Abstract Body: Background:
Periodontal disease and dental caries are a leading cause of tooth loss which has been correlated with stroke in the REGARDS study. We investigated the correlation between tooth loss and post-stroke cognitive impairment (PSCI) assessed by Montreal Cognitive Assessment (MoCA).
Methods:
The MoCA was conducted in consecutive ischemic stroke and TIA patients (N=280) enrolled in PREMIERS trial (ClinicalTrials.gov NCT#02541032) based on presence of moderately severe periodontal disease. These patients were categorized as having normal/mild cognitive impairment (MoCA>19) or severe cognitive impairment (MoCA ≤19). Regarding tooth loss, patients were categorized into two separate groups based on the number of teeth lost as noted during initial assessment. The groups were categorized into those reporting significant tooth loss (≥8) and no significant tooth loss of <7. We tested the association between tooth loss to the MoCA assessment in post-stroke/TIA patients. In addition to the clinical cofounders' patients were assessed for periventricular and deep white matter hyperintensity using axial FLAIR images. They were graded on a 3-point Fazekas scale; none/mild disease = Fazekas grades 0-1 and moderate/severe disease = Fazekas grades 2-3. Univariate and multivariable logistic regression analysis were conducted to calculate crude and adjusted Odds Ratio (OR) respectively.
Results:
We compared those with significant tooth loss (N=201) with non-significant tooth loss group (N=79). Those that scored severe on the MoCA assessment were only slightly older than those who scored normal/mild (age 61± 12 vs. 59 ± 12, respectively), slightly less likely to be male (63% vs. 64%, respectively), and more likely to be African American (83% vs. 68%, respectively). Significant tooth loss was associated with severe PSCI (Crude OR=3.25, 95% CI.; 1.65-6.41). The association remained significant after adjustment for age, sex, race, level of education, hypertension, diabetes, white matter hyperintensity assessed by Fazeka scale (Adjusted OR=2.60, 95% CI; 1.20-5.61).
Conclusion:
In summary, the results showed a significant independent association between significant tooth loss and PSCI in a patient population with moderate to severe periodontal disease. Further study is needed to see if modifying tooth loss by aggressive management of periodontal disease and dental caries could alleviate PSCI.