title: Tooth loss, periodontal disease, and cognitive decline in the Atherosclerosis Risk in Communities (ARIC) study.
abstract: OBJECTIVE
  The purpose of this prospective study was to investigate whether poor oral health predicted 8-year cognitive function change in predominantly late middle adults in the Atherosclerosis Risk in Communities (ARIC) study.
  
  
  METHODS
  Participants included a subset of ARIC participants aged 52-75 years at 1996-1998 from two study sites: Forsyth County NC and Jackson MS. All subjects completed cognitive function assessments both in 1996-1998 and 2004-2006, and the same subjects received a dental examination at the initial visit. Cognitive assessment consisted of delayed word recall (DWR), digit symbol substitution (DSS), and word fluency (WF) tests. In the analysis, cognitive function for 911 dentally screened participants was evaluated, and 558 of 785 dentate participants received comprehensive oral examinations, including periodontal probing. Measures of oral health included dental status, number of teeth, and periodontal disease classified by the biofilm-gingival interface (BGI) index. The generalized estimating equations (GEE) method was used to analyze repeated measures of cognitive scores with adjustment for socio-demographic characteristics and cardiovascular risk factors.
  
  
  RESULTS
  Of 911 study participants, 13.8% were edentulous. About 13% of dentally examined participants had periodontal pockets (≥ 4 mm) with severe bleeding. At the follow-up visit, DWR and WF scores were lower in edentulous compared to dentate people, whereas other oral health measures were not associated with cognitive function. Mean values declined over time for all three cognitive measures, although poor oral health conditions were not associated with greater degree of decline in cognitive function.
  
  
  CONCLUSIONS
  In these late middle-aged adults, complete tooth loss was significantly associated with lower cognitive performance. However, neither edentulism, number of teeth, nor periodontal disease predicted greater subsequent cognitive decline.
authors.affiliation: Department of Conservative Dentistry, School of Dentistry, Prince of Songkla University, Hat Yai, Songkla, Thailand; Department of Dental Ecology, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Supawadee
authors.initials: S
authors.lastname: Naorungroj
authors.forename: Victor J
authors.initials: VJ
authors.lastname: Schoenbach
authors.forename: Lisa
authors.initials: L
authors.lastname: Wruck
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Mosley
authors.forename: Rebecca F
authors.initials: RF
authors.lastname: Gottesman
authors.forename: Alvaro
authors.initials: A
authors.lastname: Alonso
authors.forename: Gerardo
authors.initials: G
authors.lastname: Heiss
authors.forename: James
authors.initials: J
authors.lastname: Beck
authors.forename: Gary D
authors.initials: GD
authors.lastname: Slade
mesh_terms: D000368:Aged; D003072:Cognition Disorders / Q000453:epidemiology*; D003324:Coronary Artery Disease / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008922:Mississippi / Q000453:epidemiology; D010510:Periodontal Diseases / Q000453:epidemiology*; D011446:Prospective Studies; D016388:Tooth Loss / Q000453:epidemiology*
keywords: cognitive function; periodontal disease; tooth loss