@article {160,
	title = {Periodontitis is associated with cognitive impairment among older adults: analysis of NHANES-III.},
	journal = {J Neurol Neurosurg Psychiatry},
	volume = {80},
	year = {2009},
	month = {2009 Nov},
	pages = {1206-11},
	abstract = {BACKGROUND: Periodontitis is ubiquitous and associated with serological evidence of exposure to periodontal organisms, systemic inflammation and vascular disease. Dementia is a major public health problem likely related to a complex interaction between genetics and diseases associated with systemic inflammation, including diabetes, smoking and stroke.

METHODS: To assess relationships between systemic exposure to periodontal pathogens and cognitive test outcomes, data were analysed from the Third National Health and Nutrition Examination Survey (NHANES-III), a nationally representative cross sectional observational study among older adults. We included 2355 participants >or=60 years who completed measures of cognition and Poryphyromonas gingivalis IgG. Using SUDAAN, logistic regression models examined the association of P gingivalis IgG with cognitive test performance.

RESULTS: Poor immediate verbal memory (<5/9 points) was prevalent in 5.7\% of patients, and 6.5\% overall had impaired delayed recall (<4/9); 22.1\% had difficulty with serial subtractions (<5/5 trials correct). Individuals with the highest P gingivalis IgG (>119 ELISA Units (EU)) were more likely to have poor delayed verbal recall (OR 2.89, 95\% CI 1.14 to 7.29) and impaired subtraction (OR 1.95, 95\% CI 1.22 to 3.11) than those with the lowest (<or=57 EU), with dose-response relationships for both (p trend, delayed memory = 0.045, subtraction = 0.04). After adjusting for socioeconomic and vascular variables, these relationships remained robust for the highest P gingivalis IgG group (delayed verbal memory OR 3.01 (95\% CI 1.06 to 8.53); subtraction OR 2.00 (95\% CI 1.19 to 3.36)). In contrast, immediate verbal memory was not significantly associated with P gingivalis.

CONCLUSION: A serological marker of periodontitis is associated with impaired delayed memory and calculation. Further exploration of relationships between oral health and cognition is warranted.},
	keywords = {Age Factors, Aged, Cognition, Cognition Disorders, Cross-Sectional Studies, Female, Humans, Immunoglobulin G, Male, Middle Aged, Nutrition Surveys, Periodontitis, Porphyromonas gingivalis},
	issn = {1468-330X},
	doi = {10.1136/jnnp.2009.174029},
	author = {Noble, J M and Borrell, L N and Papapanou, P N and Elkind, M S V and Scarmeas, N. and Wright, C B}
}
