Objective:We assess the association between self-reported history of periodontal disease diagnosis with self-reported cognitive and functional decline at age ∼60. We also investigate (1) the roles of social background, demographic characteristics, education, and adolescent test scores in confounding that association and (2) the role of cardiovascular disease in mediating that association.Participants and Methods:We use data from a nationally representative sample of 13,525 people who participated in the 2021 wave of the High School & Beyond (HSB) cohort study. HSB began in 1980 with a nationally-representative sample of American 10th and 12th grade students; these students have been followed up on six occasions since 1980, yielding extraordinary and prospectively-collected life course data on all key measures for a large, multicultural sample.In 2021, HSB sample members were evaluated with neuropsychological tests that evaluated list learning and memory, semantic and letter fluency, and working memory. They were also asked to self-report memory and functional decline using the AD8, using a cutoff of 2 or more items for significant concerns. Mild Cognitive Impairment will be identified using an algorithm validated in a similar sample of middle aged participants.Sample members were also asked in 2021 whether a medical professional had ever diagnosed them with periodontal disease; those responding affirmatively were then asked the years in which they started and stopped having periodontal disease.Measures of social and economic background; demographic characteristics; and educational contexts, opportunities, and attainments were measured prospectively—and in great detail—in the surveys administered in the 1980s. Critically, almost all sample members completed a series of cognitive tasks during adolescence, allowing us to address a key set of confounders in the relationship between periodontal disease and MCI. Markers of cardiovascular disease were measured in both 2013 and 2021.We estimate logistic regression models predicting significant cognitive and functional concerns as a function of periodontal disease history; we also estimate models that account for confounders, including social background, demographic characteristics, education, and cognitive skills during adolescence; finally, we estimate models that account for the mediating role of cardiovascular disease. All models account for the clustered sampling design of HSB and employ sampling weights to account for HSB’s complex sampling design and selective attrition from the panel.Results:About 15% of the cohort has been diagnosed with periodontal disease, and nearly one in five had significant cognitive and functional concerns.People with a history of periodontal disease were more likely to report significant cognitive and functional concerns. This association remains substantive and statistically significant after adjusting for confounders. All else equal, the odds of people with a history of periodontal disease having an AD8 score of 2 or higher were about 60% greater than the odds of those not reporting periodontal disease. Very little of this association can be attributed to cardiovascular disease as a mediating pathway.Conclusions:People with a history of periodontal disease are at greatly elevated risk of self-reported cognitive and functional concerns at age ∼60. This supports evidence— never before collected at this scale in a long-term, representative cohort study—that oral pathogens may contribute to cognitive well-being over the life course.

中文翻译：

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80 一项大型、多文化队列研究中牙周病与 60 岁时自我报告的认知和功能下降之间的关联

目的：我们评估自我报告的牙周病诊断史与自我报告的 60 岁时认知和功能下降之间的关联。我们还调查了（1）社会背景、人口特征、教育和青少年测试分数在混淆这种关联中的作用，以及（2）心血管疾病在调节这种关联中的作用。参与者和方法：我们使用来自全国代表性的数据参与 2021 年高中及以上 (HSB) 队列研究的 13,525 人样本。HSB 于 1980 年开始，以具有全国代表性的美国 10 年级和 12 年级学生为样本；自 1980 年以来，对这些学生进行了六次随访，针对大型多元文化样本的所有关键指标，产生了非凡的、前瞻性收集的生命历程数据。 2021 年，HSB 样本成员接受了评估列表学习和记忆的神经心理学测试，语义和字母流畅性以及工作记忆。他们还被要求使用 AD8 自我报告记忆力和功能下降，并使用 2 个或更多项目作为重大问题的截止值。将使用在中年参与者的类似样本中验证的算法来识别轻度认知障碍。样本成员还在 2021 年被问及是否有医疗专业人员诊断过他们患有牙周病；然后询问那些做出肯定回答的人开始和停止患有牙周病的年份。社会和经济背景的衡量标准；人口特征; 在 20 世纪 80 年代进行的调查中，对教育背景、机会和成就进行了前瞻性且详细的衡量。至关重要的是，几乎所有样本成员在青春期都完成了一系列认知任务，这使我们能够解决牙周病与 MCI 之间关系中的一系列关键混杂因素。心血管疾病的标志物在 2013 年和 2021 年进行了测量。我们估计逻辑回归模型预测显着的认知和功能问题作为牙周病史的函数；我们还估计了解释混杂因素的模型，包括社会背景、人口特征、教育和青春期认知技能；最后，我们估计了解释心血管疾病中介作用的模型。所有模型都考虑了 HSB 的聚类抽样设计，并采用抽样权重来考虑 HSB 的复杂抽样设计和小组的选择性减员。 结果：该队列中约 15% 的人被诊断患有牙周病，近五分之一的人患有显着的牙周病。认知和功能问题。有牙周病史的人更有可能报告严重的认知和功能问题。在调整混杂因素后，这种关联仍然具有实质性和统计显着性。其他条件都一样，有牙周病史的人 AD8 评分为 2 或更高的几率比没有报告牙周病的人高出约 60%。这种关联很少可以归因于心血管疾病作为中介途径。结论：有牙周病史的人在 60 岁时自我报告的认知和功能问题的风险大大增加。这支持了口腔病原体可能有助于整个生命过程中认知健康的证据——以前从未在长期、有代表性的队列研究中收集过如此规模的证据。