Oral health and cognitive function in the Atherosclerosis Risk in Communities (ARIC) study

Naorungroj, Supawadee

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March 22, 2019

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Naorungroj, Supawadee
- Affiliation: Gillings School of Global Public Health, Department of Epidemiology

Abstract

Emerging evidence suggests possible links between poor oral health and cognitive dysfunction in older adults; however, it is unclear whether the association is present in midlife, and whether poor oral health in midlife increases risk of subsequent cognitive decline. The present study aimed to investigate whether a) periodontal disease and tooth loss were associated with low cognitive performance and b) periodontal disease and tooth loss were predictive of eight-year cognitive decline. The study used data collected from adults aged 52-75 years who participated in the dental health component of the Atherosclerosis Risk In Communities (ARIC) study. Cognitive function tests consisted of Delayed Word Recall (DWR), Digit Symbol Substitution (DSS), and Word Fluency (WF). At ARIC Visit 4 (1996-1998), 9,874 participants also answered dental screening questions, and 5,942 of the 8,554 dentate participants received comprehensive oral examinations, including periodontal probing. From 2004-2006, cognitive function for 911 participants was reassessed as part of the Brain MRI study; 785 of these participants were dentate, and 558 of them had received periodontal examinations at ARIC Visit 4. Models fit with multiple linear regression and generalized estimating equations (GEE) used dental status, number of teeth, or clinical periodontal conditions classified by the Biofilm-Gingival Interface (BGI) Index to predict Visit 4 cognitive scores and eight-year change in cognitive scores, respectively. In our cross-sectional study, complete tooth loss was consistently associated with lower performance on all three measures of cognitive function. Number of teeth and periodontal disease were associated only with DSS and WF scores. In our cohort study, mean scores from all three cognitive measures slightly decreased. Although we found that complete tooth loss was associated with low performance on two cognitive tests, the DWR and WF, our data did not support the hypothesis that poor oral health predicted greater cognitive decline. In these late-middle aged adults, complete tooth loss was significantly associated with low cognitive performance but not with subsequent cognitive decline. Although differences in mean scores between BGI groups were small, greater extent of gingival inflammation tended to correlate with lower cognitive scores.

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