Pathways from co-occurrence of poor oral health and diabetes to Alzheimer's disease and related dementia (ADRD) and mortality

项目总结 阿尔茨海默病和相关痴呆(ADRD)是一种不可逆转的进行性大脑疾病，影响5.7 百万美国人。在所有成年人中，它是第六大死因和第五大死因 适用于65岁或以上的人。ADRD对个人和家庭在经济和情感上都是毁灭性的。 识别ADRD的单独和联合危险因素，并评估合并症对 认知障碍是改善老年人认知健康的关键。糖尿病和口腔健康不良是 在老年人中很常见，两者都是ADRD的危险因素。这项拟议的研究是第一次研究 糖尿病和口腔健康不良对ADRD和死亡率的联合作用(相加或交互作用)及其途径 从并存到ADRD和死亡率的发病。具体目标是：目标1a：审查 糖尿病与口腔健康不良并存与ADRD发生率的关系 在研究期间内倾向匹配样本。我们假设患有糖尿病和口腔不适的人 健康状况下患ADRD的可能性比那些没有这两种情况或只有其中一种情况的人更大 条件。目的1b：研究糖尿病与口腔健康不良和 在研究期间发展成ADRD的人中首次诊断ADRD的年龄。我们 假设既患有糖尿病又口腔健康状况不佳的人诊断ADRD的年龄较早。 目的1c：测试从糖尿病和口腔健康不良并存到ADRD发病的途径 检验关键中介变量(即基线后发生的心血管疾病和卒中)的中介作用。这个 共同发生与ADRD的发生和发病的关系是由CVD和 卒中。目的2a：探讨糖尿病与口腔健康不良并存的途径及其对口腔健康的影响。 AIM 1c中列出的关键调解人在研究基线后5年内死亡。我们将把研究样本分开 分成四组：活着时有ADRD，活着时没有ADRD，死时有ADRD，死时没有ADRD。我们 假设同时发生对死亡有直接和间接影响。目标2b：使用预测性 建模以确定调节因素(例如，童年逆境、饮食摄入量和遗传因素) 糖尿病的并存与口腔健康不良和基线5年内死亡的关系 调查。这项拟议中的研究首次检验了糖尿病和口腔健康不良并存的影响 关于ADRD和死亡率的研究，使用了大量的国家样本。拟议的研究将有助于更好地 通过提供关于联合风险的重要经验证据来理解ADRD的风险概况 糖尿病和口腔健康对ADRD都有帮助。此外，它还可以确定可以作为目标的可修改因素 降低ADRD的风险。这些发现将对临床实践和政策倡议产生重要影响。 用于整合初级保健和牙科保健。

Project summary Alzheimer's disease and related dementias (ADRD) is irreversible, progressive brain disease that affects 5.7 million Americans. It is the sixth leading cause of death among all adults and the fifth leading cause of death for those aged 65 or older. ADRD is devastating for individuals and families financially and emotionally. Identifying both individual and combined risk factors of ADRD and evaluating the impact of comorbidities on cognitive impairment is essential to improve cognitive health of older adults. Diabetes and poor oral health are common among older adults and both are risk factors for ADRD. The proposed study is the first to examine the joint effect (additive or interactions) of both DM and poor oral health on ADRD and mortality, and the pathways from the co-occurrence to the onset of ADRD and mortality. Specific aims are: Aim 1a: To examine the relationship between the co-occurrence of DM and poor oral health and the incidence of ADRD using a propensity matched sample within the study period. We hypothesize that persons with both DM and poor oral health will be more likely to have ADRD than those without either condition, or those with only one of these two conditions. Aim 1b: To examine the association between the co-occurrence of DM and poor oral health and the age of first diagnosis of ADRD among persons who developed ADRD during the study period. We hypothesize that persons with both DM and poor oral health will have a younger age of diagnosis of ADRD. Aim 1c: To test the pathways from the co-occurrence of DM and poor oral health to the onset of ADRD by examining the mediation effect of key mediating variables (i.e., CVD and stroke developed after baseline). The relationship between the co-occurrence and the incidence of and the onset of ADRD is mediated by CVD and stroke. Aim 2a: To examine the pathways of the co-occurrence of DM and poor oral health and the effect of key mediators, listed in Aim 1c, on death within 5 years of the study baseline. We will divide the study sample into four groups: alive with ADRD, alive without ADRD, died with ADRD, and died without ADRD. We hypothesize that the co-occurrence has both direct and indirect effects on death. Aim 2b: To use predictive modeling to identify moderators (e.g., childhood adversity, dietary intake, and genetic factors) of the relationship between the co-occurrence of DM and poor oral health and death within 5 years of the baseline survey. The proposed study is the first to examine the effect of the co-occurrence of DM and poor oral health on ADRD and mortality, using large national samples. The proposed study will contribute to a better understanding of the risk profile of ADRD by providing important empirical evidence on the combined risk of both DM and oral health for ADRD. Further, it may identify modifiable factors that can serve as targets to reduce the risk of ADRD. The findings will have important implications for clinical practice and policy initiatives for integrating primary care and dental care.