Tooth Loss and Blood Pressure in Parkinson's Disease Patients: An Exploratory Study on NHANES Data

Association of dietary selenium intake and all-cause mortality of Parkinson's disease and its interaction with blood cadmium level: a retrospective cohort study

BACKGROUND

Parkinson's disease (PD) is a slowly progressive neurodegenerating disease that may eventually lead to disabling condition and pose a threat to the health of aging populations. This study aimed to explore the association of two potential risk factors, selenium and cadmium, with the prognosis of Parkinson's disease as well as their interaction effect.

METHODS

Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 2005-2006 to 2015-2016 and National Death Index (NDI). Participants were classified as Parkinson's patients by self-reported anti-Parkinson medications usage. Cox regression models and restricted cubic spline models were applied to evaluate the association between PD mortality and selenium intake level as well as blood cadmium level. Subgroup analysis was also conducted to explore the interaction between them.

RESULTS

A total of 184 individuals were included. In full adjusted cox regression model (adjusted for age, gender, race, hypertension, pesticide exposure, smoking status and caffeine intake), compared with participants with low selenium intake, those with normal selenium intake level were significantly associated with less risk of death (95%CI: 0.18-0.76, P = 0.005) while no significant association was found between low selenium intake group and high selenium group (95%CI: 0.16-1.20, P = 0.112). Restricted cubic spline model indicated a nonlinear relationship between selenium intake and PD mortality (P for nonlinearity = 0.050). The association between PD mortality and blood cadmium level was not significant (95%CI: 0.19-5.57, P = 0.112). However, the interaction term of selenium intake and blood cadmium showed significance in the cox model (P for interaction = 0.048). Subgroup analysis showed that the significant protective effect of selenium intake existed in populations with high blood cadmium but not in populations with low blood cadmium.

CONCLUSION

Moderate increase of selenium intake had a protective effect on PD mortality especially in high blood cadmium populations.

Chewing difficulties mediated association between edentulism and depressive symptoms among middle aged and older population

BACKGROUND

Depression is a major health condition among the aging population. Previous studies indicated that edentulism was a risk factor for depression. The link between edentulism and depression has not been fully clarified.

OBJECTIVES

This study aimed to estimate whether chewing difficulties play a mediating role in the association between edentulism and depression among middle-aged and older populations with national cross-sectional data.

METHODS

Data were obtained from the latest fourth wave of the China Health and Retirement Longitudinal Study (CHARLS). The outcome variable was set as depression, which was measured by the Center for Epidemiologic Studies Depression Scale (CES-D-10). Independent and mediated variables were separately set as self-assessed edentulism and chewing difficulties. The nearest neighbour propensity score matching (PSM) method was used to construct a matching group to balance the basic characteristics of individuals with and without edentulism with minimised bias in the estimation. Causal mediation analysis was performed to estimate the degree of contribution of chewing difficulties to the association between edentulism and depression. Several sensitivity analyses were performed to evaluate the robustness of the primary result.

RESULTS

A total of 15 853 individuals remained for analysis. After PSM, 809 individuals with edentulism and 2628 without edentulism remained for analysis. Among the matched individuals, the mean age was 66.3 ± 9.2 years, 58.5% were female, 78.8% lived in rural areas, 23.5% had edentulism, 51.1% had depressive symptoms, and 50.1% had chewing difficulties. Logistic regression results showed that a higher incidence of edentulism was associated with a higher rate of depression (OR: 1.39, 95% CI: 1.19-1.63) in the matching group. Causal mediation analysis results indicated that the average mediation effect of chewing difficulties on the association between edentulism and depression was 0.010 (95% CI: 0.005-0.015), and the average direct effect was 0.072 (95% CI: 0.036-0.11). The mediation proportion of chewing difficulties was 11.7% (95% CI: 0.079-0.21).

CONCLUSION

A higher prevalence of edentulism was associated with a higher rate of depression among middle-aged and elderly populations. Chewing difficulties moderately mediated the association between edentulism and depression. Fundamental oral function should not be neglected to improve mental health among the aging population.

Oral health experiences of people living with Parkinson's disease: a scoping review

Background and aim Parkinson's disease is the fastest growing and second most common progressive neurodegenerative condition in the UK; poised to represent a major societal and health care challenge. The scoping review aims to provide an overview of the literature on the oral health (OH) experiences of people living with Parkinson's, identifying current research gaps and future priorities.Method Search strategies included three electronic databases, two grey literature databases, relevant organisations, specialist journals and hand searching of the reference lists. A data extraction tool was developed and piloted.Results A total of 121 items were included in the review. Four themes were identified: OH impact, education and training, service delivery and wider impacts of OH for people with Parkinson's (PwP). The majority of studies included were cross-sectional in design, describing the OH status of PwP.Conclusion The majority of research to date has focused on OH impact. Areas for future research include use of qualitative studies exploring the experiences, attitudes and priorities of PwP and their care partners. Inclusion of medical, dental and allied health care professionals, together with people with lived experience, is required to develop, implement and evaluate interventions to support OH.

Parkinson's disease and oral health: A systematic review

OBJECTIVE

in patients with Parkinson's Disease (PD), oral health can be affected by motor and non-motor symptoms and/or medication use. Therefore, the aim was to systematically review the literature on oral health and associated factors of oral health in PD patients.

DESIGN

a literature search was performed from inception up to April 5th, 2023. Original studies that assessed oral health-related factors in PD patients and were written in English or Dutch, were included.

RESULTS

11276 articles were identified, of which 43 met the inclusion criteria (quality range poor-good). A higher prevalence of dental biofilm, bleeding/gingivitis, pocket depth (≥4 mm), tooth mobility, caries, and number of decayed missing filled teeth/surfaces was found in PD patients than in controls. However, no difference between both groups was found when analysing edentulism and wearing dentures. Poor oral health of PD patients was associated with a longer disease duration, higher disease severity, and more prescribed medications.

CONCLUSIONS

oral health of PD patients is worse than that of healthy individuals. It is associated with the duration and severity of PD and medication use. Therefore, we advise regular appointments with oral health care professionals, with an important focus on prevention.

Association between trichlorophenols and neurodegenerative diseases: A cross-sectional study from NHANES 2003-2010

PURPOSE OF THE RESEARCH

To evaluate the association of the exposure of trichlorophenols (TCPs) on the morbidity and mortality of patients with Parkinson's disease (PD) and Alzheimer's disease (AD) using the data from the National Health and Nutrition Examination Survey (NHANES) 2003-2010. Multivariable logistic regression models and COX regression were used to evaluate the association between TCP exposure and the AD and PD risk. Least Absolute Shrinkage and Selection Operator (LASSO) methods were used to screen latent covariates.

PRINCIPAL RESULTS

A total of 6333 participants over the age of 18 years were included in the analysis. After the adjustments for major confounders, participants with higher concentrations of urinary 2,4,6-TCP had higher risk of AD (odds ratios (ORs), 3.19; 95% CI: 1.07, 9.45) than the group below the limit of detection (LOD). Compared to group of below the LOD, higher urinary concentrations of 2,4,5-TCP was associated with higher risk of all-cause mortality in PD patients (log-rank P = 0.022) and all participants (log-rank P < 0.001) without adjustments for confounders. In addition, a higher risk of all-cause mortality in all participants with high urinary concentrations of 2,4,6-TCP (log-rank P = 0.001) was found without adjustments for confounders. With the adjustments for major confounders, participants with higher concentrations of urinary 2,4,5-TCP had a higher risk of death in patients with PD (hazard ratios (HRs), 53.19; 95% CI: 2.82, 1004.13) than in the group below the LOD.

MAJOR CONCLUSIONS

Exposure to high concentration of 2,4,6-TCP may increase the risk of AD, and the level of 2,4,5-TCP may be associated with the risk of death in patients with PD. Our findings reveal the potential toxicity of TCPs, highlight the potential impact of TCPs on neurodegenerative diseases, and express concerns regarding the use of organochlorine pesticides.

Association Between High Serum Tetrahydrofolate and Low Cognitive Functions in the United States: A Cross-Sectional Study

Background: The relationship between serum folate status and cognitive functions is still controversial. Objective: To evaluate the association between serum tetrahydrofolate and cognitive functions. Methods: A total of 3,132 participants (60–80 years old) from the 2011–2014 NHANES were included in this cross-sectional study. The primary outcome measure was cognitive function assessment, determined by the Consortium to Establish a Registry for Alzheimer’s Disease Word Learning Test (CERAD-WL), CERAD-Delayed Recall Test (CERAD-DR), Animal Fluency Test (AF), Digit Symbol Substitution Test (DSST), and global cognitive score. Generalized linear model (GLM), multivariate logistic regression models, weighted generalized additive models (GAM), and subgroup analyses were performed to evaluate the association between serum tetrahydrofolate and low cognitive functions. Results: In GLM, and the crude model, model 1, model 2 of multivariate logistic regression models, increased serum tetrahydrofolate was associated with reduced cognitive functions via AF, DSST, CERAD-WL, CERAD-DR, and global cognitive score (p <  0.05). In GAM, the inflection points were 1.1, 2.8, and 2.8 nmol/L tetrahydrofolate, determined by a two-piece wise linear regression model of AF, DSST, and global cognitive score, respectively. Also, in GAM, there were no non-linear relationship between serum tetrahydrofolate and low cognitive functions, as determined by CERAD-WL or CERAD-DR. The results of subgroup analyses found that serum tetrahydrofolate levels and reduced cognitive functions as determined by AF had significant interactions for age and body mass index. The association between high serum tetrahydrofolate level and reduced cognitive functions as determined using DSST, CERAD-WL, CERAD-DR, or global cognitive score had no interaction with the associations between cognition and gender, or age, or so on. Conclusion: High serum tetrahydrofolate level is associated with significantly reduced cognitive function.

Association between tooth loss and hypertension: A systematic review and meta-analysis

OBJECTIVES

Poor oral health status may increase the risk of cardiovascular disease. However, whether a specific association exists between tooth loss and hypertension is inconclusive. Accordingly, a quantitative systematic review was conducted to investigate the relationship between tooth loss and hypertension.

METHODS

Systematic search, data analysis and quality assessment were conducted on relevant literature published in PubMed, Embase, Web of Science and Cochrane Libraries until October 2021. Odds ratio (OR) with 95% confidence interval (CI) was used as effect size to evaluate the association between tooth loss and hypertension. Meta-regression and subgroup analyses were performed to identify whether difference was associated with study-level factors.

RESULTS

Of the 56 studies selected, 28 studies in 16 different countries involving 1,224,821 individuals were eligible for the systematic review. After adjustment for confounding factors, individuals with tooth loss had a higher risk for hypertension (OR 1.20; 95%CI 1.10-1.30, I² = 40.02%). With respect to the risk of hypertension on tooth loss, individuals with hypertension still had a higher risk for tooth loss (OR 1.35; 95%CI 1.07-1.62, I² = 51.10%). Age limitation of the included population is the major source of heterogeneity. However, studies in which the population was limited to the elderly did not report an increase in association between tooth loss and hypertension compared with studies without age limitation.

CONCLUSIONS

The results suggest a bidirectional association between tooth loss and hypertension. Future longitudinal prospective studies are required to establish causality between tooth loss and hypertension.

CLINICAL SIGNIFICANCE

Subjects with severe tooth loss should be carefully monitored for the manifestation of hypertension. The oral health status of hypertensive patients should also be meticulous maintained to prevent unwarranted tooth loss.

An Exponential Curve Relationship Between Serum Urate and Migraine: A Cross-Section Study From NHANES

Background

Migraine is a common neurological disease and an important cause of disability worldwide. Serum urate is the end product of purine metabolism in Homo sapiens and other hominoids. Previous studies about the serum urate level in migraine were contradictory. Hence, we present a cross-section study to clarify the association between serum urate and migraine and explore the dose effect of serum urate on migraine.

Materials and Methods

The data for this cross-section study were acquired from the National Health and Nutrition Examination Survey (NHANES). A diagnosis of migraine was made through patient the self-reported and prescription medication. For data analysis, the weighted linear regression model, weighted chi-square test, logistic regression models, smooth curve fittings, and the two-piecewise linear regression model were utilized for data analysis. All data analysis was conducted on Empower software.

Results

Totally, 18,637 participants were enrolled in this study, of which 208 were migraineurs. The rest were set as control. There existed a statistically significant difference in mean age (p = 0.0389), gender (p< 0.0001), race (p< 0.0001), data release cycle (p = 0.048), drug usage, blood albumin (p< 0.0001), blood total protein (p< 0.0001), hemoglobin (p< 0.0001), serum iron (p< 0.0001), and serum urate (p< 0.0001) between the two groups. According to logistic regression models, there existed no consistent linear relationship between serum urate and migraine before (model 1: odd ratio (OR) = 0.83, p = 0.0004) or after adjusting for confounders (model 2: OR = 0.96, p = 0.5198; model 3: OR = 0.84, p = 0.0184). However, smooth curve fittings found an exponential curve relationship between serum urate and migraine. Furthermore, when serum urate was more than 7.8 mg/dl, higher serum urate was correlated with higher migraine occurrence (model 1: OR = 1.54, p = 0.0022; model 2: OR = 1.51, p = 0.0050; model 3: OR = 1.77, p = 0.0348). Besides, 8 out of the 208 migraineurs had a serum urate higher than 7.8 mg/dl.

Conclusions

In conclusion, there existed an exponential curve relationship between serum urate and migraine, with an infliction point of 7.8 mg/dl. When serum urate was more than 7.8 mg/dl, increased serum urate was correlated with higher migraine occurrence.

Self-reported periodontitis and C-reactive protein in Parkinson's disease: a cross-sectional study of two American cohorts

Periodontitis triggers systemic repercussions, such as elevated levels of high-sensitive C-reactive protein (hs-CRP). This has never been studied within Parkinson's Disease (PD). The aim of this study is to compare hs-CRP levels of self-reported periodontitis cases versus cases without periodontitis in PD patients. Data from the National Health and Nutrition Examination Survey (2015-2016 and 2017-2018 waves) were analyzed. PD cases were identified through medication regimens and periodontitis cases through a validated self-report questionnaire. 51 participants were included (24 females, 27 males, with mean age of 62.96 (14.71)). While the self-reported periodontitis group presented elevated levels of circulating hs-CRP (5.36 vs. 1.99 mg/L, p = 0.031), the self-reported without periodontitis group presented higher lymphocyte levels (29.35 vs. 28.03%, p = 0.007). Blood levels of hs-CRP were significantly higher in PD cases with self-reported periodontitis. Apart from the lymphocyte levels, there were no other significant differences according to the self-reported periodontal status. Future studies shall explore this association using clinical measures.

Non-linear association between Mediterranean diet and depressive symptom in U.S. adults: A cross-sectional study

The Mediterranean diet (MED), a dietary pattern rich in fruits and vegetables, whole grains, legumes, nuts, fish, and olive oil, has anti-oxidative and anti-inflammatory effects. Although some data suggest that MED adherence is associated with decreased manifestation of depressive symptoms, it remains necessary to further analyze this apparent non-linear association as well as the influence of different factors on the relationship between MED and depression. Here, we investigated associations between the alternate MED (aMED) score and depressive symptom via multivariate logistic regression, weighted generalized additive (GAM) and two-step linear regression models, analyzing data from the 2005-2018 National Health and Nutrition Examination Survey (NHANES). The most important factor relevant to aMED score that contributed to the prevalence of depressive symptom was assessed using random forest. Furthermore, we examined whether the relationship between aMED score and depressive symptom differs by age, race, sex, socioeconomic variables, lifestyle- and health-related variables, and chronic medical conditions, via subgroup analyses. A total of 19,477 participants (20-80 years of age) were included in this cross-sectional study. In crude and adjusted (1-5) multivariate logistic regression models, increased aMED score was noted to associate with non-depressive status, as defined using the Patient Health Questionnaire-9 (P < 0.05). Data analyses via GAM and two-piecewise linear regression revealed a non-linear association between aMED and depressive symptom, which had an inflection point of 3. Random forest results revealed that vegetable score contributes greatest to the relationship between aMED and depressive symptom. Subgroup analyses revealed that aMED score is significantly negatively related with depressive symptom in most different populations (P < 0.05) with the exception of high annual income, diabetes, borderline blood glucose level and Parkinson's disease (PD) (P > 0.05). In conclusion, we observed a non-linear association between aMED score and depressive symptom. Further studies are needed to validate our results.