Diabetes, tooth loss can be double trouble for aging brains

By Cara Murez

health day reporter

WEDNESDAY, March 15, 2023 (HealthDay News) — Diabetes is a known risk factor for mental decline and dementia. Coupled with total tooth loss, the potential brain damage is even greater, according to new research.

The findings underscore the importance of good dental care and diabetes control in aging adults, said Bei Wu, lead author of a new study involving nearly 10,000 adults.

“Access to dental care for older adults, especially those with diabetes, is really important,” said Wu, associate dean for research at New York University’s Rory Meyers College of Nursing and co-director of the NYU Aging Incubator in New York.

The American Diabetes Association recommends regular dental checkups for anyone with diabetes – “but how many people follow this and how many clinicians recommend this?” said Wu.

On its own, poor oral health, particularly gum disease and tooth loss, has also been linked to cognitive impairment and dementia.

Wu notes that researchers are now beginning to understand how oral health, diabetes and cognitive decline can worsen each other.

“We need to raise awareness about this,” she said.

Inflammation plays a role in both diabetes and gum disease, the study notes. These inflammatory processes can contribute to the decline of reasoning and thinking skills – what is known as cognitive decline.

Poor diet is another path. Having sore gums and missing teeth can make it difficult to chew healthy foods. This can lead to nutritional deficiency. Impaired blood sugar and insulin sensitivity seen in diabetes can also worsen nutritional deficiencies, the study found.

And certain bacteria linked to chronic periodontitis, or gum disease, can also affect cognitive function, Wu said.

To study this in combination, the researchers divided older people into age groups: 65 to 74, 75 to 84, and 85 and older.

The researchers used data from the University of Michigan Health and Retirement Study from 2006 to 2018, which measured memory and cognition every two years. This included 9,948 seniors.

Among adults aged 65 to 84, those with diabetes and complete tooth loss had the highest rate of accelerated mental decline compared to those without either condition. .

Those with only diabetes aged 65 to 74 or complete tooth loss aged 65 to 84 also had faster cognitive decline.

But mental decline was fastest among those aged 65 to 74 with both diabetes and total tooth loss.

The researchers found no conclusive evidence linking mental decline to edentulousness and diabetes in adults 85 years and older.

They speculated that perhaps the least healthy in this group had already died before reaching their late 80s. Or it is possible that this age group already had more significant cognitive impairment.

Wu noted that the study is observational and cannot prove cause and effect.

Warning that he is not a diabetes expert, Dr. Cyprien Rivier, postdoctoral fellow in neurology at the Yale School of Medicine, said the links between diabetes and periodontitis make sense. Rivier did not participate in the study.

Experts know that inflammation leads to changes in the microarchitecture of the brain.

“We know that when there are high levels of systemic inflammation, white matter becomes a bit more disorganized,” Rivier said.

This leads to deteriorating brain health and cognitive outcomes, he said.

Oral health is very important for other parts of the body, including heart health, Rivier noted. For example, the American Heart Association says patients who have had heart valve problems should take antibiotics before certain dental procedures because of bacteria that can travel in the blood.

“The effects of oral health on the whole body are now very well defined,” Rivier said.

More studies are needed to assess these links, but good dental health is an easy and important target for improving health, Rivier said.

“It’s pretty cheap. It’s quite easy to improve oral health at a population level,” Rivier said.

The study authors say that older adults who have poor dental health and diabetes would benefit from cognitive screenings from their primary care providers.

The results of the study were published on March 12 in the Journal of Dental Research.

More information

The US National Institute on Aging has more on cognitive health and older adults.

SOURCES: Bei Wu, PhD, associate dean for research, New York University Rory Meyers College of Nursing and co-director, NYU Aging Incubator, New York; Cyprien Rivier, MD, MSc, postdoctoral fellow, neurology, Yale School of Medicine, New Haven, Conn.; Journal of Dental ResearchMarch 12, 2023