Oral health in patients with cognitive complaints referred to a memory clinic. (Dementie en Mondgezondheid (DeMo) study)

Rationale: 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 status. Furthermore, there are indications that the microbiome is involved in the development and progression of neurodegenerative disorders. The potential involvement of the oral microbiome in the development and progression of cognitive disorders is yet hardly studied other than studying the gut-brain axis in general, although the gastro-intestinal tract in fact starts in the mouth. Therefore, it is considered important to study the possible differences in oral microbiome in different groups of patients with cognitive complaints. In this study an oral health assessment (including analysis of 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. Next, they will receive oral health care advice e.g. how to improve their oral health and or to visit a dentist. The recommendations will be given on paper. If desired by the patient and/or their informal caretaker, information on the actual oral health status can also be send to the family dentist. Six weeks later, it will be assessed whether this advice was followed by the patient.

- To assess the prevalence of poor oral health in patients with cognitive complaints visiting a memory clinic.
- To assess whether oral health status differs in different groups of patients with cognitive complaints.
- To assess whether the composition of the oral microbiome differs in different groups of patients with cognitive complaints.
- To assess whether the oral health care advice given to the patients has been followed (e.g patients searched for help to improve their oral health).

At the baseline visit to the memory clinic (T0) when the patient is seen for a regular work up (CGA, physical examination, blood tests, routine X-rays and cognitive tests which are performed by geriatric doctors and nurses) the patient will be taken to the oral and maxillofacial surgery department of the same hospital for an oral health assessment consisting of:
- intra-oral photographs
- dental radiographs (orthopantomogram and bite wings)
- sampling of the oral microbiome (mouthwash) (see appendix 2).

All patients and/or their informal caretakers will be informed about the oral health status during their visit. Next, they will receive oral health care advice e.g., how to maintain and/or improve their oral health. The recommendations will be given on paper. By agreement of the patient information on the actual oral health status will be sent to the family dentist.

Follow up
All patients and/or their informal caretakers who received dental care advice will be telephoned after 6 weeks to assess whether the dental care advice were followed. If the patient has not yet taken any action, the patient is encouraged again to follow the advice. In latter cases, we will assess once more after another 6 weeks whether the advice has been followed.