Abstract

BackgroundCognitive impairment and poor oral health are frequently seen among older adults. Both conditions have been identified as risk factors for mortality. However, the combined associations of cognitive impairment and poor oral health with mortality have not been well studied and are therefore the aim of this cohort study.MethodsWe analyzed data from the National Health and Nutrition Examination Survey (1999–2002) linked with mortality data obtained from the 2015 public‐use linked mortality file. Cognitive impairment was defined as a digit symbol substitution test score lower than the lowest quartile. Oral health status was assessed based on presence of untreated caries, moderate to severe periodontitis, and edentulism. The combined effects of caries/periodontitis or edentulism and cognitive impairment on all‐cause and cardiometabolic mortality were examined using the Cox proportional hazard models after adjusting for potential confounders including demographic characteristics, lifestyle, biomarkers, and comorbidities.ResultsIn total, 1973 participants were enrolled in the prospective study. At a median follow‐up of 13.4 years, 978 participants had died (264 deaths because of cardiometabolic disease). Cognitive impairment, periodontitis, and edentulism were each found to be significant predictors of all‐cause mortality. Caries, however, was not significantly related to mortality. When analyzing these predictors in combination, a diagnosis of cognitive impairment and periodontitis was associated with an 83.1% increase in all‐cause mortality risk and an 87.7% increase in cardiometabolic mortality risk compared with healthy controls. Similarly, the risk for all‐cause mortality was highest in cases where impaired cognition and edentulism co‐occurred (adjusted hazard ratio = 1.701, 1.338–2.161).ConclusionConcomitant presence of cognitive impairment and periodontitis or edentulism can be associated with a higher risk of mortality among older U.S. adults.

Highlights

  • Longer life expectancy has been increasing the proportion of older persons in industrialized countries[1] and led to a commensurate increase in the prevalence of Alzheimer disease (AD).[2]

  • Concomitant presence of cognitive impairment and periodontitis or edentulism can be associated with a higher risk of mortality among older U.S adults

  • We studied the interrelationship between cognitive impairment, poor oral health, and mortality in two steps

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Summary

Introduction

Longer life expectancy has been increasing the proportion of older persons in industrialized countries[1] and led to a commensurate increase in the prevalence of Alzheimer disease (AD).[2]. Older people with cognitive impairment and systemic vascular comorbidities (e.g., high blood pressure and diabetes mellitus) may have increased mortality risk.[12,13] In a recent systematic review, poor oral health was found to be associated with mortality.[14] A considerable proportion of such mortality could be attributed to comorbid conditions.[15] it is plausible that cognitive impairment or oral diseases may separately increase the risk of cardiometabolic death. Cognitive impairment and poor oral health are frequently seen among older adults Both conditions have been identified as risk factors for mortality. Caries was not significantly related to mortality When analyzing these predictors in combination, a diagnosis of cognitive impairment and periodontitis was associated with an 83.1% increase in all-cause mortality risk and an 87.7% increase in cardiometabolic mortality risk compared with healthy controls.

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