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ABSTRACT[/h] Alzheimer?s disease (AD) is a scourge of longevity that will drain enormous resources from public health budgets in the future. Currently, there is no diagnostic biomarker and/or treatment for this most common form of dementia in humans.
AD can be of early familial-onset or sporadic with a late-onset. Apart from the two main hallmarks, amyloid-beta and neurofibrillary tangles, inflammation is a characteristic feature of AD neuropathology. Inflammation may be caused by a local central nervous system insult and/or by peripheral infections. Numerous microorganisms are suspected in AD brains ranging from bacteria (mainly oral and non-oralTreponema species), viruses (herpes simplex type I), and yeasts (Candida species).
A causal relationship between periodontal pathogens and non-oral Treponema species of bacteria has been proposed via the amyloid-beta and inflammatory links. Periodontitis constitutes a peripheral oral infection that can provide the brain with intact bacteria and virulence factors and inflammatory mediators due to daily, transient bacteremias.
If and when genetic risk factors meet environmental risk factors in the brain, disease is expressed, in which neurocognition may be impacted, leading to the development of dementia.
To achieve the goal of finding a diagnostic biomarker and possible prophylactic treatment for AD, there is an initial need to solve the etiological puzzle contributing to its pathogenesis. This review therefore addresses oral infection as the plausible etiology of late-onset AD (LOAD).
Dementia: Alzheimer's linked to gum disease in new study
The study builds on previous research linking poor dental hygiene with the disease
Alzheimer?s patients with gum disease appear to experience faster congnitive decline than those with better dental health, a new study has shown.
The research on patients with mild to moderate levels of Alzheimer?s disease builds on previous evidence which has linked periodontitis with higher levels of inflammatory molecules associated with deteriorated mental health.
Teams at the University of Southampton and King?s College London carried out conginitive assessments on 59 people, and also took their blood samples to test for inflammatory markers.
A dental hygienist also assessed their oral health.
The majority of the participants were then assessed once more six months later.
Researchers found that participants with gum disease had a six-fold increase in the rate of cognitive decline.
Gum disease is common in older people and could be worsened in those with Alzheimer?s as it becomes more difficult for patients to care for their teeth.
The study which was published in the journal ?Plos One? suggested that the body?s inflammatory response to gum disease could explain the link between gum disease and cognitive deterioration.
Professor Clive Holmes, senior author from the University of Southampton, said that further research is needed to develop the findings of the small trial.
"However, if there is a direct relationship between periodontitis and cognitive decline, as this current study suggests, then treatment of gum disease might be a possible treatment option for Alzheimer's." Mark Ide, from the Dental Institute at King's College London, said that studies have also shown a link between developing dementia and having fewer teeth.
?Research has suggested that effective gum treatment canreduce the levels of these molecules closer to that seen in a healthy state."
Periodontitis and Cognitive Decline in Alzheimer’s Disease
Published: March 10, 2016
Abstract
Periodontitis is common in the elderly and may become more common in Alzheimer’s disease because of a reduced ability to take care of oral hygiene as the disease progresses. Elevated antibodies to periodontal bacteria are associated with an increased systemic pro-inflammatory state. Elsewhere raised serum pro-inflammatory cytokines have been associated with an increased rate of cognitive decline in Alzheimer’s disease. We hypothesized that periodontitis would be associated with increased dementia severity and a more rapid cognitive decline in Alzheimer’s disease.
We aimed to determine if periodontitis in Alzheimer’s disease is associated with both increased dementia severity and cognitive decline, and an increased systemic pro inflammatory state. In a six month observational cohort study 60 community dwelling participants with mild to moderate Alzheimer’s Disease were cognitively assessed and a blood sample taken for systemic inflammatory markers.
Dental health was assessed by a dental hygienist, blind to cognitive outcomes. All assessments were repeated at six months. The presence of periodontitis at baseline was not related to baseline cognitive state but was associated with a six fold increase in the rate of cognitive decline as assessed by the ADAS-cog over a six month follow up period. Periodontitis at baseline was associated with a relative increase in the pro-inflammatory state over the six month follow up period.
Our data showed that periodontitis is associated with an increase in cognitive decline in Alzheimer’s Disease, independent to baseline cognitive state, which may be mediated through effects on systemic inflammation.
