Department of International and Community Oral Health, Tohoku University, Graduate School of Dentistry.
Department of Dental Sociology, Kanagawa Dental University.
J Epidemiol. 2022 Jul 5;32(7):330-336. doi: 10.2188/jea.JE20200476. Epub 2021 Jul 10.
Although the feasibility of randomized trials for investigating the long-term association between oral health and cognitive decline is low, deriving causal inferences from observational data is challenging. We aimed to investigate the association between poor oral status and subjective cognitive complaints (SCC) using fixed-effects model to eliminate the confounding effect of unobserved time-invariant factors.
We used data from Japan Gerontological Evaluation Study (JAGES) which was conducted in 2010, 2013, and 2016. β regression coefficients and 95% confidence intervals [CIs] were calculated using fixed-effects models to determine the effect of deteriorating oral status on developing SCC. Onset of SCC was evaluated using the Kihon Checklist-Cognitive function score. Four oral status variables were used: awareness of swallowing difficulty, decline in masticatory function, dry mouth, and number of teeth.
We included 13,594 participants (55.8% women) without SCC at baseline. The mean age was 72.4 (standard deviation [SD], 5.1) years for men and 72.4 (SD, 4.9) years for women. Within the 6-year follow-up, 26.6% of men and 24.9% of women developed SCC. The probability of developing SCC was significantly higher when participants acquired swallowing difficulty (β = 0.088; 95% CI, 0.065-0.111 for men and β = 0.077; 95% CI, 0.057-0.097 for women), decline in masticatory function (β = 0.039; 95% CI, 0.021-0.057 for men and β = 0.030; 95% CI, 0.013-0.046 for women), dry mouth (β = 0.026; 95% CI, 0.005-0.048 for men and β = 0.064; 95% CI, 0.045-0.083 for women), and tooth loss (β = 0.043; 95% CI, 0.001-0.085 for men and β = 0.058; 95% CI, 0.015-0.102 for women).
The findings suggest that good oral health needs to be maintained to prevent the development of SCC, which increases the risk for future dementia.
虽然针对口腔健康与认知能力下降之间的长期关联进行随机试验的可行性较低，但从观察性数据中得出因果推论具有挑战性。我们旨在使用固定效应模型来研究口腔状况不良与主观认知抱怨（SCC）之间的关联，以消除未观察到的、不可随时间变化的因素的混杂影响。
我们使用了 2010 年、2013 年和 2016 年开展的日本老年评估研究（JAGES）的数据。使用固定效应模型计算 β 回归系数和 95%置信区间 [CI]，以确定口腔状况恶化对 SCC 发生的影响。使用 Kihon Checklist-Cognitive Function 评分评估 SCC 的发病情况。我们使用了 4 个口腔状况变量：吞咽困难意识、咀嚼功能下降、口干和牙齿数量。
我们纳入了基线时无 SCC 的 13594 名参与者（55.8%为女性）。男性的平均年龄为 72.4（标准差 [SD]，5.1）岁，女性为 72.4（SD，4.9）岁。在 6 年的随访期间，26.6%的男性和 24.9%的女性发生了 SCC。当参与者出现吞咽困难（男性 β = 0.088；95%CI，0.065-0.111；女性 β = 0.077；95%CI，0.057-0.097）、咀嚼功能下降（男性 β = 0.039；95%CI，0.021-0.057；女性 β = 0.030；95%CI，0.013-0.046）、口干（男性 β = 0.026；95%CI，0.005-0.048；女性 β = 0.064；95%CI，0.045-0.083）和牙齿缺失（男性 β = 0.043；95%CI，0.001-0.085；女性 β = 0.058；95%CI，0.015-0.102）时，SCC 的发病概率显著增加。
研究结果表明，为预防 SCC 的发生从而降低未来发生痴呆的风险，需要保持良好的口腔健康。
