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Periodontal disease and incident dementia: The Atherosclerosis Risk in Communities Study (ARIC).

TitlePeriodontal disease and incident dementia: The Atherosclerosis Risk in Communities Study (ARIC).
Publication TypeJournal Article
Year of Publication2020
AuthorsDemmer RT, Norby FL, Lakshminarayan K, Walker KA, Pankow JS, Folsom AR, Mosley T, Beck J
Secondary AuthorsLutsey PL
JournalNeurology
Volume95
Issue12
Paginatione1660-e1671
Date Published2020 09 22
ISSN1526-632X
KeywordsAged, Cohort Studies, Dementia, Female, Humans, Incidence, Male, Middle Aged, Periodontal Diseases, Risk Factors
Abstract

OBJECTIVE: To test the hypothesis that periodontal disease would be associated with increased risk for dementia and mild cognitive impairment (MCI) by assessing dementia/MCI outcomes after a baseline periodontal examination.

METHODS: Participants enrolled in the Atherosclerosis Risk in Communities study with a clinical periodontal examination (or edentulous participants) at visit 4 (1996-1998; mean ± SD age 63 ± 6 years, 55% female, 21% black) and adjudicated dementia outcomes through 2016 were included (n = 8,275). A subgroup of 4,559 participants had adjudicated dementia and MCI assessments at visit 5 (2011-2013). Participants received a full-mouth periodontal examination and were classified into periodontal profile classes (PPCs) based on the severity and extent of gingival inflammation and attachment loss. MCI and dementia were determined via neurocognitive testing, neurological examination and history, informant interviews, and brain MRI in a subset. Cox proportional hazards models regressed incident dementia on PPCs. Relative risk regression models were used for the composite of MCI/dementia.

RESULTS: The cumulative incidence and incidence density of dementia during follow-up (average 18.4 years) were 19% (n = 1,569) and 11.8 cases per 1,000 person-years. Multivariable adjusted hazard ratios for incident dementia among participants with severe PPC or edentulism (vs periodontal healthy) were 1.22 (95% confidence interval [CI] 1.01-1.47) and 1.21 (95% CI 0.99-1.48), respectively. For the combined dementia/MCI outcome, adjusted risk ratios among participants with mild/intermediate PPC, severe PPC, or edentulism (vs periodontal healthy) were 1.22 (95% CI 1.00-1.48), 1.15 (95% CI 0.88-1.51), and 1.90 (95% CI 1.40-2.58). Results were stronger among younger (≤62 years) participants ( for interaction = 0.02).

CONCLUSION: Periodontal disease was modestly associated with incident MCI and dementia in a community-based cohort of black and white participants.

DOI10.1212/WNL.0000000000010312
Alternate JournalNeurology
PubMed ID32727837
Grant ListHHSN268201700001I / HL / NHLBI NIH HHS / United States
HHSN268201700002I / HL / NHLBI NIH HHS / United States
HHSN268201700003I / HL / NHLBI NIH HHS / United States
HHSN268201700004I / HL / NHLBI NIH HHS / United States
HHSN268201700005I / HL / NHLBI NIH HHS / United States
U01 HL096812 / HL / NHLBI NIH HHS / United States
U01 HL096814 / HL / NHLBI NIH HHS / United States
U01 HL096899 / HL / NHLBI NIH HHS / United States
U01 HL096902 / HL / NHLBI NIH HHS / United States
U01 HL096917 / HL / NHLBI NIH HHS / United States