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Leira Y, Vivancos J, Diz P, Martín Á, Carasol M, Frank A. The association between periodontitis and cerebrovascular disease, and dementia. Scientific report of the working group of the Spanish Society of Periodontology and the Spanish Society of Neurology. Neurologia 2024; 39:302-311. [PMID: 38224833 DOI: 10.1016/j.nrleng.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/03/2023] [Indexed: 01/17/2024] Open
Abstract
OBJECTIVE This article reviews the scientific evidence on the relationship between periodontitis and neurological disease, and particularly cerebrovascular disease and dementia. We also issue a series of recommendations regarding the prevention and management of periodontitis and these neurological diseases at dental clinics and neurology units. DEVELOPMENT In response to a series of questions proposed by the SEPA-SEN working group, a literature search was performed, with no restrictions on study design, to identify the most relevant articles on the association between periodontitis and cerebrovascular disease and dementia from the perspectives of epidemiology, treatment, and the biological mechanisms involved in these associations. CONCLUSIONS Periodontitis increases the risk of ischaemic stroke and Alzheimer dementia. Recurrent bacterial infections and increased low-grade systemic inflammation seem to be possible biological mechanisms underlying this association. Limited evidence suggests that various oral health interventions can reduce the future risk of cerebrovascular disease and dementia.
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Affiliation(s)
- Y Leira
- Unidad de Periodoncia, Facultad de Odontología, Universidad de Santiago de Compostela, Santiago de Compostela, Spain; Grupo de Investigación en Neuroenvejecimiento, Laboratorio de Investigación en Neurociencias Clínicas (LINC), Instituto de Investigación Sanitaria de Santiago (IDIS), Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain; Grupo de Trabajo de la Sociedad Española de Periodoncia (SEPA) y Sociedad Española de Neurología (SEN), Madrid, Spain.
| | - J Vivancos
- Grupo de Trabajo de la Sociedad Española de Periodoncia (SEPA) y Sociedad Española de Neurología (SEN), Madrid, Spain; Servicio de Neurología, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - P Diz
- Grupo de Trabajo de la Sociedad Española de Periodoncia (SEPA) y Sociedad Española de Neurología (SEN), Madrid, Spain; Unidad de Pacientes Especiales, Facultad de Odontología, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | - Á Martín
- Grupo de Trabajo de la Sociedad Española de Periodoncia (SEPA) y Sociedad Española de Neurología (SEN), Madrid, Spain; Servicio de Neurología, Hospital Universitario de La Paz, Universidad Autónoma de Madrid, Madrid, Spain
| | - M Carasol
- Grupo de Trabajo de la Sociedad Española de Periodoncia (SEPA) y Sociedad Española de Neurología (SEN), Madrid, Spain; Grupo de Investigación en Etiología y Terapéutica de Enfermedades Periodontales y Periimplantarias, Universidad Complutense de Madrid, Madrid, Spain
| | - A Frank
- Grupo de Trabajo de la Sociedad Española de Periodoncia (SEPA) y Sociedad Española de Neurología (SEN), Madrid, Spain; Servicio de Neurología, Hospital Universitario de La Paz, Universidad Autónoma de Madrid, Madrid, Spain
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Zhou H, Wang C, Wang W, Li H, Hu Q, Huang N, Huang Y. Lesion location and serum levels of homocysteine are associated with early-onset post-stroke depression in acute ischemic stroke. Brain Behav 2023; 13:e3210. [PMID: 37587778 PMCID: PMC10570478 DOI: 10.1002/brb3.3210] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION It is well known that post-stroke depression (PSD) is a psychiatric complication after stroke which leads to worse functional outcome and poorer quality of life. Some risk factors including gender, stroke severity, lesion location, homocysteine (HCY), and so on are associated with PSD. This study aims to further explore the possible relationship between serum levels of HCY and early-onset PSD and the predictive value of HCY combined with stroke characteristics for early-onset PSD. METHODS Two hundred forty-five patients with acute ischemic stroke who met the criteria were included in this study from March 2015 to March 2017. PSD was diagnosed at 2 weeks after stroke. The severity of depressive symptoms was evaluated with the Hamilton depression scale 17 items (HAMD-17), and patients with HAMD scores ≥7 were included in the PSD group. The demographic data, clinical characteristics, serum levels of HCY, and detailed radiological variables (e.g., lesion location and quantity of the brain infarct) were also examined. RESULTS In total, 97 (39.6%) patients of the 245 patients were diagnosed with depression. The univariate analyses suggested that patients in PSD group had a higher NIHSS score, modified Rankin Scale score, and HCY levels than patients in non-PSD group (p < .001). The patients with PSD had higher proportion of multiple-site acute infarcts and frontal lobe lesion (p < .05). In multivariate logistic regression analysis, NIHSS score at admission, serum levels of HCY, and multiple-site lesions were independently related to early-onset PSD. Based on receiver operating characteristic curves analysis, the combination of HCY, NIHSS scores, multiple-site lesions, and lesion location revealed a highest area under the curve of 0.807 (95% confidence interval [CI]: 0.748-0.865, p < .001). Furthermore, there was a significantly increased risk of early-onset PSD associated with serum levels of HCY ≥16.98 μmol/L (odds ratio [OR] = 10.976, 95% CI: 5.585-21.573, p < .001). CONCLUSIONS Our study indicated that higher NIHSS score, elevated serum levels of HCY, and multiple-site lesions may be independent risk factors of early-onset PSD. The combination of HCY, NIHSS scores, multiple-site lesions, and lesion location may provide greater predictive value than HCY alone for early-onset PSD. Early intervention for elevated serum levels of HCY may be a potential target for the intervention and prevention of PSD.
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Affiliation(s)
- Hongxu Zhou
- Department of NeurologyCivil Aviation General Hospital of Peking UniversityBeijingChina
| | - Chenlong Wang
- Department of NeurologyCivil Aviation General Hospital of Peking UniversityBeijingChina
| | - Wei Wang
- Department of NeurologyCivil Aviation General Hospital of Peking UniversityBeijingChina
| | - Hongyan Li
- Department of NeurologyCivil Aviation General Hospital of Peking UniversityBeijingChina
| | - Qun Hu
- Department of NeurologyCivil Aviation General Hospital of Peking UniversityBeijingChina
| | - Ni Huang
- Department of NeurologyCivil Aviation General Hospital of Peking UniversityBeijingChina
| | - Yining Huang
- Department of NeurologyPeking University First HospitalBeijingChina
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Li Y, Guan X, He Y, Jia X, Pan L, Wang Y, Han Y, Zhao R, Yang J, Hou T. ProBDNF signaling is involved in periodontitis-induced depression-like behavior in mouse hippocampus. Int Immunopharmacol 2023; 116:109767. [PMID: 36738676 DOI: 10.1016/j.intimp.2023.109767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/15/2023] [Accepted: 01/19/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Increasing evidence supports the association between periodontitis and depression. However, the specific mechanisms remain to be further elucidated. The present study aimed to mechanistically investigate the regional roles of proBDNF (the precursor of brain-derived neurotrophic factor) in periodontitis induced depression-like behavior in mice. METHODS Experimental periodontitis model was established by periodontal injection of Porphyromonas gingivalis lipopolysaccharide (Pg-LPS) in 8-week-old male Bdnf-HA/HA mice for 3 weeks. The depression-like behaviors, spontaneous exploratory activity and the level of anxiety were assessed by behavior tests. The activation of microglia and astrocytes, as well as the expression of Interleukin (IL)-1β and Tumor necrosis factor (TNF)-α in the hippocampus, prefrontal cortex, and cortex were further assessed by immunofluorescence and western blots. The levels of IL-1β in blood serum and expression of occludin as well as claudin5 in the hippocampus, prefrontal cortex, and cortex were further determined by enzyme-linked immunosorbent assay and western blot. Finally, the expression of proBDNF, its receptors, and mature BDNF (mBDNF), as well as neuronal activity were measured by western blots and immunofluorescence. RESULTS Pg-LPS successfully induced periodontitis in mice and caused obvious depression-like behavior. Furthermore, we observed an increased activation of astrocytes and microglia, as well as a significant increase in expression of IL-1β and TNF-α in the hippocampus of mice treated with Pg-LPS, with elevated level of IL-1β in serum and decreased expression of occludin and claudin5 in the hippocampus. Importantly, we found that the levels of proBDNF and its receptors, SorCS2 and p75NTR, were increased significantly; however, the level of mBDNF was decreased, therefor leading to greater ratio of proBDNF/mBDNF. In addition, we also detected decreased neuronal activity in the hippocampus of mice treated with Pg-LPS. CONCLUSIONS Our results indicate that Pg-LPS-induced periodontitis could cause depression-like behaviors in mice, and the proBDNF signaling is involved in the process.
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Affiliation(s)
- Yingxue Li
- Key laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China; Department of Cariology and Endodontics, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China
| | - Xiaoyue Guan
- Key laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China; Department of Cariology and Endodontics, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China
| | - Yani He
- Key laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China; Department of Cariology and Endodontics, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China
| | - Xiangbin Jia
- Key laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China; Department of Cariology and Endodontics, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China
| | - Lifei Pan
- Key laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China; Department of Cariology and Endodontics, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China
| | - Yuting Wang
- Key laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China; Department of Cariology and Endodontics, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China
| | - Yue Han
- Key laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China; Department of Cariology and Endodontics, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China
| | - Rui Zhao
- Key laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China; Department of Cariology and Endodontics, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China
| | - Jianmin Yang
- Department of Medicine, Weill Cornell Medical School, Cornell University, New York, NY 10065, USA.
| | - Tiezhou Hou
- Key laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China; Department of Cariology and Endodontics, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China.
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Chen C, Zhu J, Deng X, Yang Z, Lin W, Ma Y, Huang S, Chen L, Liu Y, Zhu F. Severe periodontitis is associated with the serum levels of hypersensitive C reactive protein and lipoprotein-associated phospholipase A2 in the patients of acute ischemic stroke. J Clin Neurosci 2021; 88:232-236. [PMID: 33992190 DOI: 10.1016/j.jocn.2021.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/23/2021] [Accepted: 04/04/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Periodontitis is associated with the pathogenesis of atherosclerotic plaque, and hypersensitive C reactive protein (hs-CRP) and lipoprotein-associated phospholipase A2 (Lp-PLA2) are the serum biomarkers of the stability of atherosclerotic plaque. Whether periodontitis is associated with the serum level of hs-CRP and Lp-PLA2 of acute ischemic stroke remains unclear. MATERIAL AND METHODS We recruited 103 cases with acute ischemic stroke within 7 days after stroke onset. Pocket depth and clinical attachment loss were assessed by oral examination to define the severe periodontitis. Demographic information including gender, age and body weight index, income level, education level, past medical history include smoking history, drinking history, ischemic stroke history, coronary heart disease, hypertension, diabetes and hyperlipidemia were collected, and serum biomarkers including white blood cell (WBC), fibrinogen, total cholesterol (TC), triglyceride (TG), lower density lipoprotein (LDL-C), high density lipoprotein (HDL-C), hs-CRP, HemoglobinA1c (HbAlc), Homocysteine (HCY) and Lp-PLA2 were tested. RESULTS 65 (63.1%) cases were diagnosed as severe periodontitis. Severe periodontitis group showed more male, age, drinking history, higher levels of hs-CRP and Lp-PLA2. Multivariate logistic regression showed that severe periodontitis was were significantly associated with hs-CRP (OR = 2.367, 95%CI: 1.182-4.738; P = .015) and Lp-PLA2 (OR = 2.577, 95% CI: 1.010-6.574; P = .048). CONCLUSIONS Severe periodontitis is independently associated with the serum Level of hs-CRP and Lp-PLA2 in patients with acute ischemic stroke. Whether the improvement of periodontitis could decrease the occurrence and re-occurrence of ischemic stroke by stablizating atherosclerotic plaque need be further studied in future.
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Affiliation(s)
- Chunchun Chen
- Cognitive Impairment Ward of Neurology Department, The Third Affiliated Hospital of Shenzhen University Medical College, Shenzhen City, Guangdong Province 518001, PR China; Department of Neurology, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, Guangdong Province 512025, PR China
| | - Jinhua Zhu
- Department of Neurology, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, Guangdong Province 512025, PR China
| | - Xuhui Deng
- Department of Neurology, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, Guangdong Province 512025, PR China
| | - Zhi Yang
- Department of Neurology, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, Guangdong Province 512025, PR China
| | - Weifeng Lin
- Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou City, Guangdong Province 510632, PR China
| | - Ying Ma
- Department of Cardiology, The Third Affiliated Hospital of Shenzhen University Medical College, Shenzhen City, Guangdong Province 518001, PR China
| | - Shuxuan Huang
- Department of Neurology, People 's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, PR China
| | - Lue Chen
- Department of Neurology, Shunde Hospital of Southern Medical University, Shunde, Guangdong Province 528300, PR China
| | - Yuan Liu
- Department of Neurology, The Third People's Hospital of Hangzhou, Hangzhou, Zhejiang Province 310009, PR China
| | - Feiqi Zhu
- Cognitive Impairment Ward of Neurology Department, The Third Affiliated Hospital of Shenzhen University Medical College, Shenzhen City, Guangdong Province 518001, PR China; Department of Neurology, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, Guangdong Province 512025, PR China.
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Hada M, Azuma T, Irie K, Yonenaga T, Watanabe K, Deguchi F, Obora A, Kojima T, Tomofuji T. Periodontal Condition Is Correlated with Deep and Subcortical White Matter Hyperintensity Lesions in Japanese Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051694. [PMID: 32150917 PMCID: PMC7084602 DOI: 10.3390/ijerph17051694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 11/16/2022]
Abstract
Deep and subcortical white matter hyperintensity (DSWMH) lesions are a small-vessel disease of the brain. The aim of this cross-sectional study was to investigate the relationship between DSWMH lesions and periodontal status in Japanese adults who participated in a health check. We enrolled 444 consecutive participants (mean age, 54.5 years) who received both brain and oral health evaluation services at the Asahi University Hospital. Magnetic resonance imaging was used to detect DSWMH lesions. Periodontal status was assessed using the community periodontal index. Of the study participants, 215 (48.4%) had DSWMH lesions. Multivariate logistic regression showed that the presence of DSWMH lesions was significantly related to age ≥ 65 years (vs. < 65 years, odds ratio [OR] = 2.984, 95% confidence interval [CI] = 1.696-5.232), systolic blood pressure ≥ 140 mmHg (vs. < 140 mmHg, OR = 2.579, 95% CI = 1.252-5.314), the presence of ≥ 28 teeth (vs. < 28 teeth, OR = 0.635, 95% CI = 0.420-0.961), and probing pocket depth (PPD) ≥ 6 mm (vs. PPD < 6 mm, OR = 1.948, 95% CI = 1.132-3.354) after adjustment for confounding factors. Having PPD ≥ 6 mm may be a risk factor for DSWMH lesions in Japanese adults.
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Affiliation(s)
- Minako Hada
- Department of Community Oral Health, School of Dentistry, Asahi University, Mizuho, Gifu 501-0296, Japan; (M.H.); (T.A.); (T.Y.)
| | - Tetsuji Azuma
- Department of Community Oral Health, School of Dentistry, Asahi University, Mizuho, Gifu 501-0296, Japan; (M.H.); (T.A.); (T.Y.)
| | - Koichiro Irie
- Department of Oral Health and Preventive Dentistry, Meikai University School of Dentistry, Sakado, Saitama 350-0283, Japan;
| | - Takatoshi Yonenaga
- Department of Community Oral Health, School of Dentistry, Asahi University, Mizuho, Gifu 501-0296, Japan; (M.H.); (T.A.); (T.Y.)
| | - Kazutoshi Watanabe
- Asahi University Hospital, 3- 23 Hashimoto-cho, Gifu, Gifu 500-8523, Japan; (K.W.); (F.D.); (A.O.); (T.K.)
| | - Fumiko Deguchi
- Asahi University Hospital, 3- 23 Hashimoto-cho, Gifu, Gifu 500-8523, Japan; (K.W.); (F.D.); (A.O.); (T.K.)
| | - Akihiro Obora
- Asahi University Hospital, 3- 23 Hashimoto-cho, Gifu, Gifu 500-8523, Japan; (K.W.); (F.D.); (A.O.); (T.K.)
| | - Takao Kojima
- Asahi University Hospital, 3- 23 Hashimoto-cho, Gifu, Gifu 500-8523, Japan; (K.W.); (F.D.); (A.O.); (T.K.)
| | - Takaaki Tomofuji
- Department of Community Oral Health, School of Dentistry, Asahi University, Mizuho, Gifu 501-0296, Japan; (M.H.); (T.A.); (T.Y.)
- Correspondence: ; Tel.: +81-58-329-1496
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