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Objective: To explore the association between tooth loss and cognitive functioning among persons 65 years and older.

Methods: Data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly (Wave 1: 1993-1994, n= 3,032; Wave 2: 1995-1996, n= 2,424; and Wave 3: 1998-1999, n= 1,967). The dependent variables were the scores from the total Mini-Mental State Examination (MMSE: score 0-30) and its global domains (memory: score 0-6; and no-memory: score 0-24). Independent variables included the  number of teeth (0-12 vs. 13-32), socio-demographic characteristics, last dental office visit, medical conditions, depressive symptoms, and functional limitations which were tested for associations with the dependent variables.

Results: In bivariate analyses, participants with fewer teeth (0-12) tended to have significantly lower mean scores for memory, no-memory, and total MMSE when compared to those with more teeth (13-32), both at baseline and at follow-up. In fully adjusted longitudinal-mixed models, participants with fewer teeth had a greater decline in total MMSE through five years of follow-up with a decrease of 0.12 fewer points each year (SE ± 0.05, p <0.01), when compared to those with more teeth.

Conclusion: Having fewer teeth was associated with greater cognitive decline over time.

Carlos A Reyes Ortiz, Oakwood Hospital Medical Center

Geriatrics-Internal Medicine, Fellow
Reyes Ortiz, C. A., Luque, J. S., Eriksson, C. K., & Soto, L. (2013). Self-reported tooth loss and cognitive function: Data from the Hispanic established populations for epidemiologic studies of the elderly (Hispanic EPESE). Colombia Medica, 44(3), 139–145.

Grabe HJ, Schwahn C, Völzke H, Spitzer C, Freyberger HJ, John U, et al. Tooth loss and cognitive impairment. J Clin Periodontol. 2009; 36(7): 550-7.

Noble JM, Borrell LN, Papapanou PN, Elkind MSV, Scarmeas N, Wright CB. Periodontitis is associated with cognitive impairment among older adults: analysis of NHANES-III. J Neurol Neurosurg Psychiatry. 2009; 80(11): 1206-11.

Wu B, Plassman BL, Crout RJ, Liang J. Cognitive function and oral health among community-dwelling older adults. J Gerontol A Biol Sci Med Sci. 2008; 63(5): 495-500.

Kaye EK, Valencia A, Baba N, Spiro A 3rd, Dietrich T, Garcia RI. Tooth loss and periodontal disease predict poor cognitive function in older men. J Am Geriatr Soc. 2010; 58(4): 713-8.

Okamoto N, Morikawa M, Okamoto K, Habu N, Iwamoto J, Tomioka K, et al. Relationship of tooth loss to mild memory impairment and cognitive impairment: findings from the fujiwara-kyo study. Behav Brain Funct. 2010; 6(1): 77.

Folstein MF, Folstein SE, McHugh PR. Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12(3):189-98.

Wechsler D. Wechsler Adult Intelligence Scale. Third Edition. San Antonio: The Psychological Corporation; 1997.

Department of Health and Human Services, Administration on Aging. A statistical profile of Hispanic older Americans aged 65+. Accessed on October 11, 2011.

Nguyen HT, Black SA, Ray LA, Espino DV, Markides KS. Predictors of decline in MMSE scores among older Mexican Americans. J Gerontol A Biol Sci Med Sci. 2002; 2002(57): 181-5.

Markides KS, Rudkin L, Angel RJ, Espino DV. Health status of Hispanic elderly. In: Martin LJ, Soldo B, editors. Racial and ethnic differences in the health of older Americans. Washington, DC: National Academy Press; 1997.

Matallana D, de Santacruz C, Cano C, Reyes P, Samper-Ternent R, Markides KS. et al. The relationship between education level and Mini Mental State Examination domains among older Mexican Americans. J Geriatr Psychiatr Neurol. 2011; 24(1): 9-18.

Bird HR, Canino G, Rubio-Stipec M, Shrout P. Use of the Mini-Mental State Examination in a probability sample of a Hispanic population. J Nerv Ment Dis. 1987; 175(12): 731-7.

Randolph WM, Ostir GV, Markides KS. Prevalence of tooth loss and dental service use in older Mexican Americans. J Am Geriatr Soc. 2001; 49(5): 585-9.

Reyes-Ortiz CA, Kuo Y, DiNuzzo AR, Ray LA, Raji MA, Markides KS. Near vision impairment predicts cognitive decline: data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly. J Am Geriatr Soc. 2005; 53(4): 681-6.

Raji MA, Reyes-Ortiz CA, Kuo YF, Markides KS, Ottenbacher KJ. Depressive symptoms and cognitive change in older Mexican Americans. J Geriatr Psychiatry Neurol. 2007; 20(3): 145-52.

Reyes-Ortiz CA, Berges IM, Raji MA, Koenig HG, Kuo Y, Markides KS. Church attendance mediates the association between depressive symptoms and cognitive functioning among older Mexican Americans. J Gerontol A Biol Sci Med Sci. 2008; 63(5): 480-6.

Reyes-Ortiz CA, Soto-Llanos L. [Associated factors with the use of dentures or reported dental and gum problems with oral prosthesis use among Mexican American older adults]. Rev Estomatol. 2010; 18: 10-6.

Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977; 1(3): 385-401

Katz SC, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged: the index of ADL, a standardized measure of biological and psychosocial function. JAMA 1963; 185(12): 914-9.

Stewart R, Weyant RJ, Garcia ME, Harris T, Launer LJ, Satterfield S. Adverse oral health and cognitive decline: the health, aging and body composition study. J Am Geriatr Soc. 2013; 61(2): 61-2.

Kamer AR, Craig RG, Dasanayake AP, Brys M, Glodzik-Sobanska L. de Leon MJ. Inflammation and Alzheimer’s disease: possible role of periodontal diseases. Alzheimers Dement. 2008; 4(4): 242-50.

Gatz M, Mortimer JA, Fratiglioni L, Johansson B, Berg S, Reynolds CA, et al. Potentially modifiable risk factors for dementia in identical twins. Alzheimer’s Dementia. 2006; 2(2): 110-7.

Matthews JC, You Z, Wadley VG, Cushman M, Howard G. The association between self-reported tooth loss and cognitive function in the reasons for geographic and racial differences in Stroke study: an assessment of potential pathways. J Am Dent Assoc. 2011; 142(4): 379-90.

Stewart R, Sabbah W, Tsakos G, D’Aiuto F, Watt RG. Oral health and cognitive function in the Third National Health and Nutrition Examination Survey. NHANES III). Psychosom Med. 2008; 70(8): 936-41.



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Received 2012-12-09
Accepted 2013-08-16
Published 2013-09-30