{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:44:53Z","timestamp":1760060693199,"version":"build-2065373602"},"reference-count":46,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T00:00:00Z","timestamp":1758585600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Directorate of Research and Development, Universitas Indonesia","award":["NKB-662\/UN2.RST\/HKP.05.00\/2024"],"award-info":[{"award-number":["NKB-662\/UN2.RST\/HKP.05.00\/2024"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Geriatrics"],"abstract":"<jats:p>Background\/objectives: Aging is associated with a decline in physiological and cognitive functions. Periodontitis, a disease affecting the periodontal tissues, increases in prevalence with age. Bacteria and inflammatory mediators resulting from periodontitis can trigger neuroinflammation and potentially accelerate the progression of neurodegenerative diseases. This study aimed to evaluate the association between periodontal status, salivary flow rate, salivary cortisol levels, and cytokine levels with cognitive status in elderly Indonesian subjects. Methods: This cross-sectional study involved 70 participants aged \u2265 60 years from several social institutions in Jakarta and the Dental Hospital, Faculty of Dentistry, Universitas Indonesia. All participants provided written informed consent before the examination. Periodontal parameters, including plaque score, calculus index, bleeding on probing, number of remaining teeth, and functional tooth units, were assessed. Unstimulated salivary flow was collected over five minutes, and salivary cortisol levels were measured. Gingival crevicular fluid samples from the deepest periodontal pockets were collected to measure cytokine levels (TNF-\u03b1 and IL-1\u03b2). Both cortisol and cytokine levels were analyzed using ELISA. Cognitive function was evaluated using the Hopkins Verbal Learning Test. Results: Plaque score, calculus index, and bleeding on probing were moderately associated with cognitive scores (p &lt; 0.05). In contrast, the number of remaining teeth, functional tooth units, periodontitis severity, salivary flow rate, salivary cortisol, and cytokine levels were not significantly associated with cognitive scores (p &gt; 0.05). Conclusions: These findings suggest that elderly individuals with cognitive impairment tend to have poorer periodontal health than those with normal cognitive function.<\/jats:p>","DOI":"10.3390\/geriatrics10050127","type":"journal-article","created":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T14:32:53Z","timestamp":1758637973000},"page":"127","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Association of Periodontal Status, Salivary Flow Rate, Salivary Cortisol Levels, and Cytokine Levels with Cognitive Status in Elderly Subjects"],"prefix":"10.3390","volume":"10","author":[{"given":"Mirsarinda Anandia","family":"Leander","sequence":"first","affiliation":[{"name":"Periodontics Specialist Program, Department of Periodontics, Faculty of Dentistry, Universitas Indonesia, Jakarta 10430, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zalfa","family":"Karimah","sequence":"additional","affiliation":[{"name":"Periodontics Specialist Program, Department of Periodontics, Faculty of Dentistry, Universitas Indonesia, Jakarta 10430, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9656-1184","authenticated-orcid":false,"given":"Sandra Olivia","family":"Kuswandani","sequence":"additional","affiliation":[{"name":"Department of Periodontics, Faculty of Dentistry, Universitas Indonesia, Jakarta 10430, Indonesia"},{"name":"Graduate Research Program, UCL Eastman Dental Institute, Gower St., London WC1E 6AE, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Lessang","sequence":"additional","affiliation":[{"name":"Department of Periodontics, Faculty of Dentistry, Universitas Indonesia, Jakarta 10430, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sri Lelyati C.","family":"Masulili","sequence":"additional","affiliation":[{"name":"Department of Periodontics, Faculty of Dentistry, Universitas Indonesia, Jakarta 10430, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5976-430X","authenticated-orcid":false,"given":"Benso","family":"Sulijaya","sequence":"additional","affiliation":[{"name":"Department of Periodontics, Faculty of Dentistry, Universitas Indonesia, Jakarta 10430, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dimas Ilham","family":"Hutomo","sequence":"additional","affiliation":[{"name":"Department of Periodontics, Faculty of Dentistry, Universitas Indonesia, Jakarta 10430, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Herlis","family":"Rahdewati","sequence":"additional","affiliation":[{"name":"Department of Periodontics, Faculty of Dentistry, Universitas Indonesia, Jakarta 10430, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7019-1872","authenticated-orcid":false,"given":"Koichi","family":"Tabeta","sequence":"additional","affiliation":[{"name":"Division of Periodontology, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8514, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8767-0941","authenticated-orcid":false,"given":"Fatimah Maria","family":"Tadjoedin","sequence":"additional","affiliation":[{"name":"Department of Periodontics, Faculty of Dentistry, Universitas Indonesia, Jakarta 10430, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,23]]},"reference":[{"key":"ref_1","unstructured":"United Nations (2024). World Population Prospects 2024: Summary of Results, United Nations."},{"key":"ref_2","unstructured":"World Health Organization (2022). Global Oral Report Towards Universal Health Coverage for Oral Health by 2030 Regional Summary of the Western Pacific Region, World Health Organization."},{"key":"ref_3","unstructured":"Directorate of Social Welfare Statistics (2024). Statistics on the Elderly Population 2024."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1590\/1806-9282.63.07.651","article-title":"Mild Cognitive Impairment and Progression to Dementia of Alzheimer\u2019s Disease","volume":"63","author":"Jacinto","year":"2017","journal-title":"Rev. Assoc. Med. Bras."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1001\/archneur.56.3.303","article-title":"Mild Cognitive Impairment: Clinical Characterization and Outcome","volume":"56","author":"Petersen","year":"1999","journal-title":"Arch. Neurol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1111\/jcpe.12992","article-title":"Longitudinal Evaluation of Periodontitis and Development of Cognitive Decline among Older Adults","volume":"45","author":"Nilsson","year":"2018","journal-title":"J. Clin. Periodontol."},{"key":"ref_7","unstructured":"Health Research and Development, Ministry of Health of Indonesia (2018). National Report of Basic Health Research 2018."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1111\/prd.12323","article-title":"Recent Epidemiologic Trends in Periodontitis in the USA","volume":"82","author":"Eke","year":"2020","journal-title":"Periodontol 2000"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"S308","DOI":"10.4103\/jpbs.JPBS_92_20","article-title":"Assessment of Salivary Flow Rate in Patients with Chronic Periodontitis","volume":"12","author":"Vallabhan","year":"2020","journal-title":"J. Pharm. Bioallied Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1177\/10454411940050030201","article-title":"Saliva-Bacterium Interactions in Oral Microbial Ecology","volume":"5","author":"Scannapieco","year":"1994","journal-title":"Crit. Rev. Oral Biol. Med."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Bhuyan, R., Bhuyan, S.K., Mohanty, J.N., Das, S., Juliana, N., and Abu, I.F. (2022). Periodontitis and Its Inflammatory Changes Linked to Various Systemic Diseases: A Review of Its Underlying Mechanisms. Biomedicines, 10.","DOI":"10.3390\/biomedicines10102659"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Said-Sadier, N., Sayegh, B., Farah, R., Abbas, L.A., Dweik, R., Tang, N., and Ojcius, D.M. (2023). Association between Periodontal Disease and Cognitive Impairment in Adults. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20064707"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Tadjoedin, F.M., Masulili, S.L.C., Rizal, M.I., Kusdhany, L.S., Turana, Y., Ismail, R.I., and Bachtiar, B.M. (2022). The Red and Orange Complex Subgingival Microbiome of Cognitive Impairment and Cognitively Normal Elderly with Periodontitis. Geriatrics, 7.","DOI":"10.3390\/geriatrics7010012"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1111\/ger.12261","article-title":"Periodontal Disease, Tooth Loss and Dementia: Is There a Link? A Systematic Review","volume":"34","author":"Tonsekar","year":"2017","journal-title":"Gerodontology"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Nascimento, P.C., Castro, M.M.L., Magno, M.B., Almeida, A.P.C.P.S.C., Fagundes, N.C.F., Maia, L.C., and Lima, R.R. (2019). Association Between Periodontitis and Cognitive Impairment in Adults: A Systematic Review. Front. Neurol., 10.","DOI":"10.3389\/fneur.2019.00323"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Ide, M., Harris, M., Stevens, A., Sussams, R., Hopkins, V., Culliford, D., Fuller, J., Ibbett, P., Raybould, R., and Thomas, R. (2016). Periodontitis and Cognitive Decline in Alzheimer\u2019s Disease. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0151081"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1111\/cen3.12613","article-title":"Circulating Inflammatory Cytokine Levels Correlates with Cognitive Impairment","volume":"12","author":"Marzabadi","year":"2021","journal-title":"Clin. Exp. Neuroimmunol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1007\/s00784-009-0270-8","article-title":"Category of Functional Tooth Units in Relation to the Number of Teeth and Masticatory Ability in Japanese Adults","volume":"14","author":"Ueno","year":"2010","journal-title":"Clin. Oral. Investig."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1016\/j.kjms.2011.06.006","article-title":"Relationship between Remaining Teeth and Self-Rated Chewing Ability among Population Aged 45 Years or Older in Kaohsiung City, Taiwan","volume":"27","author":"Hsu","year":"2011","journal-title":"Kaohsiung J. Med. Sci."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Do, M.T., Vu, H., Lee, J.K., Park, S.M., Son, J.S., and Kim, H.D. (2021). Salivary Flow Rate and the Risk of Cognitive Impairment among Korean Elders: A Cross-Sectional Study. BMC Geriatr., 21.","DOI":"10.1186\/s12877-021-02200-2"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2324","DOI":"10.1016\/j.neurobiolaging.2011.11.017","article-title":"Parasympathetic Autonomic Dysfunction Is Common in Mild Cognitive Impairment","volume":"33","author":"Collins","year":"2012","journal-title":"Neurobiol. Aging"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.cca.2013.04.013","article-title":"High Cortisol Levels Are Associated with Cognitive Impairment No-Dementia (CIND) and Dementia","volume":"423","author":"Lara","year":"2013","journal-title":"Clin. Chim. Acta"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1586\/14737159.6.3.267","article-title":"Towards a Simple, Saliva-Based Test for the Detection of Oral Cancer \u201cOral Fluid (Saliva), Which Is the Mirror of the Body, Is a Perfect Medium to Be Explored for Health and Disease Surveillance\u201d","volume":"6","author":"Wong","year":"2006","journal-title":"Expert. Rev. Mol. Diagn."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"4511","DOI":"10.1007\/s10072-021-05115-3","article-title":"Cognitive Dysfunction in Young Subjects with Periodontal Disease","volume":"42","author":"Hategan","year":"2021","journal-title":"Neurol. Sci."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Levi, P.A., Rudy, R.J., Jeong, Y.N., and Coleman, D.K. (2015). Patient Examination and Assessment. Non-Surgical Control of Periodontal Diseases: A Comprehensive Handbook, Springer.","DOI":"10.1007\/978-3-662-46623-0"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1902\/jop.1972.43.1.38","article-title":"The Plaque Control Record","volume":"43","author":"Drake","year":"1972","journal-title":"J. Periodontol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1111\/j.1600-051X.1986.tb00852.x","article-title":"Bleeding on Probing. A Predictor for the Progression of Periodontal Disease?","volume":"13","author":"Lang","year":"1986","journal-title":"J. Clin. Periodontol."},{"key":"ref_28","unstructured":"Kaushik, M., and Bathla, S. (2017). Epidemiology. Textbook of Periodontics, Jaypee Brothers Medical Publishers."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1111\/prd.12579","article-title":"Conventional Diagnostic Criteria for Periodontal Diseases (Plaque-Induced Gingivitis and Periodontitis)","volume":"95","year":"2024","journal-title":"Periodontol 2000"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"113","DOI":"10.2174\/1874350102114010113","article-title":"Tooth Loss, Occlusal Teeth Support, Salivary Flow Rate, and Food Texture Choice in the Elderly with Cognitive Impairment: A Preliminary Study in Indonesia","volume":"14","author":"Sari","year":"2021","journal-title":"Open Psychol. J."},{"key":"ref_31","unstructured":"Jacobsen, S.R. (2011). Validation of Two Short Dementia Screening Tests in Indonesia. Vascular Dementia: Risk Factors, Diagnosis and Treatment, Nova Science."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1136\/ebn.4.1.24","article-title":"The Hopkins Verbal Learning Test Had High Sensitivity and Good Specificity for Detecting Mild Dementia in Older People","volume":"4","author":"Stewart","year":"2001","journal-title":"Evid. Based Nurs."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Han, F., Luo, C., Lv, D., Tian, L., and Qu, C. (2022). Risk Factors Affecting Cognitive Impairment of the Elderly Aged 65 and Over: A Cross-Sectional Study. Front. Aging Neurosci., 14.","DOI":"10.3389\/fnagi.2022.903794"},{"key":"ref_34","first-page":"1009","article-title":"Periodontal Parameters in Indonesian Elderly and Its Association with Cognitive Impairment","volume":"13","author":"Tadjoedin","year":"2020","journal-title":"J. Int. Dent. Med. Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1007\/s12603-022-1783-y","article-title":"The Association between Number of Teeth and Cognitive Frailty in Older Adults: A Cross-Sectional Study","volume":"26","author":"Zhang","year":"2022","journal-title":"J. Nutr. Health Aging"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"3493","DOI":"10.1007\/s00784-021-04318-4","article-title":"The Impact of Tooth Loss on Cognitive Function","volume":"26","author":"Ravida","year":"2022","journal-title":"Clin. Oral. Investig."},{"key":"ref_37","first-page":"10","article-title":"Tooth Loss Increases the Risk of Diminished Cognitive Function: A Systematic Review and Meta-Analysis","volume":"1","author":"Feine","year":"2016","journal-title":"JDR Clin. Trans. Res."},{"key":"ref_38","first-page":"e1143","article-title":"Oral Health Knowledge in Relation to Educational Level in an Adult Population in Spain","volume":"11","year":"2019","journal-title":"J. Clin. Exp. Dent."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Gu, W., Li, J., Li, F., Ho, T.E., Feng, X., Wang, Y., Fan, M., Cui, M., Xu, K., and Chen, X. (2023). Association between Oral Health and Cognitive Function among Chinese Older Adults: The Taizhou Imaging Study. BMC Oral Health, 23.","DOI":"10.1186\/s12903-023-03353-9"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1111\/jre.12348","article-title":"Longitudinal Relationship of Severe Periodontitis with Cognitive Decline in Older Japanese","volume":"51","author":"Iwasaki","year":"2016","journal-title":"J. Periodontal Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1111\/ger.12431","article-title":"Systemic Inflammatory Impact of Periodontitis on Cognitive Impairment","volume":"37","author":"Barrios","year":"2020","journal-title":"Gerodontology"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1016\/j.jamda.2013.05.009","article-title":"Proinflammatory Cytokines, Aging, and Age-Related Diseases","volume":"14","author":"Michaud","year":"2013","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1093\/intimm\/dxaa052","article-title":"Overcoming Immune Dysfunction in the Elderly: Trained Immunity as a Novel Approach","volume":"32","author":"Bulut","year":"2020","journal-title":"Int. Immunol."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Hammami, S., Ghzaiel, I., Hammouda, S., Sakly, N., Hammami, M., and Zarrouk, A. (2020). Evaluation of Pro-Inflammatory Cytokines in Frail Tunisian Older Adults. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0242152"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.ynstr.2017.03.002","article-title":"The Effect of an Adverse Psychological Environment on Salivary Cortisol Levels in the Elderly Differs by 5-HTTLPR Genotype","volume":"7","author":"Ancelin","year":"2017","journal-title":"Neurobiol. Stress"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1902\/jop.2009.090327","article-title":"Salivary and Gingival Crevicular Fluid Melatonin in Periodontal Health and Disease","volume":"81","author":"Srinath","year":"2010","journal-title":"J. Periodontol."}],"container-title":["Geriatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3417\/10\/5\/127\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:48:02Z","timestamp":1760035682000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3417\/10\/5\/127"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,23]]},"references-count":46,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["geriatrics10050127"],"URL":"https:\/\/doi.org\/10.3390\/geriatrics10050127","relation":{},"ISSN":["2308-3417"],"issn-type":[{"type":"electronic","value":"2308-3417"}],"subject":[],"published":{"date-parts":[[2025,9,23]]}}}