Severe Periodontitis Is Associated with Early-Onset Poststroke Depression Status
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.
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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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Cited by (6)
ProBDNF signaling is involved in periodontitis-induced depression-like behavior in mouse hippocampus
2023, International ImmunopharmacologySevere periodontitis is associated with the serum levels of hypersensitive C reactive protein and lipoprotein-associated phospholipase A2 in the patients of acute ischemic stroke
2021, Journal of Clinical NeuroscienceCitation 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.
Periodontal condition is correlated with deep and subcortical white matter hyperintensity lesions in Japanese adults
2020, International Journal of Environmental Research and Public Health
Financial Disclosure: This work was supported by Sanming Project of Medicine in Shenzhen (SZSM201801014).
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These authors contributed equally.