Oral Health Awareness in Older Adults With Varied Cognitive Function

Objectives: Anosognosia (lack of awareness) is highly prevalent in older adults with dementia. Anosognosia can impair the ability to recognize and seek help for an illness or medical problem. This study aimed to examine the oral health awareness in older adults with varied cognitive function.
Methods: Sixty-five participants aged 50 years and older (14 healthy comparison participants and 51 with documented cognitive impairment) were recruited. The Mini Mental State Examination (MMSE) was used to categorize cognitive function. Participant’s oral health awareness was assessed using 5 oral health-related questions (e.g., rating overall oral cleanliness, describing the status of the upper right front tooth, etc.). After responding to a question, participants were asked to explain the question using their own words. The question was repeated if the participant was unable to respond to or comprehend the question. Participants’ responses were then verified with a brief oral exam. The discrepancies between the self-assessments and clinical findings indicated awareness deficits.
Results: Awareness deficits occurred even before participants reached the threshold of dementia (i.e., MMSE≤24). Up to 50% of the participants with documented mild cognitive impairment showed deficits in the oral health self-assessment that required abstract thinking and judgment. Awareness deficits gradually worsened as cognitive impairment progressed and became common in participants with mild dementia (MMSE=20-24). The vast majority of the participants with moderate or severe dementia (MMSE<20) lost their capacity to provide an assessment that matched with clinical findings. A 3-point reduction in MMSE score can lead to a 34.7% decrease in the odds of being able to accurately assess oral health status in participants with cognitive impairment.
Conclusions: Deficits in oral health awareness occurred early and were prevalent in older adults with cognitive impairment. Further studies are needed to understand how this condition affects oral health and dental utilization in these individuals.