CoChat
Sign Up
Cited by 324Oral microbiology and periodontitis researchDementia and Cognitive Impairment ResearchDental Health and Care Utilization

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

Open access
Noble, J M, Borrell, L N, Papapanou, P N, Elkind, M S V, Scarmeas, N, Wright, C B·2009·Journal of Neurology, Neurosurgery & Psychiatry
DOI 10.1136/jnnp.2009.174029PMC PMC3073380
Open this paper in CoChat — free accountOpen PDF

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 >or=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 (<or=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.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1136/jnnp.2009.174029

Cites

4 of 4 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • There is a strong epidemiologic association between periodontitis and Alzheimer's disease and related dementia.

    “There is a strong epidemiologic association between periodontitis (PD) and ADRD [5,6,7,8,9,10,11,12,13] but how these two diseases intersect and whether it is at the level of causation is unclear.”

    From Oral Microbially-Induced Small Extracellular Vesicles Cross the Blood–Brain Barrier (2024) · cites this paper as [11]

    The Abstract Results report an association between a marker of periodontitis and impaired delayed memory and calculation in older adults. The Discussion calls the findings preliminary and inconclusive and describes a possible association between poor oral health and dementia. The study did not establish a strong association between periodontitis and diagnosed Alzheimer’s disease or related dementia. Page numbers are unavailable in our copy. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 36

  1. [2]Machtei EE Christersson LA Grossi SG Clinical criteria for the definition of “established periodontitis” J Periodontol 1992 63 206 214 1593413
  2. [3]Machtei EE Hausmann E Dunford R Longitudinal study of predictive factors for periodontal disease and tooth loss J Clin Periodontol 1999 26 374 380 10382577
  3. [4]Rosling B Serino G Hellstrom MK Longitudinal periodontal tissue alterations during supportive therapy. Findings from subjects with normal and high susceptibility to periodontal disease J Clin Periodontol 2001 Mar 28 241 249 11284537
  4. [5]Burt B Position paper: epidemiology of periodontal diseases J Periodontol 2005 76 1406 1419 16101377
  5. [7]Donlan RM Costerton JW Biofilms: survival mechanisms of clinically relevant microorganisms Clin Microbiol Rev 2002 15 167 193 11932229 PMC118068
  6. [8]Offenbacher S Barros SP Singer RE Periodontal disease at the biofilm-gingival interface J Periodontol 2007 78 1911 1925 18062113
  7. [9]Kulekci G Leblebicioglub B Keskina F Salivary detection of periodontopathic bacteria in periodontally healthy children Anaerobe 2008 14 49 54 17869137
  8. [10]Bretz WA Weyant RJ Corby PM Systemic inflammatory markers, periodontal diseases, and periodontal infections in an elderly population J Am Geriatr Soc 2005 53 1532 1537 16137283
  9. [11]D’Aiuto F Parkar M Andreou G Periodontitis and systemic inflammation: control of the local infection is associated with a reduction in serum inflammatory markers J Dent Res 2004 83 156 160 14742655
  10. [12]Pussinen PJ Alfthan G Jousilahti P Systemic exposure to Porphyromonas gingivalis predicts incident stroke Atherosclerosis 2007 193 222 228 16872615
  11. [14]Desvarieux M Demmer RT Rundek T Periodontal microbiota and carotid intima-media thickness: the Oral Infections and Vascular Disease Epidemiology Study (INVEST) Circulation 2005 111 576 582 15699278 PMC2812915
  12. [16]Yanbaeva DG Dentener MA Creutzberg EC Systemic effects of smoking Chest 2007 131 1557 1566 17494805
  13. [17]van Oijen M de Jong FJ Witteman JC Atherosclerosis and risk for dementia Ann Neurol 2007 61 403 410 17328068
  14. [18]Dye BA Choudhary K Shea S Serum antibodies to periodontal pathogens and markers of systemic inflammation J Clin Periodontol 2005 32 1189 1199 16268994
  15. [19]Albert M Smith LA Scherr PA Use of brief cognitive tests to identify individuals in the community with clinically diagnosed Alzheimer’s disease Int J Neurosci 1991 57 167 178 1938160
  16. [20]Perkins AJ Hendrie HC Callahan CM Association of antioxidants with memory in a multiethnic elderly sample using the Third National Health and Nutrition Examination Survey Am J Epidemiol 1999 150 37 44 10400551
  17. [21]Zhang Y Heeren T Curtis Ellison R Education modifies the effect of alcohol on memory impairment: the third national health and nutrition examination survey Neuroepidemiology 2005 24 63 69 15459511
  18. [22]Borrell LN Burt BA Neighbors HW Social factors and periodontitis in an older population Am J Public Health 2004 94 748 754 15117695 PMC1448332
  19. [23]Executive Summary of the Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) JAMA 2001 285 2486 2497 11368702
  20. [24]Beck JD Caplan DJ Preisser JS Reducing the bias of probing depth and attachment level estimates using random partial-mouth recording Community Dent Oral Epidemiol 2006 34 1 10 16423025
  21. [25]Stewart R Sabbah W Tsakos G Oral health and cognitive function in the Third National Health and Nutrition Examination Survey (NHANES III) Psychosom Med 2008 70 936 941 18842752
  22. [26]Noble JM Scarmeas N Lamster IB Northridge ME Cognitive Impairment Improving Oral Health for the Elderly 2008 New York Springer Science & Business Media
  23. [27]Kim JM Stewart R Prince M Dental health, nutritional status and recent-onset dementia in a Korean community population Int J Geriatr Psychiatry 2007 22 850 855 17266172
  24. [28]Stewart R Hirani V Dental health and cognitive impairment in an English national survey population J Am Geriatr Soc 2007 55 1410 1414 17767683
  25. [30]Kondo K Niino M Shido K A case-control study of Alzheimer’s disease in Japan—significance of life-styles Dementia 1994 5 314 326 7866485
  26. [31]Stein PS Desrosiers M Donegan SJ Tooth loss, dementia and neuropathology in the Nun study J Am Dent Assoc Oct 2007 138 1314 1322 17908844
  27. [32]Yoneyama T Yoshida M Ohrui T Oral care reduces pneumonia in older patients in nursing homes J Am Geriatr Soc 2002 50 430 433 11943036
  28. [33]Beck JD Offenbacher S Systemic effects of periodontitis: epidemiology of periodontal disease and cardiovascular disease J Periodontol 2005 76 Suppl 2089 2100 16277581
  29. [34]Munzel T Sinning C Post F Pathophysiology, diagnosis and prognostic implications of endothelial dysfunction Ann Med 2008 40 180 196 18382884
  30. [35]Tonetti MS D’Aiuto F Nibali L Treatment of periodontitis and endothelial function N Engl J Med 2007 356 911 920 17329698
  31. [36]Hoth KF Tate DF Poppas A Endothelial function and white matter hyperintensities in older adults with cardiovascular disease Stroke 2007 38 308 312 17204686 PMC2748266
  32. [37]Vicenzini E Ricciardi MC Altieri M Cerebrovascular reactivity in degenerative and vascular dementia: a transcranial Doppler study Eur Neurol 2007 58 84 89 17565221
  33. [38]Silvestrini M Pasqualetti P Baruffaldi R Cerebrovascular reactivity and cognitive decline in patients with Alzheimer disease Stroke 2006 37 1010 1015 16497984
  34. [39]Perry VH Cunningham C Holmes C Systemic infections and inflammation affect chronic neurodegeneration Nat Rev Immunol 2007 7 161 167 17220915
  35. [40]Stern Y Albert S Tang MX Rate of memory decline in AD is related to education and occupation: cognitive reserve? Neurology 1999 53 1942 1947 10599762
  36. [41]Papapanou PN Neiderud AM Disick E Longitudinal stability of serum immunoglobulin G responses to periodontal bacteria J Clin Periodontol 2004 31 985 990 15491314

Cited by

Sorted by citations

Authors
Noble, J. M., Borrell, L. N., Papapanou, P. N., Elkind, M. S. V., Scarmeas, N., & Wright, C. B.
Affiliations
  • Columbia University Irving Medical Center (US)
  • Lehman College (US)
  • University of Miami (US)
Corresponding author
Noble, J M
ORCID
Venue
Journal of Neurology, Neurosurgery & Psychiatry
Publisher
BMJ
Published
2009-05-05
Volume
80
Issue
11
Pages
1206-1211
ISSN
0022-3050 (ISSN-L)
DOI
10.1136/jnnp.2009.174029
PMC
PMC3073380
OpenAlex
W2150025846
Cited by
324
References
4
Citations by year
2026: 8 · 2025: 25 · 2024: 26 · 2023: 25 · 2022: 30 · 2021: 38 · 2020: 24 · 2019: 22 · 2018: 20 · 2017: 14 · 2016: 20 · 2015: 14 · 2014: 19 · 2013: 16 · 2012: 8
FWCI
8.07
Type
journal article
Language
en
Open access
Locations
  • Journal of Neurology Neurosurgery & Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • HighWire Press Open Archive (submittedVersion)
Funders
  • Sanofi
  • Colgate-Palmolive Company
  • National Institutes of Health
  • National Institute of Neurological Disorders and Stroke (T32NS007153, 5 T32 NS07153-23)
Topics
  • Health Sciences › Dentistry › Periodontics › Oral microbiology and periodontitis research
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Dentistry › Periodontics › Dental Health and Care Utilization
Keywords
periodontitis, cognitive impairment, dementia, Porphyromonas gingivalis, IgG, serial subtraction, older adults, systemic inflammation, NHANES III
MeSH terms
Age Factors, Aged, Cognition, Cognition Disorders, Cross-Sectional Studies, Female, Humans, Immunoglobulin G, Male, Middle Aged, Nutrition Surveys, Periodontitis, Porphyromonas gingivalis

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review