Severe Periodontitis Is Associated with Early-Onset Poststroke Depression Status

https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.104413Get rights and content

Abstract

Background

Poststroke depression (PSD) is one of the most common complications after ischemic stroke, and periodontitis is associated with depression. However, whether severe periodontitis is associated with early-onset PSD status remains unknown. In this study, we aimed to investigate whether there is an association between severe periodontitis and PSD status in acute ischemic stroke patients.

Material and Methods

We recruited 202 acute ischemic stroke patients within 7 days after stroke onset. Pocket depth and clinical attachment loss were assessed by oral examination to define the severe periodontitis. On the basis of diagnosis of PSD status according to DSM-5 criteria and a 24-item Hamilton Depression Rating Scale score greater than or equal to 8 within 2 weeks after stroke onset, we stratified patients into PSD status or non-PSD status groups and identified the independent predictors for the development of PSD status in multivariate logistic analysis.

Results

77 (38.1%) patients were diagnosed as early-onset PSD status. PSD status group showed more severe periodontitis, lower income, lower Barthel Index (BI) score and Montreal Cognitive Assessment score, higher National Institutes of Health Stroke Scale score and modified Rankin scale (mRS) score compared with non-PSD status group. Multivariate logistic regression showed that severe periodontitis (odds ratio 2.401) and NIHSS score (>4, odds ratio 2.130) were independent predictors for early-onset PSD status.

Conclusions

Severe periodontitis is found to be an important independent predictor of early-onset PSD status in patients with acute ischemic stroke, in addition to the well-known prognostic factors such as nonminor stroke assessed by NIHSS greater than 4.

Introduction

Poststroke depression (PSD) is one of the most common complications after stroke which approximately affects one third of stroke survivors at any one time,1 and is associated with poor functional outcomes2 and higher mortality.3 Like many other disorders in psychiatry, PSD is a multifaceted disorder with diverse causes. However, the pathogenesis of PSD remains unclear. Physical disability, stroke severity, prestroke depression, and cognitive impairment have been recognized as the most consistent predictors of PSD.4 And PSD status is a transitional state before PSD occurs.

Periodontitis is a chronic inflammatory periodontal disease affecting 46% of adult population in the United States, and its incidence was positively related to increasing age and was higher among males.5 Some studies have shown that periodontitis is associated with depression.6, 7, 8, 9 However, whether periodontitis is associated with PSD status remains unclear. In some patients with periodontitis, periodontal bacteria, and their products can launch an inflammatory response in the periodontal tissues with systemic consequences, thereby increasing the inflammatory burden of central nervous system.10 In addition, periodontitis is associated with atherosclerotic vascular disease,11 which may cause pathologic changes in the perfusion of cerebral atherosclerotic vessels. Thus, it is plausible that all these factors initiated by periodontitis may also contribute to the development of PSD status.

In the current study, we aimed to investigate the association between periodontitis and the development of PSD status in patient with acute ischemic stroke. We hypothesized that periodontitis may play an independent role in the development of PSD status.

Section snippets

Study Subjects

From December 2015 to December 2017, we recruited ischemic stroke patients within 7 days of stroke symptom onset in the Department of Neurology, the Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, China. The inclusion criteria included (1) age greater than or equal to 18 years old; (2) evidence of Ischemic stroke in computed tomography or magnetic resonance imaging; (3) without use of antibiotics in the past 3 months; (4) provision of a written informed

Result

We recruited a total of 202 acute ischemic stroke patients (131 males, mean age 61.20 ± 9.99 years, Table 1) within 7 days after stroke onset. Seventy-four (36.6%) patients had a NIHSS greater than 4. Ninety-one (45.0%) patients had a left-side cerebral infarct, 86 (42.6%) patients had a right-side cerebral infarct and the other 25 (12.4%) patients had infarcts on both sides of the brain. Based on the criteria from TOAST study, 106 (52.5%) patients had large artery atherosclerosis and 78

Discussion

This cross-sectional study involving 202 patients with acute ischemic stroke indicated that severe periodontitis is an independent risk factor for the early-onset PSD status after adjusting for other risk factors. The scientific evidence on the association between periodontitis and depression is limited. Several Cross-sectional studies demonstrated a positive correlation of periodontal disease severity with the depression.7, 8, 9 Recently, a large retrospective population-based cohort study

Conflict of Interest

None.

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      Citation Excerpt :

      The previous studies demonstrated that periodontitis is not only associated with the produce and progress of atherosclerotic plaque, but also is associated with the occurrence and severity of ischemic stroke [7–19]. Our previous studies also found that tooth loss and periodontitis are the independent risk factors to cognitive impairment and depression of post acute ischemic stroke [20,21]. Whether severe periodontitis is associated with the stability of atherosclerotic plaque remains unclear.

    Financial Disclosure: This work was supported by Sanming Project of Medicine in Shenzhen (SZSM201801014).

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    These authors contributed equally.

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