Relationship between cognitive function and mastication in elderly females

In Japan, the elderly population suffering from dementia is rapidly increasing. Several animal studies have indicated a relationship between reduced masticatory function in the elderly subject and cognitive impairment. However, epidemiological studies examining this have been scarce. Using an epidemiological approach, the present study investigated this relationship in 44 females with and 44 without dementia, all aged over 65 years. Age and basic activities of daily living, such as walking, eating, excreting, bathing and dressing, were matched in the two groups. Cognitive impairment of the subjects was measured using the revised Hasegawa Dementia Rating Scale. Masticatory function was assessed in terms of the number of teeth present, maximum bite force, occlusal contact area, and mastication score. The number of teeth present in cognitively normal subjects was significantly higher than in cognitively impaired subjects (P < 0.05). In addition, maximum bite force, occlusal contact area, and mastication scores of cognitively normal subjects were significantly higher than those of cognitively impaired subjects (P < 0.01). These results suggest that masticatory function in the elderly person is associated with cognitive status.     

Tooth loss and cognitive functions among older adults

Objective. To evaluate the association between the number of teeth and cognitive functions adjusted for age and education level in a cohort of older adults living in Sweden. Materials and methods. The study employed a cross-sectional design in which 1147 individuals between 60–96 years underwent a clinical oral examination. The cognitive functions were assessed using Mini-Mental State Examination (MMSE) and Clock-test. The level of education was obtained from a questionnaire. Data were subjected to Chi-square tests and multivariate logistic regression analyses were employed, grouping the different variables into pre-determined categories. Results. The co-variables age and education were significantly associated with the number of teeth (p < 0.05). The multivariate logistic regression analysis revealed that the association between the number of teeth and the cognitive functions persisted even after adjusting for age and level of education. Conclusions. The findings suggest that the presence of teeth may be of importance for cognitive abilities in older adults.     

Experience and assessment of pain in individuals with cognitive impairments

The authors review the literature on pain experience and pain assessment in people with cognitive impairments, focusing on individuals with dementia and mental retardation. The impact of cognitive impairments on pain sensation is not well understood, although some observations have been published. For example, research suggests that pain experience can be influenced by neuropathological processes in the brain and memory impairments. Reporting of pain decreases as cognitive impairment increases. In addition, poor verbal skills lead to difficulties in communicating pain. Pain assessment depends primarily on one's ability to describe the dimensions of pain. Individuals with limited ability to report pain can use pain assessment methods that rely on simple cognitive tasks. For individuals who have no ability to report pain, an outside observer must describe the discomfort experienced by interpreting the patient's body language. The authors conclude that further research is needed to develop valid and reliable assessment methods for people with cognitive impairments.     

Tooth loss and cognitive impairment

Objectives: Chronic subclinical inflammation may elevate the risk of cognitive impairment. Periodontitis is associated with subclinical inflammation and accounts in part for tooth loss. The hypothesis was tested that periodontitis and tooth loss as a proxy of chronic periodontitis is associated with cognitive impairment in the elderly.
Subjects and Methods: The population-based Study of Health in Pomerania comprises 1336 subjects (60–79 years). Cognitive impairment was assessed with the Mini-Mental Status Examination (MMSE). Tobit regression analyses were adjusted for potential confounders.
Results: A decreased number of teeth was associated with lower MMSE scores in females ( p <0.001) and males ( p =0.007) in age-adjusted models. In the fully adjusted models, tooth loss was associated with cognitive impairment in females ( p =0.002) but not in males ( p =0.825).
Conclusions: A significant association between tooth loss and cognitive impairment was found in females that was not accounted for by potential confounders. Former periodontitis may account for this association as periodontitis was frequently the cause for tooth extractions.     

Strategies to improve dental health in elderly patients with cognitive impairment: A systematic review

Background

Cognitive impairment is the gradual loss of one’s ability to learn, remember, pay attention, and make decisions. Cognitively impaired elderly people are a challenging patient population for dental health care professionals and may be at higher risk of developing oral health diseases. The authors systematically reviewed interventions effective at improving dental health in patients with cognitive impairment and described research gaps remaining.

Relationship between dental care and oral health in institutionalized elderly people in Japan

This study examined the relationship between dental care and dental health status in institutionalized elderly people in Japan through a 6-year prospective cohort study. All the 719 subjects received both baseline and follow-up surveys. The uptake of dental care was examined at the follow-up survey. We examined the relationship between baseline variables and the provision of dental care, and the relationship between dental care and change of oral health status. About 47% of the subjects and about 60% of the baseline dentate subjects received some dental treatment during the 6-year follow-up period. The subjects who were in better systemic and dental health at baseline used dental services frequently. The number of teeth needing extraction decreased in the subjects who received dental treatment, and increased in the untreated subjects. Denture status was better in the treated subjects than in the untreated subjects. Dental care appears to be an important factor in maintaining a healthy oral status for the institutionalized elderly.     

Relationship between dental health and 10-year mortality in a cohort of community-dwelling elderly people

Dental examinations were carried out as part of the Evergreen project, which focuses on functional capacity and health among the elderly residents of the city of Jyväskylä, central Finland. Dental status was examined in 1990 for the whole population born in 1910 (n = 226). Mortality data were collected over 10 yr. The aim of the study was to assess the possible role of dental health as a predictor of mortality. The Kaplan–Meier method was used to analyse survival curves and Cox regression models, with the number of chronic conditions and self‐rated health used as covariates in analysing the risks of death. The results showed that the more teeth or filled teeth a subject had, the smaller was their risk for death. The effect of missing teeth was significant after adjusting for the general health variables. Thus, our results support the hypothesis that poor dental health is linked to increased mortality among elderly people.     

Associations between self-assessed masticatory ability and higher brain function among the elderly

Among the elderly, the quality of higher brain function is a contributing factor in performing activities of daily living. The aim of the study is to elucidate, epidemiologically, associations between mastication and higher brain function. A total of 208 community-dwelling elderly persons, aged 70-74 years, were enrolled. Self-assessed masticatory ability (masticatory ability) was classified into one of three categories: ability to chew all kinds of food, ability to chew only slightly hard food, or ability to chew only soft or pureed food. Brain function was assessed by four neuropsychological tests: Raven's Colored Progressive Matrices (RCPM) test, the Verbal Paired Associates 1 (VerPA) task and the Visual Paired Associates 1 task (from the Wechsler Memory Scale Revised Edition), and the Block Design subtest (from the Wechsler Adult Intelligence Scales-Third Edition). Correlations between masticatory ability and each test were examined using Spearman rank correlation coefficients. Multinominal logistic regression models were conducted with the neuropsychological tests as the dependent variables and masticatory ability as the principal independent variable to adjust for age, gender, educational background, social activity, drinking/smoking habits, chronic medical conditions and dental status. Significant correlations were found between the RCPM test, the VerPA task, the Block Design test and masticatory ability. In multinominal logistic regression models, poor masticatory ability was significantly and independently related to the categories under the mean-s.d. points compared with those of the mean ± s.d. ranges for RCPM test and the VerPA task. Significant associations may exist between mastication and higher brain function among the elderly.     

Comparison of maximum bite force and dentate status between healthy and frail elderly persons

The purpose of the present study was to (1) determine the standard value of maximum bite force and to (2) compare the maximum bite force of the elderly between healthy and frail subjects. Subjects included 349 healthy elderly individuals (149 males, 200 females) and 24 frail elderly individuals (seven males, 17 females) ranging from 65 to 74 years of age. Maximum bite force was evaluated using a Dental Prescale system. The maximum bite force of the healthy subjects was significantly higher than that of the frail subjects in both males (P=0.020) and females (P=0.015). However, no significant difference was observed in the number of present teeth between the healthy and frail subjects. Median of maximum bite force in healthy males was 408.0 N, and that of the healthy females was 243.5 N. These results suggest that the frail elderly have latent bite force problems.     

Denture-handling ability of elderly persons with dementia: Examination of time spent inserting and removing dentures

To evaluate the effects of dementia on denture‐handling ability, we measured the amount of time that elderly subjects spent inserting and removing dentures. Elderly subjects with dementia tended to take more time inserting and removing dentures than those who were not demented. Only elderly patients who were severely demented needed signifi‐cantly more time removing partial dentures than they did removing complete dentures. There was no significant difference between the time spent inserting dentures and removing dentures. The greater amount of time required to inseri or remove dentures for subjects with dementia was due to dis‐orientation. The results indicate that elderly people with mild to moderate dementia are able to insert and remove their dentures without help.     

Caries experience of institutionalized elderly and its association with dementia and functional status

To cite this article
Int J Dent Hygiene 10 , 2012; 122–127
DOI: 10.1111/j.1601‐5037.2011.00525.x Philip P, Rogers C, Kruger E, Tennant M. Caries experience of institutionalized elderly and its association with dementia and functional status. Abstract: Objectives: The aim of this study was to assess the caries experience of the elderly residing in residential aged care facilities in Perth, Western Australia, and its association with dementia and functional status. Methods: Oral examinations were conducted in a sample of institutionalized aged persons. This study was carried out over a period of 7 years, between 2002 and 2008. Results: A total of 205 residents were examined. The mean decayed, missing and filled teeth index score was 25.9 for all residents. Residents with dementia did not have significantly different levels of caries experience than those without. The mean number of active caries and retained decayed roots, however, was higher among residents with dementia. There was a significant difference in the mean number of active decay and carious retained roots among residents based on their Activities of Daily Living Oral Health score and their status of assistance received with brushing. Conclusion: Caries experience among the institutionalized elderly is associated with disability, and oral care is lacking among the institutionalized elderly in this study. Appropriate preventive measures (as well as interventional activities) should be undertaken to control oral disease among residential aged care residents.     

Cognitive function and number of teeth in a community-dwelling elderly population without dementia

Summary  Although the number of sound or decayed teeth has been reported to be associated with cognitive function in elderly populations with dementia, little is known about this association in elderly populations without dementia. We evaluated this relationship, with adjustment for confounding factors, in Japanese populations of 60-year-old ( n  = 270; 120 males and 150 females) and 65-year-old ( n  = 123; 57 males and 66 females) individuals residing in Fukuoka Prefecture of Japan. Dental examinations were performed in all subjects, along with the Mini-mental state examination (MMSE) for assessing cognitive function. Among the total of 393 subjects, the mean MMSE score was 27·9 ± 1·9, and 391 subjects scored 24 or higher. The mean numbers of sound and decayed teeth were 12·0 ± 6·3 and 0·5 ± 1·2, respectively. Associations were found between the numbers of sound and decayed teeth and MMSE in total subjects and males, but not in females, by multiple regression analysis adjusted for gender, age, level of education, marital status, smoking, alcohol drinking, working status, systolic blood pressure and blood glucose. An association was also found between MMSE and the number of sound teeth in a logistic regression analysis. In conclusion, associations were found between normal-range cognitive function and the numbers of sound and decayed teeth, after adjustment for various confounding factors, in an elderly Japanese population.     

Associations between self-assessed masticatory disability and health of community-residing elderly people

OBJECTIVE: To examine the relationship between the self-assessed masticatory disability and the health of community-residing older people. METHODS: Of 1473 randomly selected people aged 65 years and older living in Settsu, Osaka Prefecture, in October 1992, data on general health status, history of health management, psychosocial conditions, and dental conditions were obtained from 1405 people by interviews made during home visits. Follow-up for 54 months was completed for 1306 subjects (93.0%; 1072 living, 234 deceased). RESULTS: Being over 75 years of age, having poor general health and poor dental status, not using dental health checks, not using general health checks, not participating in social activities, not feeling that life is worth living (no "ikigai"), and feeling anxious about the future were univariately and significantly associated with self-assessed masticatory disability. Logistic regression analyses indicated that being older than 75 years, having poor general health and poor dental status, not using dental health checks, and not participating in social activities were independently associated with self-assessed masticatory disability. The Cox proportional hazards model showed that being male, over 75 years of age, and in poor general health, as well as not using general health checks, and not participating in social activities were independently associated with mortality. Self-assessed masticatory disability was univariately and significantly related to mortality, but by itself was not a significant risk factor for mortality, because of the potential influence of other variables. CONCLUSIONS: Certain health and psychosocial factors are closely associated with self-assessed masticatory disability among older people. Further investigations are needed to determine whether masticatory disability is a significant risk factor for mortality.     

Oral status,cognitive and functional capacity versus oral treatment need in nursing home residents: a comparison between assessments by dental and ward staff

OBJECTIVES: The aim of this study was to study the relationships between cognitive and functional capacity versus oral health and treatment need and to compare oral status assessments and oral treatment need, assessed by nurses and dental professionals, respectively. DESIGN: Cross-sectional survey. SETTING: Nursing home. SUBJECTS: One hundred and ninety-two nursing home residents were examined in 1997. MAIN OUTCOME MEASURES: Cognitive and functional capacity in different groups of residents regarding oral health and treatment need, measured by a comprehensive assessment with the Resident Assessment Instrument (RAI) and dental status in a separate examination protocol, recorded by a dentist. RESULTS: There was a significant correlation between being dentate and having need of oral treatment. Those who were able to chew also had significantly better cognitive and functional capacity. Oral treatment need was identified most often by the dentist, intermediately by the RAI assessment and least frequently by the residents themselves. CONCLUSIONS: Being dentate and having a loss of cognitive and functional capacity is predictive of oral treatment need among nursing home residents. Enhanced interaction between nurses and dental professionals needs to be promoted for better awareness of preventive measures and better regular oral care for frail and dependent elderly persons.