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J Neurol Neurosurg Psychiatry 80:1206-1211 doi:10.1136/jnnp.2009.174029
  • Research paper

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

  1. J M Noble1,2,3,
  2. L N Borrell4,
  3. P N Papapanou5,
  4. M S V Elkind3,6,
  5. N Scarmeas1,3,
  6. C B Wright7
  1. 1
    Gertrude H Sergievsky Center, Columbia University Medical Center, New York, NY, USA and the Taub Institute on Alzheimer Disease and the Aging Brain, Columbia University Medical Center, New York, New York, USA
  2. 2
    Harlem Hospital Center, Columbia University, College of Physicians and Surgeons, New York, New York, USA
  3. 3
    Department of Neurology, The Neurological Institute of New York, Columbia University Medical Center, New York, New York, USA
  4. 4
    Department of Health Sciences, Lehman College, City University of New York, New York, New York, USA
  5. 5
    College of Dental Medicine, Section of Oral and Diagnostic Sciences, Division of Periodontics, Columbia University Medical Center, New York, New York, USA
  6. 6
    Stroke Division, Department of Neurology, The Neurological Institute of New York, Columbia University Medical Center, New York, New York, USA
  7. 7
    Evelyn F McKnight Center for Age-related Memory Loss, Division of Cognitive Disorders, Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, USA
  1. Correspondence to Dr J M Noble, Harlem Hospital Center, Columbia College of Physicians and Surgeons, Department of Neurology, 506 Lenox Ave, New York, NY 10037, USA; jn2054{at}columbia.edu
  • Received 29 January 2009
  • Revised 20 March 2009
  • Accepted 24 March 2009
  • Published Online First 5 May 2009

Abstract

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.

Footnotes

  • See Editorial Commentary, p 1184

  • Funding This research was supported by Public Health Service Grant No 5-T32-NS07153-23 and a grant from Charles L and Ann Lee Saunders Brown (for JMN). PNP has received support for research on the relationship of periodontal treatment and peripheral blood mononuclear cell activation from Colgate–Palmolive and on the relationship of periodontal disease and stage 5 kidney disease from Johnson and Johnson. MSVE has received research support from the National Institutes of Health. In addition, MSVE has received support for research on the relationship of inflammatory markers and recurrent stroke risk in lacunar stroke patients from BMS-Sanofi Pharmaceutical Partnership and on the relationship of inflammatory markers and recurrent stroke risk from Diadexus Inc.

  • Competing interests None.

  • Provenance and Peer review Not commissioned; externally peer reviewed.

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