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

项目摘要 阿尔茨海默病和相关痴呆（ADRD）是一种不可逆的进行性脑部疾病， 数百万美国人它是所有成年人的第六大死因，也是第五大死因 对于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的个体和联合风险因素，并评估合并症对ADRD的影响。 认知障碍对改善老年人的认知健康至关重要。糖尿病和口腔健康状况不佳是 在老年人中很常见，两者都是ADRD的危险因素。拟议的研究是第一次审查 糖尿病和口腔健康不良对ADRD和死亡率的联合作用（相加或相互作用），以及途径 从同时发生到ADRD发作和死亡。具体目标是：目标1a：审查 糖尿病合并口腔健康不良与ADRD发病率之间的关系， 研究期间倾向匹配样本。我们假设糖尿病和口腔不良的人 健康的人比没有任何一种情况或只有这两种情况之一的人更有可能患有ADRD 条件目的1b：研究糖尿病合并症与口腔健康不良之间的关系， 研究期间发生ADRD的患者首次诊断ADRD的年龄。我们 假设患有糖尿病和口腔健康不良的人将具有更年轻的ADRD诊断年龄。 目的1c：通过以下方法检测从糖尿病和口腔健康不良并存到ADRD发作的途径： 检查关键中介变量的中介效应（即，基线后发生CVD和卒中）。的 共现与ADRD的发病率和发作之间的关系由CVD介导， 中风目的2a：研究糖尿病和口腔健康不良共同发生的途径以及 目标1c中列出的关键介质对研究基线后5年内死亡的影响。我们将研究样本分为 分为四组：ADRD存活组、无ADRD存活组、ADRD死亡组和无ADRD死亡组。我们 假设同时发生对死亡有直接和间接的影响。目标2b：使用预测 建模以识别主持人（例如，儿童期逆境、饮食摄入和遗传因素）， 基线后5年内糖尿病与口腔健康不良和死亡并存的关系 调查.这项研究是第一次研究糖尿病和口腔健康状况不佳的共同发生的影响 关于ADRD和死亡率，使用大规模国家样本。拟议的研究将有助于更好地 了解ADRD的风险特征，提供关于以下风险的重要经验证据： 糖尿病和口腔健康的ADRD。此外，它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举措产生重要影响 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.