and from MCI to dementia (HR = 1.26, 95% CI:1.12, 1.40). The corresponding PAFs were 4.58% and 6.52%, respectively. Subgroup analyses by age and sex yielded consistent results.ConclusionsEdentulism was associated with faster progression from MCI to dementia and higher death risk. These findings highlight the importance of oral health maintenance as a potential target for Alzheimer's disease and dementia prevention.