Periodontitis Exposure and Risk of Incident Dementia

描述（由申请人提供）：牙周炎是一种细菌诱导的牙齿支撑结构炎症性疾病，与全身炎症升高相关。其患病率随着年龄的增长而显著增加，在少数民族和弱势群体中尤其高。有限的证据表明，口腔健康状况不佳与普遍的认知障碍和痴呆事件有关，但牙周炎对认知老化和痴呆的影响尚未得到详细研究。在这项提案中，我们打算正式测试的假设，牙周炎是一个未被承认的风险因素事件认知功能障碍的参与者中，目前正在招募的WHICAP队列。WHICAP是居住在北方曼哈顿的老年人的多种族纵向队列。自近20年前成立以来，已有4,000多名参与者在24个月的时间间隔内接受了医疗，社会和健康行为史，一般医学检查和神经心理学测试的连续评估。迄今为止，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和认知能力下降表达中的复杂影响的认识。除了这些措施，目前的WHICAP参与者也正在评估多种AD生物标志物，包括多模式MRI，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志物对牙周状况进行详细评估，并前瞻性地探讨牙周炎作为AD事件和认知能力下降的独立危险因素在4年内的作用。此外，我们将在基线后24个月重复相同的牙周状态评估，并将检查前2年内牙周状态恶化与随后2年内认知能力下降之间的关联。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能力下降的生物标志物之间的关联。在WHICAP研究中对牙周感染的评估提供了一个独特的机会，可以有效地探索牙周炎如何与认知老化的常规措施（如神经学和神经心理学检查）相关，同时也可以探索两种疾病的生物标志物之间的亚临床关联。考虑到老年人群中AD和痴呆症的大量无法解释的差异以及牙周炎既可预防又可治疗的事实，将牙周炎鉴定为一种慢性牙周炎， 从公共卫生的角度来看，认知障碍的潜在未被识别的危险因素/标志物将是极其有价值的。

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.