title: Tooth loss and periodontal disease predict poor cognitive function in older men.
abstract: OBJECTIVE
  To determine whether rates of tooth loss, periodontal disease progression, and caries incidence predict cognitive decline in men.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Community-dwelling men enrolled in the Veterans Affairs Dental Longitudinal Study.
  
  
  METHODS
  Five hundred ninety-seven dentate men aged 28 to 70 at study baseline who have been followed up to 32 years.
  
  
  METHODS
  Oral examinations were conducted approximately every 3 years. Periodontal disease measures included probing pocket depth and radiographic alveolar bone height. Participants underwent cognitive testing beginning in 1993. Low cognitive status was defined as less than 25 points or less than 90% of the age- and education-specific median on the Mini-Mental State Examination (MMSE) and less than 10 points on a spatial copying task.
  
  
  RESULTS
  Each tooth lost per decade since the baseline dental examination increased the risks of low MMSE score (hazard ratio (HR)=1.09, 95% confidence interval (CI)=1.01-1.18) and low spatial copying score (HR=1.12, CI=1.05-1.18). Risks were greater per additional tooth with progression of alveolar bone loss (spatial copying: HR=1.03, CI=1.01-1.06), probing pocket depth (MMSE: HR=1.04, CI=1.01-1.09; spatial copying: HR=1.04, CI=1.01-1.06), and caries (spatial copying: HR=1.05, CI=1.01-1.08). Risks were consistently higher in men who were older than 45.5 at baseline than in younger men.
  
  
  CONCLUSIONS
  Risk of cognitive decline in older men increases as more teeth are lost. Periodontal disease and caries, major reasons for tooth loss, are also related to cognitive decline.
authors.affiliation: Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA. kralle@bu.edu
authors.forename: Elizabeth Krall
authors.initials: EK
authors.lastname: Kaye
authors.forename: Aileen
authors.initials: A
authors.lastname: Valencia
authors.forename: Nivine
authors.initials: N
authors.lastname: Baba
authors.forename: Avron
authors.initials: A
authors.lastname: Spiro
authors.forename: Thomas
authors.initials: T
authors.lastname: Dietrich
authors.forename: Raul I
authors.initials: RI
authors.lastname: Garcia
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D001900:Boston / Q000453:epidemiology; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D003731:Dental Caries / Q000150:complications* / Q000175:diagnosis; D003753:Dental Health Surveys; D018450:Disease Progression; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D010510:Periodontal Diseases / Q000150:complications* / Q000175:diagnosis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D016388:Tooth Loss / Q000150:complications* / Q000175:diagnosis
references.citation: J Am Geriatr Soc. 2007 Sep;55(9):1410-4
references.pmid: 17767683
references.citation: J Am Geriatr Soc. 2007 Jan;55(1):108-13
references.pmid: 17233693
references.citation: J Am Geriatr Soc. 2008 Sep;56(9):1693-7
references.pmid: 18691281
references.citation: J Dent Res. 1973 Nov-Dec;52(6):1238-44
references.pmid: 4519061
references.citation: Psychosom Med. 2008 Oct;70(8):936-41
references.pmid: 18842752
references.citation: Neuropsychiatr Dis Treat. 2008 Oct;4(5):865-76
references.pmid: 19183779
references.citation: J Am Dent Assoc. 2007 Oct;138(10):1314-22; quiz 1381-2
references.pmid: 17908844
references.citation: Alzheimers Dement. 2006 Apr;2(2):110-7
references.pmid: 19595867
references.citation: J Psychiatr Res. 1975 Nov;12(3):189-98
references.pmid: 1202204
references.citation: Alzheimers Dement. 2008 Jul;4(4):242-50
references.pmid: 18631974
references.citation: Neurology. 1989 Sep;39(9):1159-65
references.pmid: 2771064
references.citation: Int J Geriatr Psychiatry. 2007 Sep;22(9):850-5
references.pmid: 17266172
references.citation: J Clin Periodontol. 2009 Jul;36(7):550-7
references.pmid: 19538327
references.citation: JAMA. 1993 May 12;269(18):2386-91
references.pmid: 8479064
references.citation: Arch Neurol. 2001 Nov;58(11):1790-2
references.pmid: 11708985
references.citation: Public Health Rep. 1997 Nov-Dec;112(6):497-505
references.pmid: 10822478
references.citation: Lancet. 2004 Apr 3;363(9415):1139-46
references.pmid: 15064035
references.citation: Gerodontology. 2008 Dec;25(4):199-204
references.pmid: 18422607
references.citation: J Am Geriatr Soc. 1992 Sep;40(9):922-35
references.pmid: 1512391
references.citation: Neuropsychology. 2005 Nov;19(6):770-7
references.pmid: 16351352
references.citation: Lancet. 2005 Dec 17;366(9503):2112-7
references.pmid: 16360788
references.citation: J Neurol Neurosurg Psychiatry. 2009 Nov;80(11):1206-11
references.pmid: 19419981
references.citation: J Periodontal Res. 1982 Jan;17(1):80-9
references.pmid: 6211539
references.citation: J Am Dent Assoc. 1998 Sep;129(9):1261-9
references.pmid: 9766107
references.citation: Am J Clin Nutr. 2005 Sep;82(3):627-35
references.pmid: 16155277
references.citation: J Gerontol B Psychol Sci Soc Sci. 2001 Nov;56(6):P340-6
references.pmid: 11682587