Tooth Loss Is Associated With Increased Risk of Dementia and With a Dose-Response Relationship

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Abstract

Objective: Both tooth loss and dementia are age-related and frequently-occurring diseases. Increasing attention has been given to explore the pathogenesis related to oral-brain function disorders. The present study was performed to evaluate the association between tooth loss and dementia through a dose-response meta-analysis.

Methods: Relevant cohort studies were searched from online databases up until June 20, 2018, which examined the association between tooth loss and the risk of dementia. Literature selection according to inclusion and exclusion criteria, as well as data extraction from included studies were completed independently by two reviewers. Data syntheses in this meta-analysis were performed using Stata 12.0 software.

Results: A total of 8 cohort studies were included, containing a total of 14,362 samples and 2,072 dementia patients. The result of the meta-analysis indicated that patients with tooth loss faced a 1.34 times greater risk of developing dementia (RR = 1.34,95% CI = 1.19-1.51). The result from this dose-response meta-analysis in a linear model, suggested that every missed tooth might increase the risk of dementia by 1.01 times (RR = 1.01, 95%CI = 1.00-1.02). Further subgroup analyses pointed out that tooth loss patients without dentures may have a higher risk of dementia than those with dentures (with denture: RR = 0.98, 95% CI = 0.87-1.10; without denture: RR = 1.53, 95% CI = 1.19-1.97); at the same time, the study design, study area and education level of the study participants, might also have some effect on the results.

Conclusions: Tooth loss may be a risk factor for the development of dementia. In addition, there is a dose-response relationship with the increase of missing teeth.

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Most cited references 34

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W Melsen, M Bonten, M Rovers … (2014)

Variance between studies in a meta-analysis will exist. This heterogeneity may be of clinical, methodological or statistical origin. The last of these is quantified by the I(2) -statistic. We investigated, using simulated studies, the accuracy of I(2) in the assessment of heterogeneity and the effects of heterogeneity on the predictive value of meta-analyses. The relevance of quantifying I(2) was determined according to the likely presence of heterogeneity between studies (low, high, or unknown) and the calculated I(2) (low or high). The findings were illustrated by published meta-analyses of selective digestive decontamination and weaning protocols. As expected, I(2) increases and the likelihood of drawing correct inferences from a meta-analysis decreases with increasing heterogeneity. With low levels of heterogeneity, I(2) does not appear to be predictive of the accuracy of the meta-analysis result. With high levels of heterogeneity, even meta-analyses with low I(2) -values have low predictive values. Most commonly, the level of heterogeneity in a meta-analysis will be unknown. In these scenarios, I(2) determination may help to identify estimates with low predictive values (high I(2) ). In this situation, the results of a meta-analysis will be unreliable. With low I(2) -values and unknown levels of heterogeneity, predictive values of pooled estimates may range extensively, and findings should be interpreted with caution. In conclusion, quantifying statistical heterogeneity through I(2) -statistics is only helpful when the amount of clinical heterogeneity is unknown and I(2) is high. Objective methods to quantify the levels of clinical and methodological heterogeneity are urgently needed to allow reliable determination of the accuracy of meta-analyses.

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The role of peripheral inflammatory markers in dementia and Alzheimer's disease: a meta-analysis.

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Studies that have investigated the association between markers of inflammation and risk of dementia are conflicting. Therefore, the researchers conducted a systematic review and meta-analysis of observational studies with the hypothesis that an increased level of peripheral proinflammatory markers would be associated with risk of all-cause dementia or Alzheimer's disease (AD). The researchers conducted a literature search of observational studies indexed in the PubMed and PsycInfo databases. Selected studies included those with at least one peripheral inflammatory biomarker and its association with risk of all-cause dementia or AD. Random effects models were used to generate pooled hazard ratios (HRs) comparing the top versus bottom quantile of inflammatory marker level. Heterogeneity was assessed using the I (2) statistic. Seven studies were identified, combining for a total 5,717 participants, 746 cases of all-cause dementia and 565 cases of AD. An increased level of C-reactive protein was associated with a 45% increased risk of all-cause dementia (HR: 1.45; 95% CI: 1.10, 1.91). Similarly, a higher level of interleukin-6 was associated with a 32% increased risk (HR: 1.32; 95% CI: 1.06, 1.64) of all-cause dementia. For AD alone, the association with C-reactive protein was less pronounced (HR: 1.21; 95% CI: 1.03, 1.42) and interleukin-6 was not associated with risk of AD (HR: 1.06; 95% CI: 0.83, 1.35). No significant heterogeneity was found in any of the meta-analyses (I (2) = 0%-40%, p ≥ .16). An increased peripheral level of inflammatory markers is associated with a modest increase in risk of all-cause dementia. Evidence for an association with risk of AD alone is limited.

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The interleukin 1 alpha, interleukin 1 beta, interleukin 6 and alpha-2-macroglobulin serum levels in patients with early or late onset Alzheimer's disease, mild cognitive impairment or Parkinson's disease.

Erdinç Dursun, Duygu Gezen-Ak, Hasmet Hanagasi … (2015)

Alzheimer's disease (EOAD, LOAD), mild cognitive impairment (MCI), Parkinson's disease (PD) and healthy controls were included to determine the serum interleukin-1s (IL-1α, IL-1β), IL-6 and alpha-2-macroglobulin (α2M) levels using ELISA. IL-6 might be a significant contributor to the inflammatory response in LOAD. The MCI data indicate that IL-1s, α2M and BDNF are somehow related, and this relationship might allow MCI patients to be more similar to the healthy controls. A correlation analysis of multiple biomarkers in different neurodegenerative disorders might be more useful than determining the levels of a single cytokine in a single disorder.

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Author and article information

Contributors

Jun Chen: URI : http://loop.frontiersin.org/people/655664/overview

Chang-Ju Ren: URI : http://loop.frontiersin.org/people/655697/overview

Lan Wu: URI : http://loop.frontiersin.org/people/563918/overview

Ling-Yun Xia: URI : http://loop.frontiersin.org/people/655726/overview

Jun Shao: URI : http://loop.frontiersin.org/people/652190/overview

Wei-Dong Leng: URI : http://loop.frontiersin.org/people/527199/overview

Xian-Tao Zeng: URI : http://loop.frontiersin.org/people/460677/overview

Journal

Journal ID (nlm-ta): Front Aging Neurosci

Journal ID (iso-abbrev): Front Aging Neurosci

Journal ID (publisher-id): Front. Aging Neurosci.

Title: Frontiers in Aging Neuroscience

Publisher: Frontiers Media S.A.

ISSN (Electronic): 1663-4365

Publication date (Electronic): 18 December 2018

Publication date Collection: 2018

Volume: 10

Electronic Location Identifier: 415

Affiliations

[1] ¹Department of Neurology, Taihe Hospital, Hubei University of Medicine , Shiyan, China

[2] ²Department of Evidence-Based Medicine and Clinical Epidemiology, Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Second Clinical College of Wuhan University , Wuhan, China

[3] ³Department of Stomatology, Taihe Hospital, Hubei University of Medicine , Shiyan, China

[4] ⁴Department of Stomatology, Guangzhou Hospital of Integrated Traditional and West Medicine , Guangzhou, China

Author notes

Edited by: Hanting Zhang, West Virginia University, United States

Reviewed by: William B. Grant, Sunlight Nutrition and Health Research Center, United States; Jun Lyu, First Affiliated Hospital of Xi'an Jiaotong University, China

*Correspondence: Wei-Dong Leng lengtaihe@ 123456163.com

Xian-Tao Zeng zengxiantao1128@ 123456163.com

†These authors share first authorship

Article

DOI: 10.3389/fnagi.2018.00415

PMC ID: 6305430

PubMed ID: 30618721

SO-VID: 22fe7488-59c7-4310-acbf-96d07e0bf8e6

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

History

Date received : 08 August 2018

Date accepted : 03 December 2018

Page count

Figures: 4, Tables: 3, Equations: 0, References: 47, Pages: 9, Words: 5712

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Tooth Loss Is Associated With Increased Risk of Dementia and With a Dose-Response Relationship

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Abstract

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Hearing Loss and Restoration

Most cited references 34

The effects of clinical and statistical heterogeneity on the predictive values of results from meta-analyses.

The role of peripheral inflammatory markers in dementia and Alzheimer's disease: a meta-analysis.

The interleukin 1 alpha, interleukin 1 beta, interleukin 6 and alpha-2-macroglobulin serum levels in patients with early or late onset Alzheimer's disease, mild cognitive impairment or Parkinson's disease.

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Cited by 23

Most referenced authors 1,056