The Complexities of Diabetes in Older Persons

Association Between Severe Periodontitis and Cognitive Decline in Older Adults

(1) Background: Periodontal disease, a progressive inflammatory condition, disrupts the oral microbiome and releases inflammatory cytokines, leading to systemic issues, including cognitive decline. This study investigates the association between severe periodontitis and cognitive decline, exploring the role of alkaline phosphatase (ALP), an enzyme linked to systemic inflammation, as an effect modifier. (2) Methods: We analyzed cross-sectional data from the 2013-2014 National Health and Nutrition Examination Survey (NHANES). Severe periodontitis was defined using the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) case definition. A weighted multivariable logistic regression model assessed the association between severe periodontitis and cognitive decline. An interaction term examined ALP's role as an effect modifier. (3) Results: This study included 1265 participants aged 65 and older. After adjusting for confounders, each one-point increase in cognitive function score was associated with a 2% decrease in the odds of severe periodontitis (OR = 0.98; 95% CI = 0.97-0.99; p = 0.008). ALP was a significant effect modifier in the relationship between severe periodontitis and cognitive decline. (4) Conclusions: This study, using a representative U.S. adult population aged 65 and over, suggests that lower cognitive performance correlates with higher likelihood of severe periodontitis. ALP enhances the association between severe periodontitis and cognitive decline.

The association between hypoparathyroidism and cognitive impairment: a systematic review

CONTEXT AND PURPOSE

Hypocalcemia and low parathyroid hormone levels have been commonly suggested as factors able to induce central nervous system disturbances. However, evidences on the occurrence of cognitive impairment are limited or underestimated. The aim of this review is, therefore, to systematically summarize the available evidence concerning the occurrence of cognitive impairment among subjects suffering from idiopathic or secondary hypoparathyroidism.

METHODS

A systematic selection of the available literature was performed by searching the online databases PubMed, Scopus and Web of Knowledge.

RESULTS

The present systematic review included sixteen case report articles and one cross-sectional controlled study. Case reports were the most representative literature sources and involved ten women and seven men. The presence of cognitive impairment was mostly discussed in association with idiopathic hypoparathyroidism (HPT); five articles described the occurrence of cognitive impairment following postsurgical HPT. The case-controlled study reported a significant presence of peculiar cognitive deficits (e.g. reduced inhibitory control, impairment in visuo-spatial functioning among, and psychomotor retardation) among HPT subjects compared to healthy controls, with serum total calcium and its product with phosphorus as independent predictors of neuropsychological dysfunctions.

CONCLUSION

Even though mostly based on single case reports, the presence of neuropsychological dysfunctions in the context of HPT appears to be a consistent core finding.

Comorbid Chronic Conditions Among Older Adults with Subjective Cognitive Decline, United States, 2015-2017

BACKGROUND AND OBJECTIVES

Subjective cognitive decline (SCD), the self-reported experience of worsening or more frequent confusion or memory loss, may be associated with the development or worsening of chronic conditions or complicating their self-management. The objectives of this study were to (i) establish the prevalence of chronic conditions and multiple chronic conditions among adults with SCD, and (ii) compare the prevalence of chronic conditions among people with and without SCD and SCD-related functional limitations.

RESEARCH DESIGN AND METHODS

Data were analyzed from the Cognitive Decline module of the Behavioral Risk Factor Surveillance System administered in 49 states, DC, and Puerto Rico during 2015-2017. Analyses included 220,221 respondents aged 45 years or older who answered the SCD screening question and reported their chronic conditions. Weighted estimates were calculated and chi-square tests were used for comparisons.

RESULTS

Persons with a history of stroke, heart disease, and chronic obstructive pulmonary disorder had significantly higher prevalence of SCD compared to those without. The prevalence of having at least one chronic condition was higher among adults with SCD compared to adults without SCD in each age group (45-64 years: 77.4% vs 47.1%, p < .001; ≥65 years: 86.3% vs 73.5%, p < .001). Among those with SCD, the prevalence of an SCD-related functional limitation was higher among those with at least one chronic condition compared to those with none (45-64 years: 63.3% vs 42.4%, p < .001; ≥65 years: 40.0% vs 25.1%, p < .001). Only half of adults with SCD and a chronic condition had discussed their SCD with a health care professional.

DISCUSSION AND IMPLICATIONS

SCD and chronic conditions commonly co-occur. Having a chronic condition was associated with greater SCD-related functional limitations. SCD might complicate the management of chronic conditions, and patients and providers should be aware of increased risk for cognitive decline in the presence of chronic diseases.