{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T19:29:07Z","timestamp":1793647747568,"version":"4.5.1"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"42","license":[{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"This work was supported by Guiding Technology Plan Project for Social Development of Zhenjiang under Grant","award":["FZ2023088"],"award-info":[{"award-number":["FZ2023088"]}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,10,16]]},"abstract":"<jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      This study aimed to examine the longitudinal association between baseline number of natural teeth and incident cognitive impairment among older Chinese adults in the Chinese Longitudinal Healthy Longevity Survey and explore whether dietary diversity partially mediated this association. We included 4364 participants from the 2008 Chinese Longitudinal Healthy Longevity Survey who were free of cognitive impairment at baseline and had at least 1 follow-up cognitive assessment through 2018. Incident cognitive impairment was defined as a Mini-Mental State Examination Score\u2005&lt;24 at any follow-up assessment. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between baseline number of natural teeth and incident cognitive impairment, with tooth count modeled both continuously per interquartile range (20 teeth) increase and categorically by quartiles. Restricted cubic spline analyses were performed to examine potential nonlinearity, and subgroup analyses with multiplicative interaction tests were conducted to assess potential effect modification. Over a median follow-up of 6 years (24,585 person-years), 1835 participants (42.0%) developed incident cognitive impairment. In the fully adjusted model, each interquartile range increase in natural teeth was associated with a lower risk of incident cognitive impairment (HR\u2005=\u20050.86; 95% CI: 0.78\u20130.95;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2005=\u2005.002); participants in the highest tooth-count quartile had a lower risk than those in the lowest quartile (HR\u2005=\u20050.81; 95% CI: 0.70\u20130.93;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2005=\u2005.004). Restricted cubic spline analysis supported an overall association (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2005=\u2005.013) without evidence of nonlinearity (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2005=\u2005.467). Age modified the association (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      for interaction\u2005=\u2005.043); the association was evident among participants aged \u226570 years (HR\u2005=\u20050.73; 95% CI: 0.66\u20130.82) but not among those aged\u2005&lt;70 years (HR\u2005=\u20050.95; 95% CI: 0.75\u20131.19). Exploratory mediation analysis suggested a small indirect effect through Dietary Diversity Score (indirect effect\u2005=\u20050.0012; 95% bootstrap CI: 0.0001\u20130.0024), accounting for approximately 9.9% of the total association. A higher baseline number of natural teeth was associated with a lower risk of incident cognitive impairment among older Chinese adults. Exploratory mediation analysis suggested that dietary diversity may account for a small part of the association between natural tooth count and mean follow-up Mini-Mental State Examination. These observational findings do not establish causality and warrant further investigation.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/md.0000000000051119","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T18:00:32Z","timestamp":1792173632000},"page":"e51119","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Number of natural teeth and incident cognitive impairment in older Chinese adults"],"prefix":"10.1097","volume":"105","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-2279-1715","authenticated-orcid":false,"given":"Qihang","family":"Chen","sequence":"first","affiliation":[{"name":"Zhenjiang Stomatological Hospital, Zhenjiang, Jiangsu, People\u2019s Republic of China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaobao","family":"Dang","sequence":"additional","affiliation":[{"name":"Zhenjiang Stomatological Hospital, Zhenjiang, Jiangsu, People\u2019s Republic of China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingke","family":"Liu","sequence":"additional","affiliation":[{"name":"Zhenjiang Stomatological Hospital, Zhenjiang, Jiangsu, People\u2019s Republic of China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhen","family":"Zhu","sequence":"additional","affiliation":[{"name":"Zhenjiang Stomatological Hospital, Zhenjiang, Jiangsu, People\u2019s Republic of China."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20261102","doi-asserted-by":"crossref","first-page":"100370","DOI":"10.1016\/j.tjpad.2025.100370","article-title":"Trends in cognitive impairment among older adults in China from 2002 to 2022: evaluating the impact of the COVID-19 pandemic.","volume":"13","author":"Feng","year":"2025","journal-title":"J Prev Alzheimers Dis"},{"key":"R3-20261102","doi-asserted-by":"crossref","first-page":"1605","DOI":"10.2147\/CIA.S535038","article-title":"Impact of combined cognitive and physical impairments on long-term prognosis in elderly cardiovascular disease patients: a prospective cohort study.","volume":"20","author":"Liu","year":"2025","journal-title":"Clin Interv Aging"},{"key":"R4-20261102","doi-asserted-by":"crossref","first-page":"112015","DOI":"10.1016\/j.jclinane.2025.112015","article-title":"The perioperative impact of frailty and cognitive impairment in older surgical patients: a multicentered longitudinal cohort study.","volume":"107","author":"Cheuk","year":"2025","journal-title":"J Clin Anesth"},{"key":"R5-20261102","doi-asserted-by":"crossref","first-page":"92","DOI":"10.59556\/japi.73.1075","article-title":"Unlocking the future of Alzheimer\u2019s disease: innovations in diagnosis and therapy.","volume":"73","author":"Mehndiratta","year":"2025","journal-title":"J Assoc Physicians India"},{"key":"R6-20261102","doi-asserted-by":"crossref","first-page":"e95","DOI":"10.1111\/jgs.14791","article-title":"Tooth loss and risk of dementia in the community: the Hisayama study.","volume":"65","author":"Takeuchi","year":"2017","journal-title":"J Am Geriatr Soc"},{"key":"R7-20261102","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1177\/00220345231167805","article-title":"Edentulism predicts cognitive decline in the US health and retirement cohort study.","volume":"102","author":"Jones","year":"2023","journal-title":"J Dent Res"},{"key":"R8-20261102","doi-asserted-by":"crossref","first-page":"103265","DOI":"10.1016\/j.jdent.2019.103265","article-title":"Association between oral health status and future dietary intake and diet quality in older men: the PRIME study.","volume":"92","author":"Logan","year":"2020","journal-title":"J Dent"},{"key":"R9-20261102","doi-asserted-by":"crossref","first-page":"222","DOI":"10.3390\/dj11090222","article-title":"Diet, nutrition, and oral health in older adults: a review of the literature.","volume":"11","author":"Chan","year":"2023","journal-title":"Dent J"},{"key":"R10-20261102","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1186\/s12877-023-04355-6","article-title":"Association between tooth loss and frailty among Chinese older adults: the mediating role of dietary diversity.","volume":"23","author":"Xu","year":"2023","journal-title":"BMC Geriatr"},{"key":"R11-20261102","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1007\/s12603-017-0912-5","article-title":"Dietary diversity and cognitive function among elderly people: a population-based study.","volume":"21","author":"Yin","year":"2017","journal-title":"J Nutr Health Aging"},{"key":"R12-20261102","doi-asserted-by":"crossref","first-page":"1473135","DOI":"10.3389\/fnagi.2025.1473135","article-title":"Non-linear relationship between calf circumference and global cognition in Chinese population: a cross-sectional study of 12,102 Chinese older adults.","volume":"17","author":"Nie","year":"2025","journal-title":"Front Aging Neurosci"},{"key":"R13-20261102","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1016\/j.socscimed.2010.05.013","article-title":"Childhood nutritional deprivation and cognitive impairment among older Chinese people.","volume":"71","author":"Zhang","year":"2010","journal-title":"Soc Sci Med"},{"key":"R14-20261102","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.jad.2022.08.032","article-title":"Association between frailty and cognitive function in older Chinese people: a moderated mediation of social relationships and depressive symptoms.","volume":"316","author":"Ma","year":"2022","journal-title":"J Affect Disord"},{"key":"R15-20261102","doi-asserted-by":"crossref","first-page":"1510781","DOI":"10.3389\/fnagi.2025.1510781","article-title":"Association between weight-adjusted waist index and cognitive impairment in Chinese older men: a 7-year longitudinal study.","volume":"17","author":"Lin","year":"2025","journal-title":"Front Aging Neurosci"},{"key":"R16-20261102","doi-asserted-by":"crossref","first-page":"2246","DOI":"10.1016\/j.clnu.2019.10.012","article-title":"Higher dietary diversity scores and protein-rich food consumption were associated with lower risk of all-cause mortality in the oldest old.","volume":"39","author":"Lv","year":"2020","journal-title":"Clin Nutr"},{"key":"R17-20261102","doi-asserted-by":"crossref","first-page":"105839","DOI":"10.1016\/j.jamda.2025.105839","article-title":"Beyond somatic multimorbidity: longitudinal effects of edentulism and mental health on cognition in older adults.","volume":"26","author":"Liu","year":"2025","journal-title":"J Am Med Dir Assoc"},{"key":"R18-20261102","doi-asserted-by":"crossref","first-page":"gbaf159","DOI":"10.1093\/geronb\/gbaf159","article-title":"Edentulism, social mobility, and cognitive aging: a life course perspective.","volume":"80","author":"Liu","year":"2025","journal-title":"J Gerontol B Psychol Sci Soc Sci"},{"key":"R19-20261102","doi-asserted-by":"crossref","first-page":"111528","DOI":"10.1016\/j.brainresbull.2025.111528","article-title":"Trigeminal influences and Locus Coeruleus: tips for countermeasures, therapies and precocious diagnosis in dementia.","volume":"230","author":"De Cicco","year":"2025","journal-title":"Brain Res Bull"},{"key":"R20-20261102","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1177\/0031512516683074","article-title":"Effect of gum chewing frequency on oxygenation of the prefrontal cortex.","volume":"124","author":"Yokoyama","year":"2017","journal-title":"Percept Mot Skills"},{"key":"R21-20261102","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1177\/0022034512466265","article-title":"Brain activity and human unilateral chewing: an FMRI study.","volume":"92","author":"Quintero","year":"2013","journal-title":"J Dent Res"},{"key":"R22-20261102","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1186\/s12868-016-0319-y","article-title":"Molar loss and powder diet leads to memory deficit and modifies the mRNA expression of brain-derived neurotrophic factor in the hippocampus of adult mice.","volume":"17","author":"Takeda","year":"2016","journal-title":"BMC Neurosci"},{"key":"R23-20261102","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1016\/S0140-6736(24)01296-0","article-title":"Dementia prevention, intervention, and care: 2024 report of the Lancetstanding Commission.","volume":"404","author":"Livingston","year":"2024","journal-title":"Lancet"},{"key":"R24-20261102","doi-asserted-by":"crossref","first-page":"561","DOI":"10.3233\/JAD-171042","article-title":"Homocysteine and dementia: an international consensus statement.","volume":"62","author":"Smith","year":"2018","journal-title":"J Alzheimers Dis"},{"key":"R25-20261102","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.neurobiolaging.2018.10.014","article-title":"In vivo visualization of age-related differences in the locus coeruleus.","volume":"74","author":"Liu","year":"2019","journal-title":"Neurobiol Aging"},{"key":"R26-20261102","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1038\/s41591-019-0375-9","article-title":"Adult hippocampal neurogenesis is abundant in neurologically healthy subjects and drops sharply in patients with Alzheimer\u2019s disease.","volume":"25","author":"Moreno-Jim\u00e9nez","year":"2019","journal-title":"Nat Med"},{"key":"R27-20261102","doi-asserted-by":"crossref","first-page":"1628520","DOI":"10.3389\/fnagi.2025.1628520","article-title":"Tooth loss impairs cognitive function in SAMP8 mice by aggravating pyroptosis of microglia via the cGAS\/STING pathway.","volume":"17","author":"Sun","year":"2025","journal-title":"Front Aging Neurosci"}],"container-title":["Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.1097\/MD.0000000000051119","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T19:02:04Z","timestamp":1793646124000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1097\/MD.0000000000051119"}},"subtitle":["A longitudinal CLHLS cohort study"],"short-title":[],"issued":{"date-parts":[[2026,10,16]]},"references-count":26,"journal-issue":{"issue":"42","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.1097\/md.0000000000051119","relation":{},"ISSN":["0025-7974","1536-5964"],"issn-type":[{"value":"0025-7974","type":"print"},{"value":"1536-5964","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,16]]},"assertion":[{"value":"2025-10-24","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-28","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}