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

J. M. Noble, L. N. Borrell, P. N. Papapanou, M. S V Elkind, N. Scarmeas, Clinton B Wright

Research output: Contribution to journalArticle

128 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)1206-1211
Number of pages6
JournalJournal of Neurology, Neurosurgery and Psychiatry
Volume80
Issue number11
DOIs
StatePublished - Nov 1 2009

Fingerprint

Repression (Psychology)
Nutrition Surveys
Periodontitis
Immunoglobulin G
Short-Term Memory
Cognition
Logistic Models
Enzyme-Linked Immunosorbent Assay
Inflammation
Inborn Genetic Diseases
Oral Health
Vascular Diseases
Observational Studies
Blood Vessels
Dementia
Public Health
Cross-Sectional Studies
Smoking
Stroke
Cognitive Dysfunction

ASJC Scopus subject areas

  • Clinical Neurology
  • Psychiatry and Mental health
  • Surgery

Cite this

Noble, J. M., Borrell, L. N., Papapanou, P. N., Elkind, M. S. V., Scarmeas, N., & Wright, C. B. (2009). Periodontitis is associated with cognitive impairment among older adults: Analysis of NHANES-III. Journal of Neurology, Neurosurgery and Psychiatry, 80(11), 1206-1211. https://doi.org/10.1136/jnnp.2009.174029

Periodontitis is associated with cognitive impairment among older adults : Analysis of NHANES-III. / Noble, J. M.; Borrell, L. N.; Papapanou, P. N.; Elkind, M. S V; Scarmeas, N.; Wright, Clinton B.

In: Journal of Neurology, Neurosurgery and Psychiatry, Vol. 80, No. 11, 01.11.2009, p. 1206-1211.

Research output: Contribution to journalArticle

Noble, J. M. ; Borrell, L. N. ; Papapanou, P. N. ; Elkind, M. S V ; Scarmeas, N. ; Wright, Clinton B. / Periodontitis is associated with cognitive impairment among older adults : Analysis of NHANES-III. In: Journal of Neurology, Neurosurgery and Psychiatry. 2009 ; Vol. 80, No. 11. pp. 1206-1211.
@article{d025a363271247d5aefa88dc7e802649,
title = "Periodontitis is associated with cognitive impairment among older adults: Analysis of NHANES-III",
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.",
author = "Noble, {J. M.} and Borrell, {L. N.} and Papapanou, {P. N.} and Elkind, {M. S V} and N. Scarmeas and Wright, {Clinton B}",
year = "2009",
month = "11",
day = "1",
doi = "10.1136/jnnp.2009.174029",
language = "English",
volume = "80",
pages = "1206--1211",
journal = "Journal of Neurology, Neurosurgery and Psychiatry",
issn = "0022-3050",
publisher = "BMJ Publishing Group",
number = "11",

}

TY - JOUR

T1 - Periodontitis is associated with cognitive impairment among older adults

T2 - Analysis of NHANES-III

AU - Noble, J. M.

AU - Borrell, L. N.

AU - Papapanou, P. N.

AU - Elkind, M. S V

AU - Scarmeas, N.

AU - Wright, Clinton B

PY - 2009/11/1

Y1 - 2009/11/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=72249111991&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=72249111991&partnerID=8YFLogxK

U2 - 10.1136/jnnp.2009.174029

DO - 10.1136/jnnp.2009.174029

M3 - Article

C2 - 19419981

AN - SCOPUS:72249111991

VL - 80

SP - 1206

EP - 1211

JO - Journal of Neurology, Neurosurgery and Psychiatry

JF - Journal of Neurology, Neurosurgery and Psychiatry

SN - 0022-3050

IS - 11

ER -