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Dibello V, Custodero C, Cavalcanti R, Lafornara D, Dibello A, Lozupone M, Daniele A, Pilotto A, Panza F, Solfrizzi V. Impact of periodontal disease on cognitive disorders, dementia, and depression: a systematic review and meta-analysis. GeroScience 2024:10.1007/s11357-024-01243-8. [PMID: 38943006 DOI: 10.1007/s11357-024-01243-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 06/05/2024] [Indexed: 06/30/2024] Open
Abstract
A growing body of research suggested that there was a link between poor periodontal health and systemic diseases, particularly with the early development of cognitive disorders, dementia, and depression. This is especially true in cases of changes in diet, malnutrition, loss of muscular endurance, and abnormal systemic inflammatory response. Our study aimed to determine the extent of these associations to better target the multi-level healthy aging challenge investigating the impact of periodontal disease on cognitive disorders (cognitive impairment and cognitive decline), dementia, and depression. We conducted a comprehensive literature search up to November 2023 using six different electronic databases. Two independent researchers assessed the eligibility of 7363 records against the inclusion criteria and found only 46 records that met the requirements. The study is registered on PROSPERO (CRD42023485688). We generated random effects pooled estimates and 95% confidence intervals (CI) to evaluate whether periodontal disease increased the risk of the investigated outcomes. The quality assessment revealed moderate quality of evidence and risk of bias. Periodontal disease was found to be associated with both cognitive disorders (relative risk (RR) 1.25, 95% CI 1.11-1.40, in the analysis of cross-sectional studies); cognitive impairment (RR 3.01, 95% CI 1.52-5.95 for longitudinal studies, cognitive decline); and dementia (RR 1.22, 95% CI 1.10-1.36). However, no significant increased risk of depression among subjects with periodontal disease was found (RR 1.07, 95% CI 0.95-1.21). Despite the association with two of the three explored outcomes, the available evidence on periodontal diseases and dementia, cognitive disorders, and depression is controversial due to several limitations. Therefore, further investigations involving validated and standardized tools are required.
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Affiliation(s)
- Vittorio Dibello
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cesare Frugoni" Internal and Geriatric Medicine and Memory Unit, University of Bari "Aldo Moro", Bari, Italy
| | - Carlo Custodero
- Cesare Frugoni" Internal and Geriatric Medicine and Memory Unit, University of Bari "Aldo Moro", Bari, Italy
| | - Raffaele Cavalcanti
- Department of General Surgery and Surgical-Medical Specialties, University of Catania, Catania, Italy
| | - Domenico Lafornara
- Division of Diagnostic Imaging, Department of Surgical and Biomedical Sciences, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Antonio Dibello
- Stella Maris Nursing Home and Day Care Center, Monopoli, Bari, Italy
| | - Madia Lozupone
- Department of Translational Biomedicine & Neuroscience 'DiBraiN', University of Bari Aldo Moro, Bari, Italy
| | - Antonio Daniele
- Department of Neuroscience, Catholic University of Sacred Heart, Rome, Italy
- Neurology Unit, IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Alberto Pilotto
- Cesare Frugoni" Internal and Geriatric Medicine and Memory Unit, University of Bari "Aldo Moro", Bari, Italy
- Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy
| | - Francesco Panza
- Cesare Frugoni" Internal and Geriatric Medicine and Memory Unit, University of Bari "Aldo Moro", Bari, Italy.
| | - Vincenzo Solfrizzi
- Cesare Frugoni" Internal and Geriatric Medicine and Memory Unit, University of Bari "Aldo Moro", Bari, Italy
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Beydoun HA, Beydoun MA, Noren Hooten N, Weiss J, Li Z, Georgescu MF, Maino Vieytes CA, Meirelles O, Launer LJ, Evans MK, Zonderman AB. Mediating and moderating effects of plasma proteomic biomarkers on the association between poor oral health problems and incident dementia: The UK Biobank study. GeroScience 2024:10.1007/s11357-024-01202-3. [PMID: 38809392 DOI: 10.1007/s11357-024-01202-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 05/12/2024] [Indexed: 05/30/2024] Open
Abstract
The plasma proteome can mediate poor oral health problems (POHP)'s link to incident dementia. We screened 37,269 UK Biobank participants 50-74 years old (2006-2010) for prevalent POHP, further tested against 1463 plasma proteins and incident dementia over up to 15 years of follow-up. Total effect (TE) of POHP-dementia through plasma proteomic markers was decomposed into pure indirect effect (PIE), interaction referent (INTREF), controlled direct effect (CDE), or mediated interaction (INTMED). POHP increased the risk of all-cause dementia by 17% (P < 0.05). Growth differentiation factor 15 (GDF15) exhibited the strongest mediating effects (PIE > 0, P < 0.001), explaining 28% the total effect of POHP on dementia, as a pure indirect effect. A first principal component encompassing top 4 mediators (GDF15, IL19, MMP12, and ACVRL1), explained 11% of the POHP-dementia effect as a pure indirect effect. Pathway analysis including all mediators (k = 173 plasma proteins) revealed the involvement of the immune system, signal transduction, metabolism, disease, and gene expression, while STRING analysis indicated that top mediators within the first principal component were also represented in the two largest proteomic clusters. The dominant biological GO pathway for the GDF15 cluster was GO:0007169 labeled as "transmembrane receptor protein tyrosine kinase signaling pathway." Dementia is linked to POHP mediated by GDF15 among several proteomic markers.
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Affiliation(s)
- Hind A Beydoun
- US Department of Veterans Affairs, VA National Center On Homelessness Among Veterans, Washington, DC, 20420, USA
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - May A Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, 251 Bayview Blvd, Suite 100, Baltimore, MD, 21224, USA.
| | - Nicole Noren Hooten
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, 251 Bayview Blvd, Suite 100, Baltimore, MD, 21224, USA
| | - Jordan Weiss
- Stanford Center on Longevity, Stanford University, Palo Alto, CA, 94305, USA
| | - Zhiguang Li
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, 251 Bayview Blvd, Suite 100, Baltimore, MD, 21224, USA
| | - Michael F Georgescu
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, 251 Bayview Blvd, Suite 100, Baltimore, MD, 21224, USA
| | - Christian A Maino Vieytes
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, 251 Bayview Blvd, Suite 100, Baltimore, MD, 21224, USA
| | - Osorio Meirelles
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, 251 Bayview Blvd, Suite 100, Baltimore, MD, 21224, USA
| | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, 251 Bayview Blvd, Suite 100, Baltimore, MD, 21224, USA
| | - Michele K Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, 251 Bayview Blvd, Suite 100, Baltimore, MD, 21224, USA
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, 251 Bayview Blvd, Suite 100, Baltimore, MD, 21224, USA
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Rajendran V, Uppoor A, Nayak SU, Rao SB, Dasson Bajaj P. Unraveling the cognitive implications among individuals with co-occurring chronic periodontitis and type 2 diabetes mellitus: a cross-sectional study. J Oral Biosci 2024:S1349-0079(24)00091-4. [PMID: 38815752 DOI: 10.1016/j.job.2024.05.008] [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: 02/20/2024] [Revised: 05/24/2024] [Accepted: 05/27/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVES Chronic periodontitis and type 2 diabetes mellitus (T2DM) are associated with cognitive decline when examined individually. To gain deeper insight into the combined effects of these conditions on cognitive decline, the present study aimed to examine the cognitive status of individuals with co-occurring T2DM and chronic periodontitis. METHODS We recruited 220 participants categorized into four groups: Group I, healthy subjects; Group II, individuals with chronic periodontitis; Group III, individuals with T2DM; and Group IV, individuals with both T2DM and chronic periodontitis. Medical histories were recorded for all participants, followed by periodontal examination and evaluation of cognitive status using the Montreal Cognitive Assessment (MoCA) scale. Finger dexterity was assessed using the nine-hole peg test. RESULTS A statistically significant increase in the proportion of mild cognitive impairment (MCI) was observed between groups I and IV (p<0.001). Logistic regression analysis revealed that, among the parameters assessed in this study, the adjusted odds ratio (OR) was significant for age, finger dexterity scores, and co-occurrence of T2DM and periodontitis. CONCLUSIONS The findings of this study suggest that the co-occurrence of chronic periodontitis and T2DM can have a detrimental effect on the cognitive abilities of an individual. Subsequent research should include longitudinal monitoring of the cognitive status in patients with concurrent conditions during treatment to gain deeper prognostic insights into the relationship between these co-occurring conditions and cognitive decline.
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Affiliation(s)
- Valliammai Rajendran
- Department of Periodontology, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Karnataka, Manipal, 576104, India.
| | - Ashita Uppoor
- Department of Periodontology, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Karnataka, Manipal, 576104, India.
| | - Sangeeta Umesh Nayak
- Department of Periodontology, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Karnataka, Manipal, 576104, India.
| | - Satish B Rao
- Department of Medicine, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Karnataka, Manipal, 576104, India.
| | - Parul Dasson Bajaj
- Department of Public Health Dentistry, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Karnataka, Manipal, 576104, India.
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Kusama T, Takeuchi K, Kiuchi S, Aida J, Osaka K. Poor oral health and dementia risk under time-varying confounding: A cohort study based on marginal structural models. J Am Geriatr Soc 2024; 72:729-741. [PMID: 38064294 DOI: 10.1111/jgs.18707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/09/2023] [Accepted: 11/09/2023] [Indexed: 03/19/2024]
Abstract
BACKGROUND Bidirectional association between oral health, including tooth loss and oral hypofunction, and cognitive impairment can induce time-varying confounding in association with dementia. This study aimed to investigate the association between oral health and the development of dementia among older adults, considering cognitive impairment as a time-varying confounder. METHODS This nine-year follow-up cohort study targeted independent older adults aged ≥65 years who participated in the Japan Gerontological Evaluation Study. The exposure variables were self-reported poor oral health (≤19 remaining teeth, edentulousness, chewing difficulty, swallowing problems, and xerostomia), which were assessed in 2010 and 2013. The outcome variable was the incidence of dementia between 2013 and 2019, which was obtained from the municipalities' administrative database. Furthermore, in 2010 and 2013, we considered cognitive impairment as a time-varying confounder and treated it based on a marginal structural model (MSM), including possible baseline confounders. Oral health and cognitive impairment were assessed using the items of Kihon checklist. We employed a Cox proportional hazards model with a stabilized inverse probability weight and estimated hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS Among 37,556 participants (mean age: 72.8 years [1 SD = 5.5], males: 46.8%), the dementia incidence rate was 2.2/100 person-year. The proportions of those with ≤19 remaining teeth, edentulousness, chewing difficulty, swallowing problems, and xerostomia were 61.3%, 11.0%, 24.4%, 14.7%, and 19.2%, respectively. From the regression analysis based on MSM, ≤19 remaining teeth (HR = 1.12, 95% CI = 1.03-1.23), edentulousness (HR = 1.20, 95% CI = 1.09-1.32), chewing difficulty (HR = 1.11, 95% CI = 1.02-1.21), and xerostomia (HR = 1.10, 95% CI = 1.01-1.20) were significantly associated with an increased risk of dementia; however, swallowing problems were not significantly associated with dementia onset (p > 0.05). CONCLUSIONS Even after considering time-varying confounding by cognitive function at baseline and follow-up, we observed significant associations between poor oral health and increased risk of dementia among older adults.
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Affiliation(s)
- Taro Kusama
- Division of Statistics and Data Science, Liaison Center for Innovative Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
| | - Kenji Takeuchi
- Division of Statistics and Data Science, Liaison Center for Innovative Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Sakura Kiuchi
- Division of Statistics and Data Science, Liaison Center for Innovative Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
- Frontier Research Institute for Interdisciplinary Sciences, Tohoku University, Sendai, Miyagi, Japan
| | - Jun Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
| | - Ken Osaka
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
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Lin CS, Chen TC, Verhoeff MC, Lobbezoo F, Trulsson M, Fuh JL. An umbrella review on the association between factors of oral health and cognitive dysfunction. Ageing Res Rev 2024; 93:102128. [PMID: 38007045 DOI: 10.1016/j.arr.2023.102128] [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: 07/24/2023] [Revised: 11/09/2023] [Accepted: 11/14/2023] [Indexed: 11/27/2023]
Abstract
An increasing number of systematic reviews and meta-analyses have been published on the association between oral health and cognitive dysfunction, also known as oral-cognitive links. However, there is great diversity in the oral and cognitive factors included in these studies, with different opinions for clinical practice drawn from the evidence. To understand which oral and cognitive factors are involved in those associations, we conducted an umbrella review of 28 systematic reviews, including 12 meta-analyses, on oral-cognitive links. We found that (a) periodontal diseases, oral microbiome, and dementia were frequently studied, while other factors, such as mastication and mild cognitive impairment, were less commonly investigated, and (b) severe deterioration of oral health, such as severe periodontitis or extensive tooth loss, rather than the presence of oral diseases alone, was strongly associated with cognitive dysfunction. In conclusion, the diversity of oral and cognitive factors included in the review studies reflects the complexity of oral-cognitive links. Clarifying the factors helps to form evidence-based clinical advice for healthcare.
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Affiliation(s)
- Chia-Shu Lin
- Department of Dentistry, National Yang Ming Chiao Tung University, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taiwan; Brain Research Center, National Yang Ming Chiao Tung University, Taiwan; Oral Medicine Innovation Center, National Yang Ming Chiao Tung University, Taiwan.
| | - Ta-Chung Chen
- Division of Prosthodontics, Department of Stomatology, Taipei Veterans General Hospital, Taiwan
| | - Merel Charlotte Verhoeff
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Mats Trulsson
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden; Academic Center for Geriatric Dentistry, Karolinska Institutet, Stockholm, Sweden
| | - Jong-Ling Fuh
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taiwan; Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Balistreri CR, Monastero R. Neuroinflammation and Neurodegenerative Diseases: How Much Do We Still Not Know? Brain Sci 2023; 14:19. [PMID: 38248234 PMCID: PMC10812964 DOI: 10.3390/brainsci14010019] [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: 11/27/2023] [Revised: 12/12/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
The term "neuroinflammation" defines the typical inflammatory response of the brain closely related to the onset of many neurodegenerative diseases (NDs). Neuroinflammation is well known, but its mechanisms and pathways are not entirely comprehended. Some progresses have been achieved through many efforts and research. Consequently, new cellular and molecular mechanisms, diverse and conventional, are emerging. In listing some of those that will be the subject of our description and discussion, essential are the important roles of peripheral and infiltrated monocytes and clonotypic cells, alterations in the gut-brain axis, dysregulation of the apelinergic system, alterations in the endothelial glycocalyx of the endothelial component of neuronal vascular units, variations in expression of some genes and levels of the encoding molecules by the action of microRNAs (miRNAs), or other epigenetic factors and distinctive transcriptional factors, as well as the role of autophagy, ferroptosis, sex differences, and modifications in the circadian cycle. Such mechanisms can add significantly to understanding the complex etiological puzzle of neuroinflammation and ND. In addition, they could represent biomarkers and targets of ND, which is increasing in the elderly.
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Affiliation(s)
- Carmela Rita Balistreri
- Cellular and Molecular Laboratory, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90134 Palermo, Italy
| | - Roberto Monastero
- Unit of Neurology & Neuro-Physiopathology, Department of Biomedicine, Neuroscience, and Advanced Diagnostics (Bi.N.D), University of Palermo, Via La Loggia 1, 90129 Palermo, Italy;
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Takahashi T, Hatta K, Ikebe K. Risk factors of cognitive impairment: Impact of decline in oral function. JAPANESE DENTAL SCIENCE REVIEW 2023; 59:203-208. [PMID: 38152385 PMCID: PMC10751745 DOI: 10.1016/j.jdsr.2023.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 06/18/2023] [Accepted: 06/22/2023] [Indexed: 12/29/2023] Open
Abstract
Cognitive impairment and subsequent dementia are the major causes of disability and need for nursing care among older people in worldwide. The purpose is to review well-known risk factors for cognitive impairment and dementia, focusing on the relationship between decline in oral function and current prevention strategies. Various non-modifiable and modifiable risk factors are related to cognitive impairment. Effects of oral function to cognitive impairment is not yet well recognized in the medical community, although masticatory function, occlusal force, and number of teeth have been reported to be related to cognitive function. Furthermore, occlusal force rather than number of teeth was significantly related to the early stages of cognitive impairment, and that a decline in occlusal force seemed to lead to cognitive impairment directly and indirectly through dietary intake. This relationship was significant only for occlusal force, which may be associated with the early stages of cognitive decline. Nutritional change caused by reduced masticatory function is suggested as a possible explanation. Therefore, rehabilitation or maintenance of oral function should be sought to prevent cognitive impairment.
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Affiliation(s)
- Toshihito Takahashi
- Department of Removable Prosthodontics and Gerodontology, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Kodai Hatta
- Department of Removable Prosthodontics and Gerodontology, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Kazunori Ikebe
- Department of Removable Prosthodontics and Gerodontology, Osaka University Graduate School of Dentistry, Osaka, Japan
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Banakar M, Sadabadi Y, Mehran M, Abbasi F. Beyond the mouth: the impact of periodontal disease on dementia. Evid Based Dent 2023; 24:138-139. [PMID: 37558763 DOI: 10.1038/s41432-023-00925-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/11/2023]
Abstract
DATA SOURCES The authors searched Medline via PubMed, Scopus, CINAHL, Web of Science, and PsycINFO for relevant studies published until April 2022. STUDY SELECTION Longitudinal studies that assessed periodontal health as the exposure and cognitive decline and/or dementia as the outcome were included. Case reports, reviews, cross-sectional studies, and animal studies were excluded. DATA EXTRACTION AND SYNTHESIS: Two authors independently reviewed studies for inclusion, extracted data, and assessed study quality. Meta-analysis was conducted to generate pooled odds ratios (ORs) for cognitive decline and hazard ratios (HRs) for dementia. Sources of heterogeneity were explored through subgroup analyses. RESULTS A total of 24 studies were included for cognitive decline and 23 for dementia. Poor periodontal health was associated with increased odds of cognitive decline (OR = 1.23; 95% CI: 1.05-1.44) and dementia (HR = 1.21; 95% CI: 1.07-1.38). Tooth loss also appeared to increase the risk independently. However, significant heterogeneity existed between studies. CONCLUSIONS Poor periodontal health may increase the risk of cognitive decline and dementia, but the quality of evidence was low. Further high-quality, longitudinal studies with standardized assessments are needed to establish causality.
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Affiliation(s)
- Morteza Banakar
- Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Pediatric Dentistry, Faculty of Dentistry, Shahed University, Tehran, Iran.
| | - Yoones Sadabadi
- Department of Pediatric Dentistry, Faculty of Dentistry, Shahed University, Tehran, Iran
| | - Majid Mehran
- Department of Pediatric Dentistry, Faculty of Dentistry, Shahed University, Tehran, Iran
| | - Farid Abbasi
- Department of Oral Medicine, Faculty of Dentistry, Shahed University, Tehran, Iran
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Goyal L, Gupta S, Perambudhuru Y. Association between periodontitis and cognitive impairment in adults. Evid Based Dent 2023; 24:123-124. [PMID: 37433922 DOI: 10.1038/s41432-023-00915-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/13/2023]
Abstract
DESIGN To summarize the data on association between periodontal diseases and cognitive impairment in adults this systematic review scrutinized various observational studies till September 2021. This review was carried out in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA 2020) guidelines. The authors used PECO framework question,: population-Adults (18 years or older), exposure-adults suffering from periodontitis, comparator-adult group without periodontitis, outcome-adults at high risk for cognitive impairment. CASE/CONTROL SELECTION Search for the literature was conducted on PubMed, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Search was limited to human studies with no limitation to year of publication prior to September 2021. Search terms used were related to gingiva, oral bacteria like Porphyromonas gingivalis, gum inflammation, periodontitis, dementia, neuroinflammation, cognitive impairment, Alzheimer's disease, Parkinson disease. Following research, all the studies providing association between periodontal diseases and neurodegenerative diseases with quantitative measures were included in the study. Non-human studies, studies on patients below 18 year old, studies related to influence of treatment and in subjects already suffering from neurological disease were excluded. After removing duplicates, eligible studies were identified and data extracted by two reviewers to make ensure inter examiner reliability and to prevent data entry errors. Data from the studies were tabulated as study design, sample characteristics, diagnosis, exposure biomarkers/measures, outcomes and results. DATA ANALYSIS Methodological quality of studies was assessed by adapted Newcastle-Ottawa scale. Selection of study groups, comparability and exposure/outcome were used as parameters. Case-control and cohort studies were considered as high-quality studies if six or more stars were awarded out of nine maximum stars and four or more stars for cross-sectional studies out of six stars. Comparability among the groups was studied by taking into account primary factors for Alzheimer's disease such as age and sex and secondary factors like hypertension, osteoarthritis, depression, diabetes mellitus, and cerebrovascular disease. For cohort studies, 10 year follow up and dropout of <10% was considered to be successful. RESULTS A total of 3693 studies were identified by two independent reviewers and finally 11 studies were included in the final analysis. Six cohort studies, three cross-sectional and two case-control studies were included after excluding remaining studies. Bias in studies was assessed by adapted Newcastle-Ottawa Scale. All included studies were of high methodological quality. Association between periodontitis and cognitive impairment was determined by using different criteria like International classification of disease, clinical measurement of periodontitis subjects, inflammatory biomarkers, microbes and antibodies. It was suggested that subjects with chronic periodontitis since 8 years or more, are at a higher risk of having dementia. Clinical measures of periodontal disease like probing depth, clinical attachment loss, alveolar bone loss were found to be positively associated with cognitive impairment. Inflammatory biomarkers and pre-existing elevated levels of serum IgG specific to periodontopathogens was reported to be associated with cognitive impairment. Within the limitations of the study, the authors concluded that though the patients with long-standing periodontitis are at greater risk for developing cognitive impairment by neurodegenerative diseases, the mechanism by which periodontitis can lead to cognitive impairment is still vague. CONCLUSIONS Evidence suggests a strong association between periodontitis and cognitive impairment. Still further studies should be done to explore the mechanism involved.
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Affiliation(s)
- Lata Goyal
- Periodontics Division, Department of Dentistry, All India Institute of Medical Sciences, Bathinda, India
| | - Shipra Gupta
- Oral Health Sciences Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.
| | - Yeshwanth Perambudhuru
- Periodontics Division, Department of Dentistry, All India Institute of Medical Sciences, Bathinda, India
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Mensah A, Rodgers AM, Larrañeta E, McMullan L, Tambuwala M, Callan JF, Courtenay AJ. Treatment of Periodontal Infections, the Possible Role of Hydrogels as Antibiotic Drug-Delivery Systems. Antibiotics (Basel) 2023; 12:1073. [PMID: 37370392 DOI: 10.3390/antibiotics12061073] [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: 05/02/2023] [Revised: 06/08/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
With the advancement of biomedical research into antimicrobial treatments for various diseases, the source and delivery of antibiotics have attracted attention. In periodontal diseases, antibiotics are integral in positive treatment outcomes; however, the use of antibiotics is with caution as the potential for the emergence of resistant strains is of concern. Over the years, conventional routes of drug administration have been proven to be effective for the treatment of PD, yet the problem of antibiotic resistance to conventional therapies continues to remain a setback in future treatments. Hydrogels fabricated from natural and synthetic polymers have been extensively applied in biomedical sciences for the delivery of potent biological compounds. These polymeric materials either have intrinsic antibacterial properties or serve as good carriers for the delivery of antibacterial agents. The biocompatibility, low toxicity and biodegradability of some hydrogels have favoured their consideration as prospective carriers for antibacterial drug delivery in PD. This article reviews PD and its antibiotic treatment options, the role of bacteria in PD and the potential of hydrogels as antibacterial agents and for antibiotic drug delivery in PD. Finally, potential challenges and future directions of hydrogels for use in PD treatment and diagnosis are also highlighted.
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Affiliation(s)
- Adelaide Mensah
- School of Pharmacy and Pharmaceutical Sciences, Ulster University, Coleraine BT52 1SA, UK
| | - Aoife M Rodgers
- The Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, 96 Lisburn Road, Belfast BT9 7BL, UK
| | - Eneko Larrañeta
- School of Pharmacy, Queen's University Belfast, 96 Lisburn Road, Belfast BT9 7BL, UK
| | - Lyndsey McMullan
- DJ Maguire and Associates, Floor 1, Molesworth Place, Molesworth Street, Cookstown BT80 8NX, UK
| | - Murtaza Tambuwala
- Lincoln Medical School, Universities of Nottingham and Lincoln, Brayford Pool Campus, Lincoln LN6 7TS, UK
| | - John F Callan
- School of Pharmacy and Pharmaceutical Sciences, Ulster University, Coleraine BT52 1SA, UK
| | - Aaron J Courtenay
- School of Pharmacy and Pharmaceutical Sciences, Ulster University, Coleraine BT52 1SA, UK
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Saji N, Ishihara Y, Murotani K, Uchiyama A, Takeda A, Sakurai T, Matsushita K. Cross-Sectional Analysis of Periodontal Disease and Cognitive Impairment Conducted in a Memory Clinic: The Pearl Study. J Alzheimers Dis 2023; 96:369-380. [PMID: 37781808 PMCID: PMC10657689 DOI: 10.3233/jad-230742] [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] [Accepted: 08/22/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Periodontal disease (PeD) is a risk factor of Alzheimer's disease and is associated with cognitive decline in older adults. However, the relationships between subitems of neuropsychological tests and PeD have not been fully clarified. OBJECTIVE To evaluate associations between PeD and subitems of neuropsychological tests. METHODS We performed a cross-sectional analysis of data of 183 participants (women: 50%, mean age: 79 years) from a clinical study. We enrolled patients who visited our memory clinic and assessed demographics, dementia-related risk factors, neuropsychological tests, brain magnetic resonance images, and a dental screening check. We evaluated the relationships between cognitive function and PeD using multivariable logistic regression analyses. RESULTS Participants with dementia were less likely to make periodical visits to the dentist, had fewer teeth, had less frequent tooth brushing habits, and were more likely to have PeD. Impaired cognitive function was significantly associated with an increasing degree of PeD. In multivariable logistic regression analyses, impaired visuospatial function and attention were associated with twice the risk of moderate or severe PeD compared with individuals with preserved visuospatial function and attention (odds ratio: 2.11, 95% confidence interval: 1.04-4.29, p = 0.037). Impaired word recall and recognition and following commands were associated with increased risk of PeD (odds ratio: 2.80, 95% confidence interval: 1.41-5.32, p = 0.003). CONCLUSIONS Cognitive decline, such as impaired visuospatial function, attention, word recall and recognition, and inability to follow commands were independently and strongly associated with PeD. These items can be assessed easily on a daily basis.
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Affiliation(s)
- Naoki Saji
- Center for Comprehensive Care and Research on Memory Disorders, Hospital, National Center for Geriatrics and Gerontology, Aichi, Japan
| | | | - Kenta Murotani
- Biostatistics Center, Graduate School of Medicine, Kurume University, Fukuoka, Japan
| | | | - Akinori Takeda
- Center for Comprehensive Care and Research on Memory Disorders, Hospital, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Takashi Sakurai
- Center for Comprehensive Care and Research on Memory Disorders, Hospital, National Center for Geriatrics and Gerontology, Aichi, Japan
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Aichi, Japan
- Department of Cognition and Behavioral Science, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Kenji Matsushita
- Department of Oral Disease Research, Geroscience Research Center, Research Institute, National Center for Geriatrics and Gerontology, Aichi, Japan
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