Periodontitis is associated with cognitive impairment among older adults: analysis of NHANES-III

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 80; no. 11; pp. 1206 - 1211
• Main Authors: Noble, J M, Borrell, L N, Papapanou, P N, Elkind, M S V, Scarmeas, N, Wright, C B
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01.11.2009; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: Age Factors; Aged; Alzheimer's disease; Biological and medical sciences; Blood pressure; Cardiovascular disease; Cognition; Cognition & reasoning; Cognition Disorders - complications; Cognition Disorders - epidemiology; Cross-Sectional Studies; Cytokines; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Dementia; Diabetes; Education; Family medical history; Female; Health insurance; Humans; Hypertension; Immunoglobulin G - blood; Inflammation; Male; Medical sciences; Memory; Middle Aged; Neurology; Nutrition Surveys; Older people; Pathogens; Periodontitis - complications; Periodontitis - epidemiology; Periodontitis - immunology; Porphyromonas gingivalis - immunology; Risk factors; Secondary schools; Socioeconomic factors; Stroke; Studies; Periodontal disease; Nervous system diseases; Cognitive disorder; Periodontitis; Stomatology
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp.2009.174029

Background:Periodontitis is ubiquitous and associated with serological evidence of exposure to periodontal organisms, systemic inflammation and vascular disease. Dementia is a major public health problem likely related to a complex interaction between genetics and diseases associated with systemic inflammation, including diabetes, smoking and stroke.Methods:To assess relationships between systemic exposure to periodontal pathogens and cognitive test outcomes, data were analysed from the Third National Health and Nutrition Examination Survey (NHANES-III), a nationally representative cross sectional observational study among older adults. We included 2355 participants ⩾60 years who completed measures of cognition and Poryphyromonas gingivalis IgG. Using SUDAAN, logistic regression models examined the association of P gingivalis IgG with cognitive test performance.Results:Poor immediate verbal memory (<5/9 points) was prevalent in 5.7% of patients, and 6.5% overall had impaired delayed recall (<4/9); 22.1% had difficulty with serial subtractions (<5/5 trials correct). Individuals with the highest P gingivalis IgG (>119 ELISA Units (EU)) were more likely to have poor delayed verbal recall (OR 2.89, 95% CI 1.14 to 7.29) and impaired subtraction (OR 1.95, 95% CI 1.22 to 3.11) than those with the lowest (⩽57 EU), with dose–response relationships for both (p trend, delayed memory = 0.045, subtraction = 0.04). After adjusting for socioeconomic and vascular variables, these relationships remained robust for the highest P gingivalis IgG group (delayed verbal memory OR 3.01 (95% CI 1.06 to 8.53); subtraction OR 2.00 (95% CI 1.19 to 3.36)). In contrast, immediate verbal memory was not significantly associated with P gingivalis.Conclusion:A serological marker of periodontitis is associated with impaired delayed memory and calculation. Further exploration of relationships between oral health and cognition is warranted.