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Oral Health and Cognitive Function in the Third National Health and Nutrition Examination Survey (NHANES III)

From King's College London (Institute of Psychiatry) (R.S.), London, UK; Department of Epidemiology and Public Health (W.S., G.T., R.G.W.), University College London, London, UK; Periodontology Unit (F.D.), UCL Eastman Dental Institute, London, UK.

Address correspondence and reprint requests to Robert Stewart, Section of Epidemiology (Box 60), Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. E-mail: r.stewart{at}iop.kcl.ac.uk

Objectives: To investigate the association between oral health and cognitive function in early-, mid-, and late-adult life.

Methods: A secondary analysis was carried out of a large, well-characterized community sample (NHANES III). Analyzed variables included three measures of oral health (gingival bleeding, loss of periodontal attachment, loss of teeth) and three measures of cognitive function: the Symbol Digit Substitution Test (SDST), the Serial Digit Learning Test (SDLT) (both in 5138 participants aged 20–59 years), and a Story Recall test (in 1555 participants aged 70 years). Other covariates in linear regression models included age, gender, ethnicity, education and poverty, and cardiovascular risk factors.

Results: Worse scores on all three measures of oral health status were significantly associated with poorer performance on all three measures of cognitive function after adjustment for age. Education was an important confounding factor. However, after full adjustment for all other covariates, gingival bleeding (%) and loss of periodontal attachment (%) remained associated with relative impairment on SDST score (B coefficients both = 0.003), and gingival bleeding was associated with relative impairment on SDLT (B = 0.017). No effect modification by age was observed.

Conclusions: Poor oral health is associated with worse cognitive function throughout adult life. This may, in part, be accounted for by early life education and social status. However, the possibility of direct causal pathways requires further investigation.

Key Words: oral health • cognitive function • memory • attention • community study

Abbreviations: NHANES III = Third National Health and Nutrition Examination Survey; SDST = Symbol Digit Substitution Test; SDLT = Serial Digit Learning Test.

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