Oral health in patients with cognitive complaints referred to a memory clinic.

The risk of developing cognitive problems increases with age. Patients with
cognitive problems can be referred to a memory clinic. In such clinics,
cognitive and general health status of these patients is assessed amongst
others by a comprehensive geriatric assessment (CGA). CGA is considered to be a
complete assessment from a medical and psychological perspective. An assessment
of oral health, however, is not included in the CGA, although oral health has
been linked to general- and mental health and quality of life in the recent
literature. Therefore, an assessment of oral health is presumed to be of added
value to the GCA in the diagnostic work-up of patients referred to a memory
clinic; it is important to gain insight in oral health status of patients
referred to these clinics and which factors in this heterogeneous groups of
patients are related to poor oral health. Furthermore, there are indications
that the microbiome (oral microflora) is involved in the development and
progression of neurodegenerative disorders. In this study an oral health
assessment (including sampling the oral microbiome) will be added to the
routine CGA in the diagnostic work-up of patients with cognitive problems
referred to a memory clinic. All patients and/or their informal caretakers will
be informed during their visit about the oral health status. They will also
receive oral health care advice, e.g., how to maintain and or improve their
oral health (e.g., using specific toothpaste, brushing teeth more often and or
to visit a dentist). The recommendations will be given on paper. When agreed
upon by the patient and/or their informal caretaker, information on the actual
oral health status will also be send to the family dentist. Six weeks later, it
will be assessed whether this advice was followed or not by the patient.

Primary Objective:
- To assess oral health in patients with memory complaints visiting a memory
clinic. Oral health is defined for this study as the presence of deep caries
lesions, periodontal pockets >6 mm, swollen and red gums, chewing problems (one
cannot eat properly), mobile elements, mucosal pathology and/or bone pathology.

Secondary Objectives:
- To assess whether an oral health care advice given to the patients is
followed (e.g., checking if patients are using the advised oral care products,
if they visited a dentist as advised etc).
- To assess the composition of the oral microbiome.

Explorative study

In patients who are prepared to participate in this pilot study, when they
visit the memory clinic, the following will be added:
- administered two questionnaires about their oral health and dental visits.
- intra-oral photographs
- dental radiographs (orthopantomogram and bite wings)
- sampling of the oral microbiome (mouthwash).

All the patients who have an appointment/invitation in the memory clinic will
receive a letter from the clinician at the memory clinic with written
information about the oral health study and the options to participate.
Patients who want to participate need to send the informed consent (that is
attached to the information letter for the patient) back to the memory clinic.
When the memory clinic receives the informed consent, the questionnaires will
be sended to the patient and the patient will be asked to return the
questionnaires when they visit the memory clinic.
The day the patient visit the memory clinic it will be checked if the patient
is incapacitated. If not, the patient will be included. Next , intra-oral
photographs and conventional dental radiographs (orthopantogram and two
bitewings) are made and the oral microbiome is sampled (mouth rinse). The oral
health assessment will take approximately 10-15 minutes on average. There are
no risks as all procedures are routine dental examinations that are commonly
applied during routine dental check-ups. The benefit for the patients is that
they will be informed about their oral health and that they will receive oral
health care advice when oral health is considered poor. This can help patients
to prevent further decline of their oral health and thereby prevent possible
general health problems that are related to poor oral health. The proposed
study will give insight into the possible added value of oral health assessment
next to the CGA for patients referred to the memory clinic as oral health is
not included yet in the CGA assessment. The exploratory study will give also
more insight whether oral health and the oral microbiome differs in subgroups
of patients based on cognitive function, frailty. If differences are noted
further research can be performed to gain more insight in the potential role of
oral health and the oral microbiome in the process of dementia.
When added value is proven an oral health assessment can be considered to
become a component of the GCA. This way, oral health problems will be
recognized early as well as that patients will be advised how to take care of
their oral health.