Tooth Loss in Diabetes Linked to Increased Risk of Cognitive Decline

Bei Wu, PhD
Courtesy: New York University

Data from a study conducted by investigators from the New York University (NYU) Rory Myers College of Nursing suggests tooth loss in people with diabetes could signal an increased risk of developing dementia.

A 12-year retrospective analysis of data from more than 5000 people focused on aging and oral health, results of the study demonstrate either risk factor was associated with increased risk among older adults, but cooccurrence was associated with an even further intensification of risk among this patient population.¹

“Our findings underscore the importance of dental care and diabetes management for older adults in reducing the devastating personal and societal costs of Alzheimer’s disease and other related dementias,” said Bei Wu, PhD, vice dean for research at NYU Rory Meyers College of Nursing and co-director of the NYU Aging Incubator.²

As the aging population has been made to bear the burden of diabetes, cognitive decline has emerged as a major risk factor in recent years, with a 2021 analysis of the UK Biobank cohort linking both prediabetes and known diabetes to increased risk of cognitive decline.³ In the current study, investigators planned to estimate the impact of cooccurring edentulism and diabetes on risk of cognitive decline among patients included in the University of Michigan’s Health and Retirement Study.

A longitudinal panel study surveying a representative sample of 20,000 people in America⁴, the National Institute on Aging-support study provided investigators with data related to a cohort of 9948 individuals in the current analysis. Of these 9948, a total of 5440 were aged 65-74 years, 3300 were aged 75-84 years, and 1208 were aged 85 years or older.¹

The primary outcome of interest for the study was the rates of cognitive decline stratified by age cohorts. Associations between cooccurring edentulism and diabetes with cognitive decline were assessed using linear mixed-effect regression models.¹

Upon analysis, initial results indicated older adults aged 65 to 74 y (β = -1.12 [95% confidence interval [CI], -1.56 to -0.65]; P <.001) and those aged 75 to 84 y with both conditions (β = -1.35 [95% CI, -2.09 to -0.61]; P <.001) had a worse cognitive function compared to their counterparts with neither diabetes mellitus nor edentulism at baseline. When assessing rate of cognitive decline relative to their counterparts in the same age cohort without either condition, older adults aged 65-74 years with both conditions declined at a higher rate (β = -0.15 [95% CI, -0.20 to -0.10]; P <.001).¹

When assessing the impact of individual risk factors on cognitive decline, results indicated diabetes mellitus alone was associated with increased cognitive decline in adults aged 65-74 years while having edentulism alone was associated with accelerated decline in those 65-74 years (β = -0.13 [95% CI, -0.17 to -0.08]; P <.001) and those aged 75-84 years (β = -0.10 [95% CI, -0.17 to -0.03]; P <.001).¹

“Access to dental care for older adults—especially those with diabetes—is critical, and health care providers should educate their patients about the connection between oral health and cognition,” Wu added.²

References:

1. Wu B, Luo H, Tan C, et al. Diabetes, Edentulism, and Cognitive Decline: A 12-Year Prospective Analysis. Journal of Dental Research. 2023;0(0). doi:10.1177/00220345231155825
2. New York University. Diabetes and toothlessness together worsen cognitive decline. EurekAlert! https://www.eurekalert.org/news-releases/982472N. Published March 13, 2023. Accessed March 15, 2023.
3. Garfield, V, Farmaki, A-E, Eastwood, SV, et al. HbA1c and brain health across the entire glycaemic spectrum. Diabetes Obes Metab. 2021; 23: 1140– 1149. https://doi.org/10.1111/dom.14321
4. University of Michigan. The Health and Retirement Study. HRS. https://hrs.isr.umich.edu/about. Accessed March 15, 2023.