Periodontitis Exposure and Risk of Incident Dementia

描述(申请人提供)：牙周炎是一种由细菌引起的牙齿支持结构的炎症性疾病，与全身炎症升高有关。它的患病率随着年龄的增长而显著增加，在少数群体和弱势群体中尤为严重。有限的证据表明，口腔健康不良与普遍存在的认知障碍和偶发痴呆症有关，但牙周炎对认知老化和痴呆症的影响尚未得到详细研究。在这项提案中，我们打算正式测试这一假设，即牙周炎是目前正在纳入的WHICAP队列中的参与者中未被认识到的认知障碍的风险因素。WHICAP是一个居住在曼哈顿北部的多种族纵向老年队列。自近20年前开始以来，超过4,000名参与者在24个月的间隔内接受了一系列评估，包括医疗、社会和健康行为史、一般医学检查和神经心理测试。到目前为止，对WHICAP数据的分析显著增加了我们对社会人口统计学、遗传学、健康行为和生活方式、教育、识字和血管疾病在AD发病和认知能力下降表达中的复杂影响的了解。除了这些措施外，目前的WHICAP参与者还接受了多种AD生物标志物的评估，包括多模式磁共振成像、淀粉样蛋白标记的脑正电子发射断层扫描(淀粉样蛋白-PET)和血浆淀粉样蛋白。我们建议使用临床、微生物学和血清学标记物对牙周状况进行详细评估，并前瞻性地探讨牙周炎在4年期间作为发生AD和认知功能下降的独立危险因素的作用。此外，我们将在基线后24个月重复相同的牙周状况评估，并将检查前两年牙周状况恶化与随后两年认知功能下降之间的关系。我们还将前瞻性地评估牙周炎的微生物和血清学标志物与认知功能衰退的生物标志物之间的关系。将牙周感染评估纳入WHICAP研究提供了一个独特的机会，不仅可以有效地探索牙周炎可能如何与认知老化的常规指标(如神经学和神经心理学检查)有关，还可以探索这两种疾病的生物标志物之间的亚临床联系。鉴于老年人群中阿尔茨海默病和痴呆症的显著差异，以及牙周炎既可预防又可治疗的事实，将牙周炎确定为一种 从公共卫生的角度来看，认知损害的潜在未被认识的危险因素/标记物将是非常有价值的。

DESCRIPTION (provided by applicant): Periodontitis is a bacterially induced inflammatory disorder of the tooth-supporting structures that is associated with elevated systemic inflammation. Its prevalence increases significantly with age and is particularly elevated in minority and disadvantaged populations. Limited evidence suggests that poor oral health is associated with prevalent cognitive impairment and incident dementia, but the effect of periodontitis on cognitive aging and dementia has not been examined in detail. In this proposal, we intend to formally test the hypothesis that periodontitis is an unrecognized risk factor for incident cognitive impairment among the participants in the WHICAP cohort currently being enrolled. WHICAP is a multi-ethnic longitudinal cohort of aging elderly residing in northern Manhattan. Since its inception nearly 20 years ago, more than 4,000 participants have been serially assessed in 24-month intervals with medical, social, and health behavior histories, general medical exams, and neuropsychological testing. To date, analyses of WHICAP data have markedly increased our knowledge of the complex influence of sociodemographics, genetics, health behavior and lifestyle, education, literacy, and vascular disease in the expression of incident AD and cognitive decline. In addition to these measures, current WHICAP participants are also being assessed for multiple AD biomarkers including multimodal MRI, amyloid-labeled brain positron emission tomography (amyloid-PET), and plasma amyloid. We propose to perform a detailed assessment of periodontal status using clinical, microbiological and serological markers and prospectively explore the role of periodontitis as an independent risk factor for incident AD and cognitive decline over a 4-year period. Furthermore, we will repeat the same assessments of periodontal status at 24 months after baseline, and will examine the association between the deterioration of periodontal status over the first 2-year period and incident cognitive decline over the subsequent 2-year period. We will also assess prospectively the association between microbial and serological markers of periodontitis and biomarkers of cognitive decline. Incorporating assessments of periodontal infection within the WHICAP study provides a unique opportunity to explore efficiently how periodontitis may relate to conventional measures of cognitive aging (such as neurologic and neuropsychological examinations) but also to explore sub-clinical associations among biomarkers of both diseases. Given the substantial unexplained variance in AD and dementia in the elderly population and the fact that periodontitis is both preventable and treatable, identification of periodontitis as a potential unrecognized risk factor/marker for cognitive impairment will be extremely valuable from a public health standpoint.