老年人牙齿缺失与痴呆及认知功能障碍风险相关性的Meta分析

Correlations between tooth loss and risks of dementia and cognitive dysfunction of the elderly:a meta-analysis

目的系统评价老年人牙齿缺失与痴呆以及认知功能障碍发病风险相关性,为预防痴呆及认知障碍提供参考依据。方法检索中国知网、万方、维普、PubMed、Web of Science、Cochrane Library等数据库有关牙齿缺失引起痴呆及认知功能障碍的队列研究,经逐层筛选及质量评价后,采用STATA13.1软件进行Meta分析。结果共纳入11篇文献,合计237584例患者。Meta分析结果显示:相比于牙齿未缺失或最少数量牙齿缺失的老年人,最大缺齿量老年人的痴呆风险在调整混杂因素前[RR=1.71,95%CI(1.17~2.49)],只调整年龄因素[RR=1.79,95%CI(1.54~2.09)]或调整所有混杂因素[RR=1.32,95%CI(1.22~1.43)]后均增高,差异具有统计学意义(P<0.001)。缺齿量最大者患认知障碍的风险在调整年龄和性别因素[RR=1.81,95%CI(1.06~3.08)]及所有混杂因素[RR=1.46,95%CI(1.29~1.67)]后亦均增加,差异均具有统计学意义(P<0.05)。结论牙齿缺失是独立于年龄、性别等因素之外能引起老年人痴呆及认知障碍发病风险的重要危险因素,口腔疾病的预防管理可能有助于神经退行性疾病的预防。

Objective To evaluate the relationship between tooth loss and cognitive impairment in the elderly,especially the risk of dementia,so as to provide reference for the prevention of dementia and cognitive impairment.Methods A retrieval was conducted for cohort studies on the risk of dementia and cognitive dysfunction caused by tooth loss all through the databases of CNKI,WanFang,VIP,PubMed,Web of Science and Cochrane Library.STATA 13.1 software were used for statistical analysis.Results After systematic screening,11 cohort studies with a total of 237,584 patients were included in the analysis.By meta-analysis,before and after adjustment of the confounding factors,the elderly with the maximum number of missing teeth had the highest risk of dementia compared with the elderly without missing teeth or with the minimum number of missing teeth:with RR of 1.71(95%CI:1.17~2.49)for unadjusted confounders,1.79(95%CI:1.54~2.09)for only adjusted age,and 1.32(95%CI:1.22~1.43)for adjusted all confounders,all with statistically significant difference(P<0.001).At the same time,after adjustment of the confounding factors,the risk of cognitive impairment was significantly increased in those with the largest tooth loss:The RR for the incidence of cognitive impairment was 1.81(95%CI:1.06~3.08)for adjusted age and gender,and 1.46(95%CI:1.29~1.67)for all adjusted confounding factors,both with statistically significant difference(P<0.05).Conclusions Tooth loss is an important risk factor for dementia and cognitive impairment in the elderly,independent of age,gender,education level and other factors.Preventive management of oral diseases may contribute to the prevention of neurodegenerative diseases.