Department of Conservative Dentistry with Endodontics, Medical University of Silesia, 40-055 Katowice, Poland.
Int J Mol Sci. 2022 Dec 5;23(23):15320. doi: 10.3390/ijms232315320.
It has been suggested that molecular pathological mechanisms responsible for periodontitis can be linked with biochemical alterations in neurodegenerative disorders. Hypothetically, chronic systemic inflammation as a response to periodontitis plays a role in the etiology of cognitive impairment. This study aimed to determine whether periodontitis (PDS) is a risk factor for age-related cognitive impairment (ACI) based on evidence of clinical studies. A comprehensive, structured systematic review of existing data adhering to the Preferred Reporting Items for Systematic Review and Meta Analyses (PRISMA) guidelines was carried out. Five electronic databases, PubMed, Embase, Scopus, Web of Science, and Cochrane, were searched for key terms published in peer-reviewed journals until January 2021. The Newcastle-Ottawa scale was used to assess the quality of studies and risk of bias. The primary and residual confounders were explored and evaluated. A meta-analysis synthesizing quantitative data was carried out using a random-effects model. Seventeen clinical studies were identified, including 14 cohort, one cross-sectional, and two case-control studies. Study samples ranged from 85 to 262,349 subjects, with follow-up between 2 and 32 years, and age above 45 years, except for two studies. The findings of studies suggesting the PDS-ACI relationship revealed substantial differences in design and methods. A noticeable variation related to the treatment of confounders was observed. Quality assessment unveiled a moderate quality of evidence and risk of bias. The subgroups meta-analysis and pooled sensitivity analysis of results from seven eligible studies demonstrated overall that the presence of PDS is associated with an increased risk of incidence of cognitive impairment (OR = 1.36, 95% CI 1.03-1.79), particularly dementia (OR = 1.39, 95% CI 1.02-1.88) and Alzheimer's disease (OR = 1.03 95% CI 0.98-1.07)). However, a considerable heterogeneity of synthesized data (I = 96%) and potential publication bias might affect obtained results. While there is a moderate statistical association between periodontitis and dementia, as well as Alzheimer's disease, the risk of bias in the evidence prevents conclusions being drawn about the role of periodontitis as a risk factor for age-related cognitive impairment.
有人提出，导致牙周炎的分子病理机制可能与神经退行性疾病的生化改变有关。假设作为对牙周炎的反应的慢性全身炎症在认知障碍的病因学中起作用。本研究旨在根据临床研究证据确定牙周炎（PDS）是否是与年龄相关的认知障碍（ACI）的危险因素。根据 Preferred Reporting Items for Systematic Review and Meta Analyses（PRISMA）指南，对现有的数据进行了全面、结构化的系统综述。在同行评议期刊上发表的关键词，在五个电子数据库中进行了搜索，包括 PubMed、Embase、Scopus、Web of Science 和 Cochrane，直到 2021 年 1 月。使用 Newcastle-Ottawa 量表评估研究质量和偏倚风险。探讨和评估了主要和残余混杂因素。使用随机效应模型对定量数据进行了荟萃分析。确定了 17 项临床研究，包括 14 项队列研究、1 项横断面研究和 2 项病例对照研究。研究样本范围从 85 到 262349 名受试者，随访时间为 2 至 32 年，年龄在 45 岁以上，除了两项研究。表明 PDS-ACI 关系的研究结果表明，在设计和方法上存在显著差异。观察到与混杂因素处理相关的明显差异。质量评估显示证据质量为中等，存在偏倚风险。对来自七项合格研究的结果进行的亚组荟萃分析和综合敏感性分析表明，总体而言，PDS 的存在与认知障碍发生率的增加相关（OR = 1.36，95%CI 1.03-1.79），尤其是痴呆症（OR = 1.39，95%CI 1.02-1.88）和阿尔茨海默病（OR = 1.03，95%CI 0.98-1.07））。然而，综合数据的异质性较大（I = 96%），可能存在发表偏倚，这可能会影响到研究结果。虽然牙周炎与痴呆症和阿尔茨海默病之间存在中度统计学关联，但证据中的偏倚风险阻止了关于牙周炎作为与年龄相关的认知障碍的危险因素的作用的结论。
