Alzheimer’s disease patients with gum disease (periodontitis) show higher rates of cognitive decline: Study

Alzheimer’s disease patients with gum disease (periodontitis) show higher rates of cognitive decline. The researchers from University of Southampton and King’s College London found that periodontitis is common among older people and can become more common among those with Alzheimer’s disease due to lagging oral hygiene as patients become forgetful to take care of their oral health. Higher levels of antibodies to periodontal bacteria increase inflammation throughout the body, raising the risk of Alzheimer’s disease.

The study included 59 participants with mild to moderate Alzheimer’s disease. Their blood samples were assessed to measure inflammatory markers. Dental health was also examined, and 52 participants went for a follow-up six months later.

The presence of periodontitis at baseline was associated with a sixfold increase in the rate of cognitive decline over the six-month follow-up period. This led the authors to conclude that gum disease is associated with greater cognitive decline, possibly linked to inflammatory response.

Senior author Clive Holmes said, “These are very interesting results which build on previous work we have done that shows that chronic inflammatory conditions have a detrimental effect on disease progression in people with Alzheimer’s disease. Our study was small and lasted for six months so further trials need to be carried out to develop these results. 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.”

First author Dr. Mark Ide added, “Gum disease is widespread in the U.K. and U.S., and in older age groups is thought to be a major cause of tooth loss. In the U.K. in 2009, around 80 percent of adults over 55 had evidence of gum disease, whilst 40 percent of adults aged over 65 to 74 (and 60 percent of those aged over 75) had less than 21 of their original 32 teeth, with half of them reporting gum disease before they lost teeth.”

“A number of studies have shown that having few teeth, possibly as a consequence of earlier gum disease, is associated with a greater risk of developing dementia. We also believe, based on various research findings, that the presence of teeth with active gum disease results in higher body-wide levels of the sorts of inflammatory molecules, which have also been associated with an elevated risk of other outcomes, such as cognitive decline or cardiovascular disease. Research has suggested that effective gum treatment can reduce the levels of these molecules closer to that seen in a healthy state.”

“Previous studies have also shown that patients with Alzheimer’s disease have poorer dental health than others of similar age and that the more severe the dementia the worse the dental health, most likely reflecting greater difficulties with taking care of oneself as dementia becomes more severe,” Dr. Ide concluded.

Tips to keep good oral health with dementia

In dementia and Alzheimer’s disease, patients are getting progressively forgetful. Remembering to brush and floss becomes a greater challenge as the disease worsens. It’s important to still maintain proper oral hygiene as it can have negative consequences on overall health. Here are some tips to keep good oral hygiene with dementia.

• If a person is in the early stages of dementia, they should carry out oral hygiene practices on their own as long as possible – friendly reminders and supervision is okay.
• An oral hygiene routine should be established early on when dementia is first diagnosed.
• When dementia progresses and the patient stops caring or becomes more forgetful, guided instructions are required to ensure the patient is still following through.
• The caregiver can brush the patient’s teeth by having the patient sit on a chair with the caregiver standing behind the patient holding onto their head for support with one hand while brushing their teeth with the other.

Some indications of oral health tissues in Alzheimer’s patients include refusal to eat – especially hard or cold food, frequent pulling at the face or mouth, leaving dentures out of their mouth, increased restlessness, moaning, or shouting, disturbed sleep, refusal to take part in activities, and aggressive behavior.

Spotting oral hygiene problems early on can help reduce the risk of complications and worsening of dementia.