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Letter to the editor regarding: Summary of the evidence on modifiable risk factors for cognitive decline and dementia: A population‐based perspective

2015; Elsevier BV; Volume: 1; Issue: 4 Linguagem: Inglês

10.1016/j.dadm.2015.08.003

2352-8729

Angela R. Kamer, Malvin N. Janal, Mony J. de Leon,

Salivary Gland Disorders and Functions

Alzheimer's & Dementia: Diagnosis, Assessment & Disease MonitoringVolume 1, Issue 4 p. 385-386 Letter to the EditorOpen Access Letter to the editor regarding: Summary of the evidence on modifiable risk factors for cognitive decline and dementia: A population-based perspective Angela R. Kamer, Corresponding Author Angela R. Kamer ark5@nyu.edu Department of Periodontology and Implant Dentistry, College of Dentistry, New York University, New York, NY, USA∗Corresponding author. Tel.: +1-212-998-9868; Fax: +1-212-998-9850.Search for more papers by this authorMalvin N. Janal, Malvin N. Janal Department of Epidemiology and Health Promotion, College of Dentistry, New York University, New York, NY, USASearch for more papers by this authorMony de Leon, Mony de Leon Department of Psychiatry, Center for Brain Health, New York University School of Medicine, New York, NY, USASearch for more papers by this author Angela R. Kamer, Corresponding Author Angela R. Kamer ark5@nyu.edu Department of Periodontology and Implant Dentistry, College of Dentistry, New York University, New York, NY, USA∗Corresponding author. Tel.: +1-212-998-9868; Fax: +1-212-998-9850.Search for more papers by this authorMalvin N. Janal, Malvin N. Janal Department of Epidemiology and Health Promotion, College of Dentistry, New York University, New York, NY, USASearch for more papers by this authorMony de Leon, Mony de Leon Department of Psychiatry, Center for Brain Health, New York University School of Medicine, New York, NY, USASearch for more papers by this author First published: 01 September 2015 https://doi.org/10.1016/j.dadm.2015.08.003 No conflict of interest is reported for A.R.K. and M.N.J. M.d.L. has a patent on a technology that was licensed to Abiant Imaging, Inc, by NYU, has a financial interest in this license agreement, hold stock, and stock options in the company. M.d.L. has received compensation for consulting services from Abiant Imaging. AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat The article entitled "Summary of the evidence on modifiable risk factors for cognitive decline and dementia: A population-based perspective" was published recently by M Baumghart et al. in Alzheimer's & Dementia on behalf of the Alzheimer's Association. This article succinctly reviews the evidence for many putative modifiable risk factors of Alzheimer's disease (AD) and cognitive decline 1 and concludes that there is strong evidence for some risk factors, e.g. diabetes and obesity. However, although the article sampled a broad range of risk factors, it was not comprehensive. Considering the vast implications of this article for practice guidelines and AD research priorities, we suggest attention to another well-studied and modifiable risk for AD—periodontal disease. Periodontal disease is a chronic polymicrobial disease of the tissues supporting the teeth. Others and we have studied the association between AD/cognition and periodontal disease using a variety of exposure indexes, study designs, and outcomes. In one longitudinal study of 597 subjects followed for 32 years, there was an association (1.03< hazard ratio [HR] >1.09) between pocket depth, alveolar bone loss, and tooth loss (indices of current and historical periodontal disease) and cognitive decline 2, 3. Another showed that periodontal inflammation predicted cognitive decline in 947 subjects with mild-to-moderate strength (odds ratio [OR] = 1.57 [95% confidence interval (CI), 1.01–2.45]) 4. Other studies defining periodontal disease by immunologic parameters 5 also show strong prediction (OR = HR = 3.1; 95% CI, 1.5–6.4) 6. Because of its convenient assessment, the most prevalent index of periodontal exposure is tooth loss (it is also the ultimate outcome of the untreated periodontal disease), and seven longitudinal studies show increasing risk for AD/cognitive decline with increasing numbers of missing teeth (OR range: 1.05–2.38) 7, 8. Together, these studies provide strong evidence for a link between periodontal disease and AD/cognition. Periodontal disease is thought to contribute to AD progression through multiple mechanisms 9 including inflammation, infection, and upregulation of the brain amyloid burden 10, and some of these mechanisms have been proposed for other chronic diseases such as diabetes 11. Notably, Sparks 5 showed that high levels of immunoglobulin G antibodies to periodontal bacteria are present 10 years before conversion to AD, indicating the importance of periodontal infections in AD pathogenesis. Periodontal disease is highly prevalent in the general population. In the United States, 46% of adults comprising 64.7 million people have periodontitis 12. Thus, even low-to-moderate size risks produce a substantial burden on the population. Furthermore, periodontal disease can be successfully managed, suggesting that prevention and treatment could limit risk in a significant number of AD cases. As Robert Stewart (2015) recognized, oral health is often overlooked when assessing medical risks. Nevertheless, periodontal disease is an established and modifiable risk for AD, and deserves a place in this list. Acknowledgments This study was supported by NIH/NIA grants AG035137, AG032554, AG022374, and AG13616, NIH DE023139-02, Alzheimer's Association NIRG-12-173937 and NIH/NCATS UL1 TR000038. References 1M. Baumgart, H.M. Snyder, M.C. Carrillo, S. Fazio, H. Kim, H. Johns. Summary of the evidence on modifiable risk factors for cognitive decline and dementia: A population-based perspective. Alzheimers Dementia. 11: 2015; 718– 726 2E.K. Kaye, A. Valencia, N. Baba, A. Spiro3rd, T. Dietrich, R.I. Garcia. Tooth loss and periodontal disease predict poor cognitive function in older men. J Am Geriatr Soc. 58: 2010; 713– 718 3A.R. Kamer, D.E. Morse, P. Holm-Pedersen, E.L. Mortensen, K. Avlund. Periodontal inflammation in relation to cognitive function in an older adult Danish population. J Alzheimers Dis. 28: 2012; 613– 624 4R. Stewart, R.J. Weyant, M.E. Garcia, T. Harris, L.J. Launer, S. Satterfield, et al.Adverse oral health and cognitive decline: The health, aging and body composition study. J Am Geriatr Soc. 61: 2013; 177– 184 5P. Sparks Stein, M.J. Steffen, C. Smith, G. Jicha, J.L. Ebersole, E. Abner, et al.Serum antibodies to periodontal pathogens are a risk factor for Alzheimer's disease. Alzheimers Dementia. 8: 2012; 196– 203 6J.M. Noble, N. Scarmeas, R.S. Celenti, M.S. Elkind, C.B. Wright, N. Schupf, et al.Serum IgG antibody levels to periodontal microbiota are associated with incident Alzheimer disease. PLoS One. 9: 2014; e114959 7J.M. Noble, N. Scarmeas, P.N. Papapanou. Poor oral health as a chronic, potentially modifiable dementia risk factor: review of the literature. Curr Neurol Neurosci Rep. 13: 2013; 384 8N. Okamoto, M. Morikawa, K. Tomioka, M. Yanagi, N. Amano, N. Kurumatani. Association between tooth loss and the development of mild memory impairment in the elderly: the Fujiwara-kyo Study. J Alzheimers Dis. 44: 2015; 777– 786 9A.R. Kamer, R.G. Craig, A.P. Dasanayake, M. Brys, L. Glodzik-Sobanska, M.J. de Leon. Inflammation and Alzheimer's disease: Possible role of periodontal diseases. Alzheimers Dementia. 4: 2008; 242– 250 10A.R. Kamer, E. Pirraglia, W. Tsui, H. Rusinek, S. Vallabhajosula, L. Mosconi, et al.Periodontal disease associates with higher brain amyloid load in normal elderly. Neurobiol Aging. 36: 2015; 627– 633 11G. Mushtaq, J.A. Khan, T.A. Kumosani, M.A. Kamal. Alzheimer's disease and type 2 diabetes via chronic inflammatory mechanisms. Saudi J Biol Sci. 22: 2015; 4– 13 12P.I. Eke, B.A. Dye, L. Wei, G.D. Slade, G.O. Thornton-Evans, W.S. Borgnakke, et al.Update on prevalence of periodontitis in adults in the United States: NHANES 2009 to 2012. J Periodontol. 86: 2015; 611– 622 Volume1, Issue4December 2015Pages 385-386 ReferencesRelatedInformation