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Severe periodontitis with tooth loss as a modifiable risk factor for the development of Alzheimer, vascular, and mixed dementia: National Health Insurance Service-National Health Screening Retrospective Cohort 2002-2015

  • Kim, Do-Hyung (Department of Periodontology, Daejeon Dental Hospital, Institute of Wonkwang Dental Research, Wonkwang University College of Dentistry) ;
  • Jeong, Seong-Nyum (Department of Periodontology, Daejeon Dental Hospital, Institute of Wonkwang Dental Research, Wonkwang University College of Dentistry) ;
  • Lee, Jae-Hong (Department of Periodontology, Daejeon Dental Hospital, Institute of Wonkwang Dental Research, Wonkwang University College of Dentistry)
  • Received : 2020.01.22
  • Accepted : 2020.05.08
  • Published : 2020.10.30

Abstract

Purpose: The purpose of this study was to evaluate severe periodontitis with tooth loss as a modifiable risk factor for Alzheimer dementia (AD), vascular dementia (VaD), and mixed dementia (MD) using the National Health Insurance Service-National Health Screening Retrospective Cohort database with long-term follow-up over 14 years. Methods: Multivariate Cox hazards regression analysis was applied to a longitudinal retrospective database, which was updated in 2018, to evaluate the association between severe periodontitis with few remaining teeth and dementia after adjusting for potential risk factors, including sociodemographic factors and comorbid diseases. Results: Among 514,866 individuals in South Korea, 237,940 (46.2%) participants satisfying the inclusion criteria were selected. A total of 10,115 age- and sex-matched participants with severe periodontitis and 10,115 periodontally healthy participants were randomly selected and evenly assigned. The results showed that the risks of AD (hazard ratio [HR], 1.08), VaD (HR, 1.24), and MD (HR, 1.16) were significantly higher in patients with severe periodontitis with 1-9 remaining teeth after adjustment for sociodemographic factors, anthropomorphic measurements, lifestyle factors, and comorbidities. Conclusions: Severe periodontitis with few remaining teeth (1-9) may be considered a modifiable risk factor for the development of AD, VaD, and MD in Korean adults.

Keywords

References

  1. Sposato LA, Kapral MK, Fang J, Gill SS, Hackam DG, Cipriano LE, et al. Declining incidence of stroke and dementia: coincidence or prevention opportunity? JAMA Neurol 2015;72:1529-31. https://doi.org/10.1001/jamaneurol.2015.2816
  2. Sorbi S, Hort J, Erkinjuntti T, Fladby T, Gainotti G, Gurvit H, et al. EFNS-ENS Guidelines on the diagnosis and management of disorders associated with dementia. Eur J Neurol 2012;19:1159-79. https://doi.org/10.1111/j.1468-1331.2012.03784.x
  3. Alzheimer's Association. Alzheimer's Association Report: 2017 Alzheimer's disease facts and figures. Alzheimers Dement 2017;13:325-73. https://doi.org/10.1016/j.jalz.2017.02.001
  4. Hebert LE, Weuve J, Scherr PA, Evans DA. Alzheimer disease in the United States (2010-2050) estimated using the 2010 census. Neurology 2013;80:1778-83. https://doi.org/10.1212/WNL.0b013e31828726f5
  5. Liu CC, Liu CC, Kanekiyo T, Xu H, Bu G. Apolipoprotein E and Alzheimer disease: risk, mechanisms and therapy. Nat Rev Neurol 2013;9:106-18. https://doi.org/10.1038/nrneurol.2012.263
  6. Abbayya K, Puthanakar NY, Naduwinmani S, Chidambar YS. Association between periodontitis and Alzheimer's disease. N Am J Med Sci 2015;7:241-6. https://doi.org/10.4103/1947-2714.159325
  7. O'Brien JT, Thomas A. Vascular dementia. Lancet 2015;386:1698-706. https://doi.org/10.1016/S0140-6736(15)00463-8
  8. Iadecola C. The pathobiology of vascular dementia. Neuron 2013;80:844-66. https://doi.org/10.1016/j.neuron.2013.10.008
  9. Schneider JA, Arvanitakis Z, Bang W, Bennett DA. Mixed brain pathologies account for most dementia cases in community-dwelling older persons. Neurology 2007;69:2197-204. https://doi.org/10.1212/01.wnl.0000271090.28148.24
  10. Lee JH, Jeong SN, Choi SH. Predictive data mining for diagnosing periodontal disease: the Korea National Health and Nutrition Examination Surveys (KNHANES V and VI) from 2010 to 2015. J Public Health Dent 2019;79:44-52. https://doi.org/10.1111/jphd.12293
  11. Lee JH, Oh JY, Youk TM, Jeong SN, Kim YT, Choi SH. Association between periodontal disease and non-communicable diseases: a 12-year longitudinal health-examinee cohort study in South Korea. Medicine (Baltimore) 2017;96:e7398. https://doi.org/10.1097/MD.0000000000007398
  12. Lee JH, Lee JS, Park JY, Choi JK, Kim DW, Kim YT, et al. Association of lifestyle-related comorbidities with periodontitis: a nationwide cohort study in Korea. Medicine (Baltimore) 2015;94:e1567. https://doi.org/10.1097/MD.0000000000001567
  13. Choi JK, Kim YT, Kweon HI, Park EC, Choi SH, Lee JH. Effect of periodontitis on the development of osteoporosis: results from a nationwide population-based cohort study (2003-2013). BMC Womens Health 2017;17:77. https://doi.org/10.1186/s12905-017-0440-9
  14. Lee JH, Kweon HH, Choi JK, Kim YT, Choi SH. Association between periodontal disease and prostate cancer: results of a 12-year longitudinal cohort study in South Korea. J Cancer 2017;8:2959-65. https://doi.org/10.7150/jca.20532
  15. Philip P, Rogers C, Kruger E, Tennant M. Oral hygiene care status of elderly with dementia and in residential aged care facilities. Gerodontology 2012;29:e306-11. https://doi.org/10.1111/j.1741-2358.2011.00472.x
  16. Ghezzi EM, Ship JA. Dementia and oral health. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;89:2-5. https://doi.org/10.1016/S1079-2104(00)80003-7
  17. Maurer K, Rahming S, Prvulovic D. Dental health in advanced age and Alzheimer's disease: a possible link with bacterial toxins entering the brain? Psychiatry Res Neuroimaging 2018;282:132-3. https://doi.org/10.1016/j.pscychresns.2018.06.009
  18. Riviere GR, Riviere KH, Smith KS. Molecular and immunological evidence of oral Treponema in the human brain and their association with Alzheimer's disease. Oral Microbiol Immunol 2002;17:113-8. https://doi.org/10.1046/j.0902-0055.2001.00100.x
  19. Lafon A, Pereira B, Dufour T, Rigouby V, Giroud M, Bejot Y, et al. Periodontal disease and stroke: a meta-analysis of cohort studies. Eur J Neurol 2014;21:1155-61. https://doi.org/10.1111/ene.12415
  20. Lee JH, Lee JS, Choi JK, Kweon HI, Kim YT, Choi SH. National dental policies and socio-demographic factors affecting changes in the incidence of periodontal treatments in Korean: A nationwide population-based retrospective cohort study from 2002-2013. BMC Oral Health 2016;16:118. https://doi.org/10.1186/s12903-016-0310-0
  21. Choi S, Kim K, Chang J, Kim SM, Kim SJ, Cho HJ, et al. Association of chronic periodontitis on Alzheimer's disease or vascular dementia. J Am Geriatr Soc 2019;67:1234-9. https://doi.org/10.1111/jgs.15828
  22. Yoo JJ, Yoon JH, Kang MJ, Kim M, Oh N. The effect of missing teeth on dementia in older people: a nationwide population-based cohort study in South Korea. BMC Oral Health 2019;19:61. https://doi.org/10.1186/s12903-019-0750-4
  23. Dubois B, Feldman HH, Jacova C, Dekosky ST, Barberger-Gateau P, Cummings J, et al. Research criteria for the diagnosis of Alzheimer's disease: revising the NINCDS-ADRDA criteria. Lancet Neurol 2007;6:734-46. https://doi.org/10.1016/S1474-4422(07)70178-3
  24. Langa KM, Foster NL, Larson EB. Mixed dementia: emerging concepts and therapeutic implications. JAMA 2004;292:2901-8. https://doi.org/10.1001/jama.292.23.2901
  25. Takeuchi K, Ohara T, Furuta M, Takeshita T, Shibata Y, Hata J, et al. Tooth loss and risk of dementia in the community: the Hisayama study. J Am Geriatr Soc 2017;65:e95-100. https://doi.org/10.1111/jgs.14791
  26. Zhu J, Li X, Zhu F, Chen L, Zhang C, McGrath C, et al. Multiple tooth loss is associated with vascular cognitive impairment in subjects with acute ischemic stroke. J Periodontal Res 2015;50:683-8. https://doi.org/10.1111/jre.12251
  27. Okamoto N, Morikawa M, Okamoto K, Habu N, Iwamoto J, Tomioka K, et al. Relationship of tooth loss to mild memory impairment and cognitive impairment: findings from the Fujiwara-kyo study. Behav Brain Funct 2010;6:77. https://doi.org/10.1186/1744-9081-6-77
  28. Okamoto N, Morikawa M, Okamoto K, Habu N, Hazaki K, Harano A, et al. Tooth loss is associated with mild memory impairment in the elderly: the Fujiwara-kyo study. Brain Res 2010;1349:68-75. https://doi.org/10.1016/j.brainres.2010.06.054
  29. Lee JH, Choi JK, Kim SH, Cho KH, Kim YT, Choi SH, et al. Association between periodontal flap surgery for periodontitis and vasculogenic erectile dysfunction in Koreans. J Periodontal Implant Sci 2017;47:96-105. https://doi.org/10.5051/jpis.2017.47.2.96
  30. Lee JH, Choi JK, Jeong SN, Choi SH. Charlson comorbidity index as a predictor of periodontal disease in elderly participants. J Periodontal Implant Sci 2018;48:92-102. https://doi.org/10.5051/jpis.2018.48.2.92
  31. Engelhart MJ, Geerlings MI, Meijer J, Kiliaan A, Ruitenberg A, van Swieten JC, et al. Inflammatory proteins in plasma and the risk of dementia: the Rotterdam study. Arch Neurol 2004;61:668-72. https://doi.org/10.1001/archneur.61.5.668
  32. Sparks Stein P, Steffen MJ, Smith C, Jicha G, Ebersole JL, Abner E, et al. Serum antibodies to periodontal pathogens are a risk factor for Alzheimer's disease. Alzheimers Dement 2012;8:196-203. https://doi.org/10.1016/j.jalz.2011.04.006
  33. Foschi F, Izard J, Sasaki H, Sambri V, Prati C, Muller R, et al. Treponema denticola in disseminating endodontic infections. J Dent Res 2006;85:761-5. https://doi.org/10.1177/154405910608500814
  34. Miklossy J, Kis A, Radenovic A, Miller L, Forro L, Martins R, et al. Beta-amyloid deposition and Alzheimer's type changes induced by Borrelia spirochetes. Neurobiol Aging 2006;27:228-36. https://doi.org/10.1016/j.neurobiolaging.2005.01.018
  35. D'Aiuto F, Parkar M, Andreou G, Suvan J, Brett PM, Ready D, et al. Periodontitis and systemic inflammation: control of the local infection is associated with a reduction in serum inflammatory markers. J Dent Res 2004;83:156-60. https://doi.org/10.1177/154405910408300214
  36. Fernando MS, Ince PG; MRC Cognitive Function and Ageing Neuropathology Study Group. Vascular pathologies and cognition in a population-based cohort of elderly people. J Neurol Sci 2004;226:13-7. https://doi.org/10.1016/j.jns.2004.09.004
  37. Straka M, Trapezanlidis M. Periodontitis and stroke. Neuroendocrinol Lett 2013;34:200-6.
  38. Kalaria RN, Maestre GE, Arizaga R, Friedland RP, Galasko D, Hall K, et al. Alzheimer's disease and vascular dementia in developing countries: prevalence, management, and risk factors. Lancet Neurol 2008;7:812-26. https://doi.org/10.1016/S1474-4422(08)70169-8
  39. Lee JH, Oh JY, Choi JK, Kim YT, Park YS, Jeong SN, et al. Trends in the incidence of tooth extraction due to periodontal disease: results of a 12-year longitudinal cohort study in South Korea. J Periodontal Implant Sci 2017;47:264-72. https://doi.org/10.5051/jpis.2017.47.5.264
  40. Kim YT, Choi JK, Kim DH, Jeong SN, Lee JH. Association between health status and tooth loss in Korean adults: longitudinal results from the National Health Insurance Service-Health Examinee Cohort, 2002-2015. J Periodontal Implant Sci 2019;49:158-70. https://doi.org/10.5051/jpis.2019.49.3.158

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