Skip to main content
Top
Published in: Alzheimer's Research & Therapy 1/2017

Open Access 01-12-2017 | Research

Association between chronic periodontitis and the risk of Alzheimer’s disease: a retrospective, population-based, matched-cohort study

Authors: Chang-Kai Chen, Yung-Tsan Wu, Yu-Chao Chang

Published in: Alzheimer's Research & Therapy | Issue 1/2017

Login to get access

Abstract

Background

Although recent short-term cross-sectional studies have revealed that chronic periodontitis (CP) may be a risk factor for increased cognitive impairment in patients with Alzheimer’s disease (AD), systematic reviews and long-term longitudinal studies have provided less clear evidence regarding the relationship between CP and AD. Therefore, we conducted a retrospective cohort study using the National Health Insurance Research Database (NHIRD) of Taiwan to determine whether patients with CP are at increased risk of developing AD.

Methods

We conducted a retrospective matched-cohort study using the NHIRD of Taiwan. We identified 9291 patients newly diagnosed with CP between 1997 and 2004. A total of 18,672 patients without CP were matched to the patient cohort according to sex, age, index year, co-morbidity and urbanisation level. Cox proportional hazards regression analyses were performed to evaluate the subsequent risk of AD.

Results

Patients with CP had a higher prevalence of hyperlipidaemia, depression, traumatic brain injury and co-morbidities, as well as higher urbanisation levels, than those in the unexposed cohort (all p < 0.01). At the final follow-up, totals of 115 (1.24%) and 208 (1.11%) individuals in the CP exposed and unexposed groups, respectively, had developed AD. Patients with 10 years of CP exposure exhibited a higher risk of developing AD than unexposed groups (adjusted HR 1.707, 95% CI 1.152–2.528, p = 0.0077).

Conclusions

Our findings demonstrate that 10-year CP exposure was associated with a 1.707-fold increase in the risk of developing AD. These findings highlight the need to prevent progression of periodontal disease and promote healthcare service at the national level.
Literature
1.
go back to reference Gaur S, Agnihotri R. Alzheimer’s disease and chronic periodontitis: is there an association? Geriatr Gerontol Int. 2015;15:391–404.CrossRefPubMed Gaur S, Agnihotri R. Alzheimer’s disease and chronic periodontitis: is there an association? Geriatr Gerontol Int. 2015;15:391–404.CrossRefPubMed
2.
go back to reference Lin RT, Lai CL, Tai CT, Liu CK, Yen YY, Howng SL. Prevalence and subtypes of dementia in southern Taiwan: impact of age, sex, education, and urbanization. J Neurol Sci. 1998;160:67–75.CrossRefPubMed Lin RT, Lai CL, Tai CT, Liu CK, Yen YY, Howng SL. Prevalence and subtypes of dementia in southern Taiwan: impact of age, sex, education, and urbanization. J Neurol Sci. 1998;160:67–75.CrossRefPubMed
3.
go back to reference Peng D, Shi Z, Xu J, Shen L, Xiao S, Zhang N, et al. Demographic and clinical characteristics related to cognitive decline in Alzheimer disease in China: a multicenter survey from 2011 to 2014. Medicine (Baltimore). 2016;95:e3727. Peng D, Shi Z, Xu J, Shen L, Xiao S, Zhang N, et al. Demographic and clinical characteristics related to cognitive decline in Alzheimer disease in China: a multicenter survey from 2011 to 2014. Medicine (Baltimore). 2016;95:e3727.
4.
go back to reference Tzeng NS, Chung CH, Yeh CB, Huang RY, Yuh DY, Huang SY, et al. Are chronic periodontitis and gingivitis associated with dementia? A nationwide, retrospective, matched-cohort study in Taiwan. Neuroepidemiology. 2016;47:82–93.CrossRefPubMed Tzeng NS, Chung CH, Yeh CB, Huang RY, Yuh DY, Huang SY, et al. Are chronic periodontitis and gingivitis associated with dementia? A nationwide, retrospective, matched-cohort study in Taiwan. Neuroepidemiology. 2016;47:82–93.CrossRefPubMed
5.
go back to reference Martande SS, Pradeep AR, Singh SP, Kumari M, Suke DK, Raju AP, et al. Periodontal health condition in patients with Alzheimer’s disease. Am J Alzheimers Dis Other Demen. 2014;29:498–502.CrossRefPubMed Martande SS, Pradeep AR, Singh SP, Kumari M, Suke DK, Raju AP, et al. Periodontal health condition in patients with Alzheimer’s disease. Am J Alzheimers Dis Other Demen. 2014;29:498–502.CrossRefPubMed
6.
go back to reference Brookmeyer R, Johnson E, Ziegler-Graham K, Arrighi HM. Forecasting the global burden of Alzheimer’s disease. Alzheimers Dement. 2007;3:186–91.CrossRefPubMed Brookmeyer R, Johnson E, Ziegler-Graham K, Arrighi HM. Forecasting the global burden of Alzheimer’s disease. Alzheimers Dement. 2007;3:186–91.CrossRefPubMed
7.
go back to reference Marchesi VT. Alzheimer’s dementia begins as a disease of small blood vessels, damaged by oxidative-induced inflammation and dysregulated amyloid metabolism: implications for early detection and therapy. FASEB J. 2011;25:5–13.CrossRefPubMed Marchesi VT. Alzheimer’s dementia begins as a disease of small blood vessels, damaged by oxidative-induced inflammation and dysregulated amyloid metabolism: implications for early detection and therapy. FASEB J. 2011;25:5–13.CrossRefPubMed
8.
go back to reference Tonsekar PP, Jiang SS, Yue G. Periodontal disease, tooth loss and dementia: is there a link? A systematic review. Gerodontology. 2017;34:151–63.CrossRefPubMed Tonsekar PP, Jiang SS, Yue G. Periodontal disease, tooth loss and dementia: is there a link? A systematic review. Gerodontology. 2017;34:151–63.CrossRefPubMed
9.
go back to reference Huang CC, Chung CM, Leu HB, Lin LY, Chiu CC, Hsu CY, et al. Diabetes mellitus and the risk of Alzheimer’s disease: a nationwide population-based study. PLoS One. 2014;9, e87095.CrossRefPubMedPubMedCentral Huang CC, Chung CM, Leu HB, Lin LY, Chiu CC, Hsu CY, et al. Diabetes mellitus and the risk of Alzheimer’s disease: a nationwide population-based study. PLoS One. 2014;9, e87095.CrossRefPubMedPubMedCentral
10.
go back to reference Moreno Cervantes C, Mimenza Alvarado A, Aguilar Navarro S, Alvarado Ávila P, Gutiérrez Gutiérrez L, Juárez Arellano S, et al. Factors associated with mixed dementia vs Alzheimer disease in elderly Mexican adults. Neurologia. 2017;32:309–15.CrossRefPubMed Moreno Cervantes C, Mimenza Alvarado A, Aguilar Navarro S, Alvarado Ávila P, Gutiérrez Gutiérrez L, Juárez Arellano S, et al. Factors associated with mixed dementia vs Alzheimer disease in elderly Mexican adults. Neurologia. 2017;32:309–15.CrossRefPubMed
11.
go back to reference Vanhanen M, Koivisto K, Moilanen L, Helkala EL, Hanninen T, Soininen H, et al. Association of metabolic syndrome with Alzheimer disease: a population-based study. Neurology. 2006;67:843–7.CrossRefPubMed Vanhanen M, Koivisto K, Moilanen L, Helkala EL, Hanninen T, Soininen H, et al. Association of metabolic syndrome with Alzheimer disease: a population-based study. Neurology. 2006;67:843–7.CrossRefPubMed
12.
go back to reference Helmer C, Stengel B, Metzger M, Froissart M, Massy ZA, Tzourio C, et al. Chronic kidney disease, cognitive decline, and incident dementia: the 3C Study. Neurology. 2011;77:2043–51.CrossRefPubMed Helmer C, Stengel B, Metzger M, Froissart M, Massy ZA, Tzourio C, et al. Chronic kidney disease, cognitive decline, and incident dementia: the 3C Study. Neurology. 2011;77:2043–51.CrossRefPubMed
13.
go back to reference Burke SL, Maramaldi P, Cadet T, Kukull W. Associations between depression, sleep disturbance, and apolipoprotein E in the development of Alzheimer’s disease: dementia. Int Psychogeriatr. 2016;28:1409–24.CrossRefPubMed Burke SL, Maramaldi P, Cadet T, Kukull W. Associations between depression, sleep disturbance, and apolipoprotein E in the development of Alzheimer’s disease: dementia. Int Psychogeriatr. 2016;28:1409–24.CrossRefPubMed
14.
go back to reference Huang CY, Li YC, Wang HK, Sung PS, Wang LC, Sun YT, et al. Stroke suggests increased risk of dementia. Curr Alzheimer Res. 2015;12:287–95.CrossRefPubMed Huang CY, Li YC, Wang HK, Sung PS, Wang LC, Sun YT, et al. Stroke suggests increased risk of dementia. Curr Alzheimer Res. 2015;12:287–95.CrossRefPubMed
15.
go back to reference Wang HK, Lin SH, Sung PS, Wu MH, Hung KW, Wang LC, et al. Population based study on patients with traumatic brain injury suggests increased risk of dementia. J Neurol Neurosurg Psychiatry. 2012;83:1080–5.CrossRefPubMed Wang HK, Lin SH, Sung PS, Wu MH, Hung KW, Wang LC, et al. Population based study on patients with traumatic brain injury suggests increased risk of dementia. J Neurol Neurosurg Psychiatry. 2012;83:1080–5.CrossRefPubMed
16.
go back to reference Kamer AR, Craig RG, Dasanayake AP, Brys M, Glodzik-Sobanska L, de Leon MJ. Inflammation and Alzheimer’s disease: possible role of periodontal diseases. Alzheimers Dement. 2008;4:242–50.CrossRefPubMed Kamer AR, Craig RG, Dasanayake AP, Brys M, Glodzik-Sobanska L, de Leon MJ. Inflammation and Alzheimer’s disease: possible role of periodontal diseases. Alzheimers Dement. 2008;4:242–50.CrossRefPubMed
17.
go back to reference Watts A, Crimmins EM, Gatz M. Inflammation as a potential mediator for the association between periodontal disease and Alzheimer’s disease. Neuropsychiatr Dis Treat. 2008;4:865–76.CrossRefPubMedPubMedCentral Watts A, Crimmins EM, Gatz M. Inflammation as a potential mediator for the association between periodontal disease and Alzheimer’s disease. Neuropsychiatr Dis Treat. 2008;4:865–76.CrossRefPubMedPubMedCentral
18.
go back to reference Al-Shammari KF, Al-Khabbaz AK, Al-Ansari JM, Neiva R, Wang HL. Risk indicators for tooth loss due to periodontal disease. J Periodontol. 2005;76:1910–8.CrossRefPubMed Al-Shammari KF, Al-Khabbaz AK, Al-Ansari JM, Neiva R, Wang HL. Risk indicators for tooth loss due to periodontal disease. J Periodontol. 2005;76:1910–8.CrossRefPubMed
19.
go back to reference Paraskevas S, Huizinga JD, Loos BG. A systematic review and meta-analyses on C-reactive protein in relation to periodontitis. J Clin Periodontol. 2008;35:277–90.CrossRefPubMed Paraskevas S, Huizinga JD, Loos BG. A systematic review and meta-analyses on C-reactive protein in relation to periodontitis. J Clin Periodontol. 2008;35:277–90.CrossRefPubMed
20.
go back to reference Passoja A, Puijola I, Knuuttila M, Niemelä O, Karttunen R, Raunio T, et al. Serum levels of interleukin-10 and tumour necrosis factor-α in chronic periodontitis. J Clin Periodontol. 2010;37:881–7.CrossRefPubMed Passoja A, Puijola I, Knuuttila M, Niemelä O, Karttunen R, Raunio T, et al. Serum levels of interleukin-10 and tumour necrosis factor-α in chronic periodontitis. J Clin Periodontol. 2010;37:881–7.CrossRefPubMed
21.
22.
go back to reference Lakschevitz F, Aboodi G, Tenenbaum H, Glogauer M. Diabetes and periodontal diseases: interplay and links. Curr Diabetes Rev. 2011;7:433–9.CrossRefPubMed Lakschevitz F, Aboodi G, Tenenbaum H, Glogauer M. Diabetes and periodontal diseases: interplay and links. Curr Diabetes Rev. 2011;7:433–9.CrossRefPubMed
23.
go back to reference Liu TC, Sheu JJ, Lin HC, Jensen DA. Increased risk of parkinsonism following chronic periodontitis: a retrospective cohort study. Mov Disord. 2013;28:1307–8.CrossRefPubMed Liu TC, Sheu JJ, Lin HC, Jensen DA. Increased risk of parkinsonism following chronic periodontitis: a retrospective cohort study. Mov Disord. 2013;28:1307–8.CrossRefPubMed
24.
go back to reference Roher AE, Esh C, Kokjohn TA, Kalback W, Luehrs DC, Seward JD, et al. Circle of Willis atherosclerosis is a risk factor for sporadic Alzheimer’s disease. Arterioscler Thromb Vasc Biol. 2003;23:2055–62.CrossRefPubMed Roher AE, Esh C, Kokjohn TA, Kalback W, Luehrs DC, Seward JD, et al. Circle of Willis atherosclerosis is a risk factor for sporadic Alzheimer’s disease. Arterioscler Thromb Vasc Biol. 2003;23:2055–62.CrossRefPubMed
25.
go back to reference Honig LS, Kukull W, Mayeux R. Atherosclerosis and AD: analysis of data from the US National Alzheimer’s Coordinating Center. Neurology. 2005;64:494–500.CrossRefPubMed Honig LS, Kukull W, Mayeux R. Atherosclerosis and AD: analysis of data from the US National Alzheimer’s Coordinating Center. Neurology. 2005;64:494–500.CrossRefPubMed
26.
go back to reference Uppoor AS, Lohi HS, Nayak D. Periodontitis and Alzheimer’s disease: oral systemic link still on the rise? Gerodontology. 2013;30:239–42.CrossRefPubMed Uppoor AS, Lohi HS, Nayak D. Periodontitis and Alzheimer’s disease: oral systemic link still on the rise? Gerodontology. 2013;30:239–42.CrossRefPubMed
27.
go back to reference Ide M, Harris M, Stevens A, Sussams R, Hopkins V, Culliford D, et al. Periodontitis and cognitive decline in Alzheimer’s disease. PLoS One. 2016;11, e0151081.CrossRefPubMedPubMedCentral Ide M, Harris M, Stevens A, Sussams R, Hopkins V, Culliford D, et al. Periodontitis and cognitive decline in Alzheimer’s disease. PLoS One. 2016;11, e0151081.CrossRefPubMedPubMedCentral
28.
30.
go back to reference Hsu CC, Wahlqvist ML, Lee MS, Tsai HN. Incidence of dementia is increased in type 2 diabetes and reduced by the use of sulfonylureas and metformin. J Alzheimers Dis. 2011;24:485–93.PubMed Hsu CC, Wahlqvist ML, Lee MS, Tsai HN. Incidence of dementia is increased in type 2 diabetes and reduced by the use of sulfonylureas and metformin. J Alzheimers Dis. 2011;24:485–93.PubMed
31.
go back to reference Romano PS, Roos LL, Jollis JG. Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives. J Clin Epidemiol. 1993;46:1075–9. discussion 1081–90.CrossRefPubMed Romano PS, Roos LL, Jollis JG. Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives. J Clin Epidemiol. 1993;46:1075–9. discussion 1081–90.CrossRefPubMed
32.
go back to reference Gil-Montoya JA, Sanchez-Lara I, Carnero-Pardo C, Fornieles F, Montes J, Vilchez R, et al. Is periodontitis a risk factor for cognitive impairment and dementia? A case-control study. J Periodontol. 2015;86:244–53.CrossRefPubMed Gil-Montoya JA, Sanchez-Lara I, Carnero-Pardo C, Fornieles F, Montes J, Vilchez R, et al. Is periodontitis a risk factor for cognitive impairment and dementia? A case-control study. J Periodontol. 2015;86:244–53.CrossRefPubMed
33.
go back to reference Lee YT, Lee HC, Hu CJ, Huang LK, Chao SP, Lin CP, et al. Periodontitis as a modifiable risk factor for dementia: a nationwide population-based cohort study. J Am Geriatr Soc. 2017;65:301–5.CrossRefPubMed Lee YT, Lee HC, Hu CJ, Huang LK, Chao SP, Lin CP, et al. Periodontitis as a modifiable risk factor for dementia: a nationwide population-based cohort study. J Am Geriatr Soc. 2017;65:301–5.CrossRefPubMed
34.
go back to reference Liu CY, Hung YT, Chuang YL, Chen YJ, Weng WS, Liu JS, et al. Incorporating development stratification of Taiwan townships into sampling design of large scale health interview survey. J Health Manag (China). 2006;4:1–22. Liu CY, Hung YT, Chuang YL, Chen YJ, Weng WS, Liu JS, et al. Incorporating development stratification of Taiwan townships into sampling design of large scale health interview survey. J Health Manag (China). 2006;4:1–22.
35.
go back to reference Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.CrossRefPubMed Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.CrossRefPubMed
36.
go back to reference Wong CS, Lin YC, Hong LY, Chen TT, Ma HP, Hsu YH, et al. Increased long-term risk of dementia in patients with carbon monoxide poisoning: a population-based study. Medicine (Baltimore). 2016;95:e2549. Wong CS, Lin YC, Hong LY, Chen TT, Ma HP, Hsu YH, et al. Increased long-term risk of dementia in patients with carbon monoxide poisoning: a population-based study. Medicine (Baltimore). 2016;95:e2549.
37.
go back to reference McGeer PL, McGeer EG. Inflammation, autotoxicity and Alzheimer disease. Neurobiol Aging. 2001;22:799–809.CrossRefPubMed McGeer PL, McGeer EG. Inflammation, autotoxicity and Alzheimer disease. Neurobiol Aging. 2001;22:799–809.CrossRefPubMed
38.
go back to reference D’Aiuto F, Graziani F, Tete S, Gabriele M, Tonetti MS. Periodontitis: from local infection to systemic diseases. Int J Immunopathol Pharmacol. 2005;18(3 Suppl):1–11.PubMed D’Aiuto F, Graziani F, Tete S, Gabriele M, Tonetti MS. Periodontitis: from local infection to systemic diseases. Int J Immunopathol Pharmacol. 2005;18(3 Suppl):1–11.PubMed
39.
go back to reference Yan Q, Zhang J, Liu H, Babu-Khan S, Vassar R, Biere AL, et al. Anti-inflammatory drug therapy alters β-amyloid processing and deposition in an animal model of Alzheimer’s disease. J Neurosci. 2003;23:7504–9.PubMed Yan Q, Zhang J, Liu H, Babu-Khan S, Vassar R, Biere AL, et al. Anti-inflammatory drug therapy alters β-amyloid processing and deposition in an animal model of Alzheimer’s disease. J Neurosci. 2003;23:7504–9.PubMed
40.
go back to reference Llibre Rodriguez JJ, Ferri CP, Acosta D, Guerra M, Huang Y, Jacob KS, et al. Prevalence of dementia in Latin America, India, and China: a population-based cross-sectional survey. Lancet. 2008;372:464–74.CrossRefPubMed Llibre Rodriguez JJ, Ferri CP, Acosta D, Guerra M, Huang Y, Jacob KS, et al. Prevalence of dementia in Latin America, India, and China: a population-based cross-sectional survey. Lancet. 2008;372:464–74.CrossRefPubMed
41.
go back to reference Campos CH, Ribeiro GR, Costa JL, Rodrigues Garcia RC. Correlation of cognitive and masticatory function in Alzheimer’s disease. Clin Oral Investig. 2017;21:573–8.CrossRefPubMed Campos CH, Ribeiro GR, Costa JL, Rodrigues Garcia RC. Correlation of cognitive and masticatory function in Alzheimer’s disease. Clin Oral Investig. 2017;21:573–8.CrossRefPubMed
42.
go back to reference Campos CH, Ribeiro GR, Stella F, Rodrigues Garcia RC. Mandibular movements and bite force in Alzheimer’s disease before and after new denture insertion. J Oral Rehabil. 2017;44:178–86.CrossRefPubMed Campos CH, Ribeiro GR, Stella F, Rodrigues Garcia RC. Mandibular movements and bite force in Alzheimer’s disease before and after new denture insertion. J Oral Rehabil. 2017;44:178–86.CrossRefPubMed
43.
go back to reference Wen BW, Tsai CS, Lin CL, Chang YJ, Lee CF, Hsu CH, et al. Cancer risk among gingivitis and periodontitis patients: a nationwide cohort study. QJM. 2014;107:283–90.CrossRefPubMed Wen BW, Tsai CS, Lin CL, Chang YJ, Lee CF, Hsu CH, et al. Cancer risk among gingivitis and periodontitis patients: a nationwide cohort study. QJM. 2014;107:283–90.CrossRefPubMed
Metadata
Title
Association between chronic periodontitis and the risk of Alzheimer’s disease: a retrospective, population-based, matched-cohort study
Authors
Chang-Kai Chen
Yung-Tsan Wu
Yu-Chao Chang
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Alzheimer's Research & Therapy / Issue 1/2017
Electronic ISSN: 1758-9193
DOI
https://doi.org/10.1186/s13195-017-0282-6

Other articles of this Issue 1/2017

Alzheimer's Research & Therapy 1/2017 Go to the issue