Tooth loss, dementia and neuropathology in the Nun study.

BACKGROUND Numerous studies have linked dementia to the subsequent deterioration of oral health. Few investigators, however, have examined oral disease as a potential risk factor in the development of dementia. The authors conducted a study to investigate a potential association between a history of oral disease and the development of dementia. METHODS Longitudinal dental records supplemented data collected from 10 annual cognitive assessments of 144 Milwaukee participants in the Nun Study, a longitudinal study of aging and Alzheimer disease, who were 75 to 98 years old. Neuropathologic findings at autopsy were available for 118 participants who died. RESULTS A low number of teeth increased the risk of higher prevalence and incidence of dementia. CONCLUSION Participants with the fewest teeth had the highest risk of prevalence and incidence of dementia. CLINICAL IMPLICATIONS Edentulism or very few (one to nine) teeth may be predictors of dementia late in life.

[1]  J. Beck,et al.  Relationships among clinical measures of periodontal disease and their associations with systemic markers. , 2002, Annals of periodontology.

[2]  S. Levy,et al.  Oral health of persons with and without dementia attending a geriatric clinic. , 1997, Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry.

[3]  B. Gurland,et al.  The performance test of activities of daily living. , 1976, International journal of aging & human development.

[4]  S. Gordon.  Survey of dental need among veterans with severe cognitive impairment. , 1988, Gerodontics.

[5]  J. Morris,et al.  The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part I. Clinical and neuropsychological assesment of Alzheimer's disease , 1989, Neurology.

[6]  B. Winblad,et al.  Alzheimer's disease, oral function and nutritional status. , 1996, Gerodontology.

[7]  James A. Mortimer,et al.  Potentially modifiable risk factors for dementia in identical twins , 2006, Alzheimer's & Dementia.

[8]  P. Vokonas,et al.  Periodontal Disease and Cardiovascular Disease. , 1996, Journal of periodontology.

[9]  R. Skinner,et al.  In vivo and in vitro evidence supporting a role for the inflammatory cytokine interleukin-1 as a driving force in Alzheimer pathogenesis , 1996, Neurobiology of Aging.

[10]  U. John,et al.  The Interleukin-1 Polymorphism, Smoking, and the Risk of Periodontal Disease in the Population-based SHIP Study , 2003, Journal of dental research.

[11]  W. Loesche,et al.  The relationship between dental disease and cerebral vascular accident in elderly United States veterans. , 1998, Annals of periodontology.

[12]  A. Spencer,et al.  The prevalence and experience of oral diseases in Adelaide nursing home residents. , 2002, Australian dental journal.

[13]  P. Allison.  Survival analysis using the SAS system : a practical guide , 1995 .

[14]  A. Spencer,et al.  Oral diseases and conditions in community-living older adults with and without dementia. , 2003, Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry.

[15]  U. John,et al.  Dose-effect relation of smoking and the interleukin-1 gene polymorphism in periodontal disease. , 2004, Journal of periodontology.

[16]  Scott A. Puckett,et al.  Longitudinal Study on Oral Health in Subjects with Alzheimer's Disease , 1994, Journal of the American Geriatrics Society.

[17]  David A. Snowdon,et al.  Healthy Aging and Dementia: Findings from the Nun Study , 2003, Annals of Internal Medicine.

[18]  K Kondo,et al.  A case-control study of Alzheimer's disease in Japan--significance of life-styles. , 1994, Dementia.

[19]  W. Markesbery,et al.  Delayed recall, hippocampal volume and Alzheimer neuropathology , 2004, Neurology.

[20]  F. Hoek,et al.  Elevation of systemic markers related to cardiovascular diseases in the peripheral blood of periodontitis patients. , 2000, Journal of periodontology.

[21]  H. Becher,et al.  Periodontal Disease as a Risk Factor for Ischemic Stroke , 2004, Stroke.

[22]  S. Sonis,et al.  Cavernous sinus thrombosis and brain abscess initiated and maintained by periodontally involved teeth. , 1982, Journal of oral medicine.

[23]  M. Ganguli,et al.  Medical and Cognitive Correlates of Denture Wearing in Older Community‐Dwelling Adults , 2004, Journal of the American Geriatrics Society.

[24]  B. Loos.  Systemic Markers of Inflammation in Periodontitis. , 2005, Journal of periodontology.

[25]  Association of early‐onset Alzheimer's disease with an interleukin‐1α gene polymorphism , 2000, Annals of neurology.

[26]  F. Pociot,et al.  A Taql polymorphism in the human interleukin‐1β (IL‐1β) gene correlates with IL‐1β secretion in vitro , 1992 .

[27]  C. Plata-salamán,et al.  Inflammation and Alzheimer’s disease , 2000, Neurobiology of Aging.

[28]  D. Remick,et al.  Cytokines and the brain: implications for clinical psychiatry. , 2000, The American journal of psychiatry.

[29]  Walter C. Willett,et al.  Periodontal Disease, Tooth Loss, and Incidence of Ischemic Stroke , 2003, Stroke.

[30]  R W Pew,et al.  Simulated activities of daily living examination. , 1972, Archives of physical medicine and rehabilitation.

[31]  M. Steffen,et al.  Systemic acute‐phase reactants, C‐reactive protein and haptoglobin, in adult periodontitis , 1997, Clinical and experimental immunology.

[32]  G. Rebeck.  Confirmation of the genetic association of interleukin-1A with early onset sporadic Alzheimer's disease , 2000, Neuroscience Letters.

[33]  R. Page.  The pathobiology of periodontal diseases may affect systemic diseases: inversion of a paradigm. , 1998, Annals of periodontology.

[34]  J. Ebersole,et al.  Acute-phase reactants in infections and inflammatory diseases. , 2000, Periodontology 2000.

[35]  S. Offenbacher.  Periodontal diseases: pathogenesis. , 1996, Annals of periodontology.

[36]  M. Trevisan,et al.  Periodontal infections contribute to elevated systemic C-reactive protein level. , 2001, Journal of periodontology.

[37]  H. Becher,et al.  Association between acute cerebrovascular ischemia and chronic and recurrent infection. , 1997, Stroke.

[38]  M. Faddy,et al.  A longitudinal study of interleukin-1 gene polymorphisms and periodontal disease in a general adult population. , 2001, Journal of clinical periodontology.

[39]  S. Gordon,et al.  Dental needs related to primary cause for institutionalization. , 1991, Special Care in Dentistry: managing special patients, settings, and situations.

[40]  G. Duff,et al.  Interleukin-1 genetic association with periodontitis in clinical practice. , 2000, Journal of periodontology.

[41]  J. Toole,et al.  Relationship of Periodontal Disease and Edentulism to Stroke/TIA , 2003, Journal of dental research.

[42]  H. O. Wiggerts,et al.  Disseminated actinomycosis due to Actinomyces meyeri and Actinobacillus actinomycetemcomitans. , 1992, Scandinavian journal of infectious diseases.

[43]  A D Roses,et al.  Utility of the apolipoprotein E genotype in the diagnosis of Alzheimer's disease. Alzheimer's Disease Centers Consortium on Apolipoprotein E and Alzheimer's Disease. , 1998, The New England journal of medicine.

[44]  A. Jette,et al.  Oral Disease and Physical Disability in Community‐Dwelling Older Persons , 1993, Journal of the American Geriatrics Society.

[45]  W. Markesbery,et al.  Alzheimer's neurofibrillary pathology and the spectrum of cognitive function: Findings from the Nun Study , 2002, Annals of neurology.

[46]  David A. Snowdon,et al.  Early life linguistic ability, late life cognitive function, and neuropathology: findings from the Nun Study , 2005, Neurobiology of Aging.

[47]  J. Ship,et al.  Dementia and oral health. , 2000, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[48]  Dianxu Ren,et al.  Systemic Inflammatory Markers, Periodontal Diseases, and Periodontal Infections in an Elderly Population , 2005, Journal of the American Geriatrics Society.

[49]  J. Haines,et al.  Gene dose of apolipoprotein E type 4 allele and the risk of Alzheimer's disease in late onset families. , 1993, Science.

[50]  H. Braak,et al.  Neuropathological stageing of Alzheimer-related changes , 2004, Acta Neuropathologica.

[51]  I. Soh,et al.  Influence of Dentition Status on Physical Disability, Mental Impairment, and Mortality in Institutionalized Elderly People , 2001, Journal of dental research.

[52]  H. Braak,et al.  Close-meshed prevalence rates of different stages as a tool to uncover the rate of Alzheimer's disease-related neurofibrillary changes , 1995, Neuroscience.

[53]  J. Ebersole.  Systemic humoral immune responses in periodontal disease. , 1990, Critical reviews in oral biology and medicine : an official publication of the American Association of Oral Biologists.

[54]  M. Pericak-Vance,et al.  Specificity, sensitivity, and predictive value of apolipoprotein-E genotyping for sporadic Alzheimer's disease , 1996, The Lancet.

[55]  D. Snowdon,et al.  Aging and Alzheimer's disease: lessons from the Nun Study. , 1997, The Gerontologist.

[56]  L. Launer,et al.  Association of interleukin-1 gene polymorphisms with dementia in a community-based sample: The Honolulu-Asia Aging Study , 2006, Neurobiology of Aging.

[57]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[58]  W. Markesbery,et al.  Brain infarction and the clinical expression of Alzheimer disease. , 1997, JAMA.

[59]  D. Remick,et al.  Cytokines in Health and Disease , 1992 .

[60]  R. Mrak,et al.  Interleukin-1, neuroinflammation, and Alzheimer’s disease , 2001, Neurobiology of Aging.

[61]  J. J. Taylor,et al.  Association of interleukin-1 gene polymorphisms with early-onset periodontitis. , 2000, Journal of clinical periodontology.

[62]  R. Garcia,et al.  Caries incidence in patients with dementia. , 1993, Gerodontology.

[63]  H. Worthington,et al.  The dental health of the elderly mentally ill: a preliminary report , 1987, British Dental Journal.

[64]  R. M. Shaw,et al.  Normative dental treatment needs of Alzheimer patients. , 1991, Australian dental journal.

[65]  W. Markesbery,et al.  Progression of regional neuropathology in Alzheimer disease and normal elderly: findings from the Nun study. , 1999, Alzheimer disease and associated disorders.

[66]  J. Pankow,et al.  Acute-phase Inflammatory Response to Periodontal Disease in the US Population , 2000, Journal of dental research.

[67]  J. Ship,et al.  Oral health of patients with Alzheimer's disease. , 1992, Journal of the American Dental Association.

[68]  C Lindh,et al.  Type 2 diabetes and risk for periodontal disease: a role for dental health awareness. , 2006, Journal of clinical periodontology.

[69]  W. Loesche,et al.  Dental findings in geriatric populations with diverse medical backgrounds. , 1995, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[70]  I. Lamster,et al.  The Influence of Interleukin Gene Polymorphism on Expression of Interleukin-1β and Tumor Necrosis Factor-α in Periodontal Tissue and Gingival Crevicular Fluid. , 1999, Journal of periodontology.

[71]  R. Rosenberg.  The Molecular and Genetic Basis of Neurologic and Psychiatric Disease , 2007 .

[72]  G. Swart,et al.  Pericarditis, pneumonia and brain abscess due to a combined Actinomyces--Actinobacillus actinomycetemcomitans infection. , 1992, The Journal of infection.

[73]  J. Bauer,et al.  Detection of interleukin-6 and alpha 2-macroglobulin immunoreactivity in cortex and hippocampus of Alzheimer's disease patients. , 1992, Laboratory investigation; a journal of technical methods and pathology.

[74]  Boston F. Martin,et al.  Brain abscess due to Actinobacillus actinomycetemcomitans , 1967, Neurology.

[75]  W. Markesbery,et al.  Brain infarction and the clinical expression of Alzheimer disease. The Nun Study. , 1997, JAMA.

[76]  G. Riviere,et al.  Molecular and immunological evidence of oral Treponema in the human brain and their association with Alzheimer's disease. , 2002, Oral microbiology and immunology.

[77]  T. Renton,et al.  Cerebral abscess complicating dental treatment. Case report and review of the literature. , 1996, Australian dental journal.

[78]  D R Wekstein,et al.  Linguistic ability in early life and cognitive function and Alzheimer's disease in late life. Findings from the Nun Study. , 1996, JAMA.

[79]  P. Marks,et al.  Multiple brain abscesses secondary to dental caries and severe periodontal disease. , 1988, British Journal of Oral and Maxillofacial Surgery.

[80]  R. Gomez,et al.  A functional interleukin-1 beta gene polymorphism is associated with chronic periodontitis in a sample of Brazilian individuals. , 2005, Journal of periodontal research.

[81]  James A. Mortimer,et al.  Brain Infarction and the Clinical Expression of Alzheimer Disease-Reply , 1997 .

[82]  H. Horton,et al.  Parietal lobe abscess after routine periodontal recall therapy. Report of a case. , 1990, Journal of periodontology.

[83]  Salomon Amar,et al.  The impact of periodontal infection on systemic diseases. , 2003, Medical science monitor : international medical journal of experimental and clinical research.