A study on the correlation between oral health status and cognitive impairment in elderly population

doi:10.7518/hxkq.2025.2024108

Abstract

Abstract:

Objective This cross-sectional study aims to explore the association between oral health status and cognitive function in Chinese elderly individuals. Methods The survey participants were composed of elderly people aged≥60 who were admitted to West China Hospital of Stomatology, Sichuan University from August 2022 to March 2024. They were divided into a cognitive impairment (CI) group and a healthy control (HC) group according to the Montreal Cognitive Assessment (MoCA) score. General information and oral health indicators of all elderly people were collected. Independent sample t-test and chi-square test were used for inter-group comparison, and multiple linear regression model was applied for multivariate analysis of MoCA scores. Results A total of 402 elderly people were included in the study, and the number of remaining teeth in the CI group was significantly lower than that in the HC group. The decayed, missing, filled teeth index, debris index-simplified, gingival index, probing depth (PD), and clinical attachment loss in the CI group were all significantly higher than those in the HC group. There was no difference in denture wearing between the two groups. The results of multiple linear regression showed that there was a correlation between the number of remaining teeth and PD and MoCA scores after correcting for confounding factors. Conclusion Elderly individuals with CI have more prominent oral health issues compared to those with normal cognitive function. There may be a bidirectional relationship between the number of remaining teeth, PD, and cognitive function in elderly people.

Key words: cognitive impairment, the elderly, dental caries, periodontal diseases, tooth loss, multiple linear regression

CLC Number:

R787

Xu Lisheng, Liu Fan, Wei Jingyi, Zheng Xin, Li Xiaoying, Zhang Ling. A study on the correlation between oral health status and cognitive impairment in elderly population[J]. West China Journal of Stomatology, 2025, 43(2): 220-226.

Figures/Tables 3

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References 29

1	尹孟凡, 崔玉蓉, 陈芝蕙, 等. 1990―2019年中国阿尔茨海默病疾病负担及危险因素[J]. 中华疾病控制杂志, 2024, 28(1): 32-39.
	Yin MF, Cui YR, Chen ZH, et al. Analysis of disease burden and risk factors of Alzheimer disease in China from 1990 to 2019[J]. Chin J Dis Control Prev, 2024, 28(1): 32-39.
2	史路平, 姚水洪, 王薇. 中国老年人群轻度认知障碍患病率及发展趋势的Meta分析[J]. 中国全科医学, 2022, 25(1): 109-114.
	Shi LP, Yao SH, Wang W. Prevalence and distribution trends of mild cognitive impairment among Chinese ol-der adults: a meta-analysis[J]. Chin Gen Pract, 2022, 25(1): 109-114.
3	Sung CE, Huang RY, Cheng WC, et al. Association between periodontitis and cognitive impairment: analysis of national health and nutrition examination survey (NHANES) Ⅲ[J]. J Clin Periodontol, 2019, 46(8): 790-798.
4	姜健红, 石兴莲, 何权敏, 等. 老年慢性牙周炎患者健康素养与生活质量的相关性研究[J]. 华西口腔医学杂志, 2023, 41(6): 694-700.
	Jiang JH, Shi XL, He QM, et al. Correlation between health literacy and life quality in elderly patients with chronic periodontitis[J]. West China J Stomatol, 2023, 41(6): 694-700.
5	Nangle MR, Manchery N. Can chronic oral inflammation and masticatory dysfunction contribute to cognitive impairment[J]. Curr Opin Psychiatry, 2020, 33(2): 156-162.
6	Winning L, Naseer A, De Looze C, et al. Tooth loss and cognitive decline in community dwelling older Irish adults: a cross-sectional cohort study[J]. J Dent, 2022, 119: 104077.
7	Xu SY, Huang X, Gong Y, et al. Association between tooth loss rate and risk of mild cognitive impairment in older adults: a population-based longitudinal study[J]. Aging (Albany NY), 2021, 13(17): 21599-21609.
8	陶玉飞, 何梦娜, 胡红艳, 等. 牙周炎与认知功能障碍的相关性研究[J]. 华西口腔医学杂志, 2022, 40(5): 549-553.
	Tao YF, He MN, Hu HY, et al. Correlation study of pe-riodontitis with cognitive impairment[J]. West China J Stomatol, 2022, 40(5): 549-553.
9	Fereshtehnejad SM, Garcia-Ptacek S, Religa D, et al. Dental care utilization in patients with different types of dementia: a longitudinal nationwide study of 58 037 individuals[J]. Alzheimers Dement, 2018, 14(1): 10-19.
10	Naorungroj S, Slade GD, Beck JD, et al. Cognitive decline and oral health in middle-aged adults in the ARIC study[J]. J Dent Res, 2013, 92(9): 795-801.
11	World Health Organization. Oral health surveys basic methods[M]. 5th ed. Geneva: WHO Press, 2013.
12	中国痴呆与认知障碍诊治指南写作组, 中国医师协会神经内科医师分会认知障碍疾病专业委员会. 2018中国痴呆与认知障碍诊治指南(三): 痴呆的认知和功能评估[J]. 中华医学杂志, 2018, 98(15): 1125-1129.
	Chinese Dementia and Cognitive Disorder Diagnosis and Treatment Guidelines Writing Group, Committee of Cognitive Disorders, Branch of Neurologist, Chinese Medical Doctor Association. 2018 Chinese dementia and cognitive disorder diagnosis and treatment guidelines (Ⅲ): cognitive and functional evaluation of dementia[J]. Natl Med J China, 2018, 98(15): 1125-1129.
13	中国痴呆与认知障碍诊治指南写作组, 中国医师协会神经内科医师分会认知障碍疾病专业委员会. 2018中国痴呆与认知障碍诊治指南(五):轻度认知障碍的诊断与治疗[J]. 中华医学杂志, 2018, 98(17): 1294-1301.
	Chinese Dementia and Cognitive Disorder Diagnosis and Treatment Guidelines Writing Group, Committee of Cognitive Disorders, Branch of Neurologist, Chinese Medical Doctor Association. 2018 Chinese dementia and cognitive disorder diagnosis and treatment guidelines (V): diagnosis and treatment of mild cognitive impairment[J]. Natl Med J China, 2018, 98(17): 1294-1301.
14	陈红, 于慧, 王春霞. 蒙特利尔认知评估量表(北京版)在青岛市老年人群中应用的信效度研究[C]. 中华医学会, 中华医学会精神医学分会. 中华医学会第十三次全国精神医学学术会议论文汇编. 济南: 中华医学会精神医学分会, 2015: 59-60.
	Chen H, Yu H, Wang CX. A study on the reliability and validity of the montreal cognitive assessment scale (Beijing version) in the elderly population of Qingdao city[C]. Chinese Medical Association, Chinese Society of Psychiatry. Compilation of papers from the 13th Natio-nal Conference on Psychiatry of the Chinese Medical Association. Jinan: Chinese Society of Psychiatry, 2015: 59-60.
15	Kim HY. Statistical notes for clinical researchers: assessing normal distribution (2) using skewness and kurtosis[J]. Restor Dent Endod, 2013, 38(1): 52-54.
16	Gao SS, Chen KJ, Duangthip D, et al. The oral health status of Chinese elderly people with and without dementia: a cross-sectional study[J]. Int J Environ Res Public Health, 2020, 17(6): 1913.
17	Chen X, Clark JJ, Naorungroj S, et al. Oral health in nursing home residents with different cognitive statuses[J]. Gerodontology, 2013, 30(1): 49-60.
18	Chen X, Xie XJ, Yu L. The pathway from cognitive impairment to caries in older adults: a conceptual model[J]. J Am Dent Assoc, 2018, 149(11): 967-975.
19	Chen X, Clark JJ, Chen H, et al. Cognitive impairment, oral self-care function and dental caries severity in community-dwelling older adults[J]. Gerodontology, 2015, 32(1): 53-61.
20	Silva M, Hopcraft M, Morgan M. Dental caries in Victorian nursing homes[J]. Aust Dent J, 2014, 59(3): 321-328.
21	Iwasaki M, Kimura Y, Ogawa H, et al. Periodontitis, periodontal inflammation, and mild cognitive impairment: a 5-year cohort study[J]. J Periodontal Res, 2019, 54(3): 233-240.
22	Yang HL, Li FR, Chen PL, et al. Tooth loss, denture use, and cognitive impairment in Chinese older adults: a community cohort study[J]. J Gerontol A Biol Sci Med Sci, 2022, 77(1): 180-187.
23	Delwel S, Binnekade TT, Perez RSGM, et al. Oral hygiene and oral health in older people with dementia: a comprehensive review with focus on oral soft tissues[J]. Clin Oral Investig, 2018, 22(1): 93-108.
24	Poole S, Singhrao SK, Kesavalu L, et al. Determining the presence of periodontopathic virulence factors in short-term postmortem Alzheimer's disease brain tissue[J]. J Alzheimers Dis, 2013, 36(4): 665-677.
25	Ishida N, Ishihara Y, Ishida K, et al. Periodontitis induced by bacterial infection exacerbates features of Alzheimer’s disease in transgenic mice[J]. NPJ Aging Me-ch Dis, 2017, 3: 15.
26	Fang WL, Jiang MJ, Gu BB, et al. Tooth loss as a risk fa-ctor for dementia: systematic review and meta-analysis of 21 observational studies[J]. BMC Psychiatry, 2018, 18(1): 345.
27	Douma JG, Volkers KM, Vuijk PJ, et al. The effects of video observation of chewing during lunch on masticatory ability, food intake, cognition, activities of daily living, depression, and quality of life in older adults with dementia: a study protocol of an adjusted randomized controlled trial[J]. BMC Geriatr, 2016, 16: 37.
28	Alvarenga MOP, Ferreira RO, Magno MB, et al. Masticatory dysfunction by extensive tooth loss as a risk factor for cognitive deficit: a systematic review and meta-analysis[J]. Front Physiol, 2019, 10: 832.
29	Gómez-Gómez ME, Zapico SC. Frailty, cognitive decline, neurodegenerative diseases and nutrition interventions[J]. Int J Mol Sci, 2019, 20(11): E2842.

项目	HC组	CI组	统计量	P值
年龄/岁	69.49±7.07	71.62±7.61	-2.874^a	0.004^**
性别			2.183^b	0.140
女	129	104
男	106	63
学历			18.338^b	<0.001^***
初中及以下	65	81
高中及以上	170	86
婚姻状况			4.719^b	0.194
已婚	201	143
离异	4	0
丧偶	28	24
未婚	2	0
居住地			1.094^b	0.296
农村	17	17
城镇	218	150
目前居住情况			6.596^b	0.086
独居	24	14
夫妻	146	93
子女	65	57
其他	0	3
工作状态			14.948^b	<0.001^***
在职	8	1
离退休	218	144
无业	9	22
人均年收入/万元	6.51±4.62	5.44±4.89	2.218^a	0.027^*
BMI	23.73±3.24	23.36±3.03	1.152^a	0.250
睡眠时间			2.019^b	0.155
<5 h	70	61
5~10 h	165	106
视力受损			1.063^b	0.302
无	105	66
有	130	101
听力受损			2.465^b	0.116
无	206	137
有	29	30
慢性病种类			4.026^b	0.045^*
0~1种	184	116
≥2种	51	51
服药数量			3.016^b	0.082
0~5种	223	151
>5种	12	16
BADL	98.7±4.2	95.21±11.63	3.711^a	<0.001^***
吸烟			0.080^b	0.777
戒烟/不吸烟	209	150
吸烟	26	17
喝酒			0.860^b	0.354
从不喝/戒酒	190	141
喝酒	45	26

项目	整体	HC组	CI组	统计量	P值
余留牙数量	21.84±6.66	23.5±5.57	19.49±7.35	5.941^a	<0.001^***
义齿佩戴情况				0.018^b	0.895
佩戴义齿	191	111	80
无义齿	211	124	87
DT	2.56±3.66	2.48±3.61	2.67±3.73	-0.524^a	0.601
MT	2.17±4.56	1.35±3.68	3.34±5.37	-4.142^a	<0.001^***
FT	1.16±2.65	1.04±2.36	1.32±3.02	-1.062^a	0.289
DMFT	5.95±6.38	4.90±5.78	7.41±6.89	-3.847^a	<0.001^***
DI-S	5.25±3.52	4.87±3.52	5.78±3.45	-2.574^a	0.010^*
CI-S	4.91±3.91	4.59±3.88	5.36±3.90	-1.960^a	0.051
GI	1.13±0.70	1.01±0.71	1.28±0.65	-3.946^a	<0.001^***
PD	2.07±1.27	1.82±1.21	2.42±1.26	-4.765^a	<0.001^***
CAL	1.42±1.41	1.16±1.31	1.78±1.46	-4.371^a	<0.001^***

	B值	标准误	β值	t值	P值	容忍度	VIF
常量	13.944	2.266		6.154	<0.001
无业	-4.930	0.718	-0.300	-6.870	<0.001	0.866	1.154
余留牙数量	0.147	0.028	0.222	5.255	<0.001	0.923	1.084
学历	2.001	0.399	0.219	5.017	<0.001	0.870	1.149
PD	-0.509	0.149	-0.147	-3.415	<0.001	0.895	1.118
BADL得分	0.079	0.022	0.150	3.668	<0.001	0.989	1.011

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[2]	Zhang Jing, Wang Yan.. Meta-analysis of prevalence and filling rate of dental caries in preschool children in China [J]. West China Journal of Stomatology, 2023, 41(5): 573-581.
[3]	Tao Yufei, He Mengna, Hu Hongyan, Gao Ziwen, Huang Ziang, Li Hui, Li Yuqing, Li Xiaoshu. Correlation study of periodontitis with cognitive impairment [J]. West China Journal of Stomatology, 2022, 40(5): 549-553.
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[6]	Luo Yuxue, Sun Manlin, Shi Peilei, Liu Pan, Chen Yiyin, Peng Xian. Research progress in the relationship between Veillonella and oral diseases [J]. West China Journal of Stomatology, 2020, 38(5): 576-582.
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[12]	Gao Jing, Huang Wenming.. Dynamic changes of aciduric virulence factor membrane-bound proton-translocating ATPase of Streptococcus mutans in the development of dental caries [J]. West China Journal of Stomatology, 2016, 34(2): 200-204.
[13]	Zhang Yangyang, He Jinzhi, Xu Xin, Zhou Xuedong. Bacterial diversity in the oral cavity of adolescents with different caries susceptibilities [J]. West China Journal of Stomatology, 2015, 33(6): 602-606.
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[15]	Jiang Lin, Zhuang Qingming, Wang Jinhua, Deng Jun, Zhao Hechuan, He Songlin, Dai Lina.. Investigation on deciduous dental caries among preschool children in Chongqing city [J]. West China Journal of Stomatology, 2014, 32(5): 472-475.