Table 1.

Characteristics of longitudinal studies of oral health and cognitive status^a

Author/Location/ Study Title	Sample/ Study Design	Cognitive Measures	Oral Health Measures	Primary Covariates	Key findings and analytic proceduresb
ORAL DISEASE PREDICTS COGNITIVE IMPAIRMENT
Shimazaki et al., 200111 Kitakyushu City, Japan 29 institutions for elderly	Baseline: 10/1988-02/1989 N=1929 (87% of residents) Followup:10/1994-03/1995 N=719 (856 died, 167 status unknown, 187 hospitalized) M=169; F=550 Age range: 59–107; mean age 79.7±7.5y	From medical records Mental health status: Good/ Fair/ Poor re: symptoms of dementia or cognitive disability Followup: Deterioration = symptoms of dementia, or cognitive disability status at lower level	Baseline: 2 dentists trained in use of epidemiological indices for oral health No. teeth (excluding retained roots) categorized, denture use for eating	From medical records Age, sex, mobility, type of institution, chronic diseases	Logistic regression adjusted for age, physical health status, type of institution, cerebrovascular disorder: No. teeth, denture use, not associated with decline in mental health status Reference = 20+ teeth (OR, 95% CI) 1–19 teeth+dentures 1.9 (0.8–4.6) 1–19 teeth-dentures 2.3 (0.9–5.8) 0 teeth+dentures 1.0 (0.7–4.0) 0 teeth-dentures 2.4 (0.9–6.5)
Yoneyama et al., 200212 Japan 11 nursing homes	Baseline: 09/1996, followed at 6, 12, 18, 24 months N=366, randomized: 184 oral care (M=36, F=148; mean age 82.0±7.8y) 182 no oral care (M=37, F=145; mean age 82.1±7.5y) Oral intervention – brush teeth for 5” after each meal, or clean oral cavity. Clean dentures daily. Plaque and calculus control as necessary.	MMSE score at baseline, 24 months	Debris index for plaque score		Survivors only. 24 month change in MMSE score: Oral care: −1.5 +/− 4.9 No oral care: −3.0 +/− 5.9 P <.05
Gatz M et al., 200615 Sweden, Swedish Twin Registry HARMONY study	Questionnaires mailed 1961, 1963, 1967 (1970 if no response in 1967) 1998 survivors age 65+ of same sex twins born before 1926, and contacted for HARMONY study N=310 dementia (M=85, F=225), average onset age: 78.95±7.00y N=3,063 nondemented (M=1,200, F=1,863), mean age 79.23 ± 4.73y	Dementia determined from Swedish Inpatient Discharge Registry and Swedish Cause of Death Registry (sensitivity 63%, specificity 98% for dementia)	Self-report of own teeth at age 35 (all or most/ half/ few or none)	Age, sex, education CVD Lifestyle before age 40: Mental activity (reading, cultural activities, studies) Physical exercise Adult height (>1sd shorter vs. rest) Parents’ social class (upper, middle, lower)	Analyses adjusted for all covariates. Loss of all teeth Case control analysis predicting (1) all dementias, (2) Alzheimer’s disease: (1) OR 1.49 (1.14–1.95) (2) OR 1.68 (1.21–2.32) Monozygotic co-twin control analyses: (1) OR 3.60 (1.34–9.70) OR 5.50 (1.22–24.80)
Stein et al., 20079 Milwaukee, WI Nun Study25 (Snowdon, 1997)	Baseline: 1991–1992 N=144 nuns with cognitive assessment and known APOE ε4 status Age range 75–98y N=32 with dementia N=112 without dementia. N=101 with adequate followup data Neuropathology data on 118/129 decedents Followup: annual, 12 years	CERAD neuro- psychology battery, administered annually for 12 years Dementia criteria: NINCDS-ADRDA Braak staging for AD neuropathology	40 years of dental records No. teeth excluding non- third molars present at first cognitive evaluation. Presence of periodontal damage	Age, education APOE ε4 status Medical history in dental records (N=133) Medical conditions associated with inflammatory process	Incident dementia over 12 years: Adjusted for age, education, APOE ε4: 0–9 teeth vs 10–28 teeth: HR 2.20 (1.1–4.5) Further adjusted for periodontal damage, no association HR 2.4 (0.86–6.6) For 118 deceased, adjusted for age, education, APOE ε4: No association between no. of teeth and severity of AD neuropathology (Braak stage): 1.1 (0.49–2.7); or brain infarcts: 1.14 (0.49–2.66)
Kaye et al., 201016 US Dept. of Veterans Affairs Dental Longitudinal Study Boston, Mass metropolitan area	Baseline: 1968 Original N = 1,231 Race: 97% White, 3% Black Current study: N=597 men with necessary dental and cognitive data Age 24–84 Convenience sample, community dwellers Followup: up to 32 years (until 2002)	Given at each dental exam. (~every 3 years) MMSE (low score = <25, or <90% of age/education specific median) Spatial copying task (SCT)	Dental exam ~every 3 years by calibrated periodontist, reliability of measurements determined Number of teeth, maximum probing pocket depth for each tooth, alveolar bone loss Caries or restoration (5 tooth surfaces examined)	Age, education smoking aspirin use, NSAIDs BMI, CHD, stroke, hypertension, CVD, cancer, diabetes alcohol, coffee, tea, folate, B6, B12	Adjusted analyses Additional tooth loss/decade associated with low: MMSE: HR 1.09 (1.01–1.18) SCT: HR 1.12 (1.05–1.18) Increased alveolar bone loss associated with low: MMSE: HR 1.03 (1.00–1.07) SCT: HR 1.03 (1.01–1.06) Increased pocket depth associated with low: MMSE: HR1.04 (1.01–1.09) SCT: HR 1.04 (1.01–1.06) New caries, restoration: associated with low: MMSE: HR 1.02 (0.97–1.08) SCT: HR 1.05 (1.01–1.08)
Stein et al., 201010 Milwaukee, WI	Same sample as Stein et al., 2007	Delayed word recall (from CERAD Neuropsychology battery)	Same as Stein et al., 2007.	Education (≤high school vs >high school) APOE ε4	Persons with APOE ε4 allele, ≤9 teeth, or both, had poorer delayed recall scores at baseline and declined faster than those with either one or neither of these risk factors.
Arrivé, et al., 201217 PAQUIDENT (PAQUID Dental study), substudy of Personnes Agées QUID (PAQUID) study (Dartigues et al., 1992) Gironde, southwest France	PAQUIDENT baseline: 1989–1990 N=405 Age 66–80 Median age=70 M=184, F=221 No dementia Median followup=10y PAQUID baseline: 1988 Followup: 1,3,5,8,10,13,15y (through 2003) Community dwellers	MMSE, Benton Visual Retention Test, Wechsler Paired Associates, verbal fluency, visuospatial attention, digit symbol Dementia criteria: DSM-III-R NINCDS-ADRDA (for AD) Hachinski score (vascular dementia) Dementia status ascertained after in- person assessment by neurologist (demented vs normal).	In-home oral exam by 10 trained, calibrated dentists. No. decayed, missing, filled teeth (DFMT) (for 28 teeth) No. missing teeth (denture substitution counts as own teeth) Plaque/calculus Periodontal exam for Community Periodontal Index (CPI)	Sex, education (lower vs higher, years not specified), living condition, Tobacco, alcohol use Health status: CES-D depression, BMI, vascular risk factors	Adjusted for sex, BMI, vascular risk factors Predicting incident dementia Higher education ≥11 missing teeth vs <11: HR 1.07 (0.57–2.02) Bleed/calculus: HR 0.71 (0.31–1.63) Pockets: HR 0.42 (0.15–1.15) No eligible sextant: HR 1.51 (0.63–3.57) Lower education ≥11 missing teeth vs <11: HR 0.30 (0.11–0.79) Bleed/calculus: HR 1.24 (0.39–3.88) HR Pockets: 0.97 (0.29–3.19) No eligible sextant: HR 0.02 (0.28–3.66)
Paganini-Hill et al., 201219 Leisure World Laguna Hills, CA, USA	Study dates: 1992–2010 N=5,468 Median age: 81y, range 52– 105 M=1,733; F=3,735 No. with incident dementia: 1,145 (followed up to 18 years) Retirement community	Dementia determined by: In-person evaluation for age 90+ (n=519 with dementia, identified by different study). Self-report (n=90), hospital records (n= 46), death certificates (n=490) Date of diagnosis = date dementia first mentioned	Self-report: # natural teeth: <16/ 16–25/ 26+ Adequate natural dentition (10 in upper jaw, 6 in lower jaw) Inadequate natural dentition: wears dentures/ does not Oral health habits	1992 -- Self-reported education, head injury, first degree relative with Alzheimer’s disease, senility or dementia 1983/1985 – smoke, alcohol, caffeine BMI, hypertension, angina pectoris, heart attack, rheumatoid arthritis, cancer, HBP, stroke, diabetes Active/sedentary	Fully adjusted, predicting incident dementia. Separate analyses for men and women No. natural teeth – NS (men and women) Inadequate natural dentition, no dentures, men: HR 1.91 (1.13–3.21), women: HR 1.22 (0.86–1.73) Inadequate dentition, alone or with dentures: – NS (men + women) Oral health habits (40 comparisons) No daily tooth brushing: HR 1.65 (1.05–2.62), women only. No dental visits last 12 months: HR 1.89 (1.21–2.95), men only
Yamamoto et al., 201223 Aichi Gerontological Evaluation Study (AGES) Six municipalities in Aichi province, Japan	Baseline: 2003 N=4,425 (from mail survey of random sample of 9,783 community residents) Age: 65+ Sex: M=2,158; F=2,267 Race/ethnicity: Asian Follow up: 4-year cohort study Community residents	Dementia onset: from administrative data -- Certified to receive insurance benefits, based on Ministry questionnaire on functional, cognitive, behavioral, communication problems in dementia. Graded I-IV, M (I=can still live independently, IV=consistent care needed, M=severe psychiatric symptoms, specialized medical service needed)	Self-report ≥20 teeth/≤19 teeth Few teeth + denture use Few teeth no dentures Data missing Mastication: Chew anything/ cannot chew at all Have regular dentist (yes/no) Personal dental care good (yes/no)	Age, gender, adjusted household income BMI, current illnesses (up to 18 conditions) Smoking history, alcohol use Exercise Forgetfulness	Adjusted for all characteristics excluding “forgetfulness”. Predicting incident dementia. Only significant findings reported. Oral health status. Reference: ≥20 teeth Few teeth no dentures: HR 1.85 (1.04–3.29) Mastication Can’t chew very well: HR 1.47 (0.95–2.25) No regular dentist HR 1.44 (1.04–2.01) Poor personal dental care HR 2.01 (1.11–3.63)
Batty et al., 201314 ADVANCE trial Impact of reducing blood pressure, intensive glucose control, on Type II diabetes. 215 centers, 20 countries	Baseline: 2001–2003 N=11,140 M=6,407; F=4,733 Age: 55–88 (all with type II diabetes and history of major macro- or microvascular disease, or at least 1 other cardiovascular risk factor) White (67%) (other ethnicities not reported) Followup: for 5 years	MMSE (3 assessments over 5 years) If MMSE <24, or MD or nurse suspected dementia, referred to specialist for dementia evaluation, DSM IV criteria Cognitive decline = drop ≥ 3 MMSE points by 3rd assessment	Baseline: Self-reported no. of natural teeth connected to gum or jawbone. No. days bleeding gums in past 12 mos.	Age, sex, EQ-5D, socioeconomic, CVD risk factors: -behavioral -physiological -psychological	Fully adjusted Incident dementia (N=109) No. of teeth Reference ≥22 teeth 0 teeth HR 1.48 (1.24–1.78) 1–21 teeth HR 1.24 (1.05–1.46) Bleeding gums ≥12 days HR 1.19 (0.51–2.75) <12 days HR 0.42 (0.10–1.71) Cognitive decline (N=1,806) No. of teeth 0 teeth HR 1.39 (1.21–1.59) 1–21 teeth HR 1.23 (1.10–1.38) Bleeding gums ≥12 days HR 0.94 (0.77–1.15) <12 days HR 0.92 (0.75–1.13)
Stewart et al., 201320 Memphis and Pittsburgh, US Health Aging & Body Composition (Health ABC) study	Baseline: 1997/1998 N=947 (with cognitive data, y5) Age 70–79 M=~50%; F=~50% Race/ethnicity: Black 34%, White 66% Healthy Medicare community residents in local area, unimpaired basic ADL or mobility. Included all Blacks, and random sample of Whites Sample based on year 2 oral health participants Followup: year 5	Cognitive assessment: 1997/1998 (y1), 1999/2000 (y3), 2000/2001 (y5) Cognitive impairment: 3MS score <80 (bottom 10%) Cognitive decline: Decline ≥5 points (~20%) Year 3 -- Digit Symbol Substitution test (DSST), clock drawing Cognitive impairment = bottom 10%	Dental examination 1998/99 (year 2) No. of teeth No. occluding tooth pairs Probing depth Attachment loss (no. & proportion of sites) Mean gingival index Mean plaque score No. sites bleeding on probing All measures categorized into quartiles	Age, sex, education, race Self-reported cardiovascular disease and risk factors CES-D score C-reactive protein, IL- 6 at y1; weight loss y1-y3 Anticholinergic medication APOE ε4	Change in year1-year3 3MS 3MS cognitive impairment and decline; stratified by APOE ε4 genotype to ascertain effect modification. No significant association of any dental measure with cognitivedecline on 3MS Closest: no. of teeth, OR 0.88 (0.77– 1.00), gingival index OR 1.17 (0.99–1.38) DSST decline: no association Dichotomized gingival index (Q4/rest): associated with decline in 3MS, fully adjusted: OR 2.28 (1.60– 3.25) No association with DSST
COGNITIVE IMPAIRMENT PREDICTS ORAL DISEASE
Study	Sample	Cognitive Assessment	Oral Health Measures	Primary covariates	Key findings
Jones et al., 19938 Dept. of Veterans Affairs (VA) Longitudinal Study of Dementia. VAMC, Bedford, MA Dept. of Veterans Affairs Dental Longitudinal Study – VA-DLS (subset of VA Normative Aging Study). Boston VA	Baseline: 1986–1989 Dementia (AD) N=23 male veterans (from Dept. of Veterans Affairs Longitudinal Study of Dementia) Age: 67.4±7.5 Controls (matched on age, number of teeth, education) N=46 male veterans (VA-DLS) Age: 65±12 Followup: 23, 50 months Retrospective data	AD cases drawn from VA Longitudinal Study of Dementia, with previously determined diagnosis. MMSE	Initial caries examination: after teeth scaled and polished 50 month followup: caries examination (teeth not scaled or polished) NIDR criteria Katz criteria for root caries evaluation Annualized net caries increment (% per 100 available surfaces)	Demographic (from medical records)	Annualized followup: Veterans with AD had increased coronal caries increment 2.29±4.29 vs 0.88±1.14; root caries 2.38±5.57 vs. 0.31±0.69 per 100 available surfaces compared with control group. All findings NS.
Ship & Puckett, 199413 National Institute on Aging Normative Aging Program Also, Clinical Center, National Institutes of Health, Bethesda, MD	Baseline: AD: N = 21 M=13; F=8 Age: 64±9 Controls (age, gender matched) N=21; M=13; F=8 (from National Institute on Aging Normative Aging Program Age: 65±12 Community residents, unmedicated Persons with other medical, neurological, psychiatric conditions excluded. Followup interval: AD 23±11 months Controls: 36±1.5 months	NINCDS-ADRDA criteria for AD (vigorous screening) MMSE Change in MMSE score	Unstimulated & stimulated major salivary gland flow rates Extensive assessment of gingival, periodontal (NIDR criteria), dental and oral mucosal tissues. Standard criteria and scales used in assessment. Test-retest reliability of assessment determined. Annualized change		No association between change in salivary flow rate and change in MMSE Gingival health: Poorer MMSE scores associated with increased gingival bleeding and plaque. Periodontal health: no difference between groups Number of teeth, restored surfaces no difference Loss of tooth attachment: findings unclear Intraoral mucosal tissue: no difference between groups, but lower MMSE scores related to diminished mucosal health
Chalmers et al., 200221 “Oral health of community dwelling older adults with dementia” South Australian Dental Longitudinal Study (SADLS) Adelaide, Australia	Baseline: 1998/99 116 dementia 116 no dementia Gender, age matched (M=66, F=50), age (≤79 = 91, ≥80 = 25) Followup: 1999/2000 103 dementia 113 no dementia. Exclusionary factors: Edentulous, too ill, refused Dementia cases -- in-home assessment only No dementia – in-home or clinic assessment Community residents	Physician confirmed diagnosis Dementia: 76% AD, 24% other MMSE ≥26 no dementia 21–25 mild 11–20 moderate ≤10 severe dementia GDS	Two calibrated dentists NIDR protocol Tooth status (present, absent, replaced, root status) Caries (initial, incident): coronal, root surface; sound, decayed, treated; gingival recession Assessed as crude caries increment (CCI), net caries increment (NCI), adjusted caries increment (ADJCI) Reliability of assessing caries incidence determined	ADL (Katz) IADL (Lawton Brody) No. medical conditions Anticholinergics: (severity: none, low, high) Dental care issues Zarit Burden Scale Medical status, medication status, cognitive status	Caries increments (dementia vs nondementia): Coronal: CCI=3.7 vs 1.5 NCI=3.5 vs 1.4 ADJCI=3.6 vs 1.4, all P<0.01. Incidence: 71.8% vs 48.7%, P<0.01. Root surfaces: CCI=1.9 vs 0.9 NCI=1.7 vs 0.8 ADJCI=1.8 vs 0.9, all P<0.01. Incidence: 62.1% vs 44.2%, P<0.01. Greater root caries incidence in high maintenance patients. Dementia group – coronal caries increment: 3.5 (for 1 increment in nondemented) (p=0.001) GDS moderate-severe dementia -- additional 1.78 coronal increments (p=0.01); 0.95 root caries increment (p = 0.001)
Ellefsen et al., 200922 Copenhagen, Denmark Two hospital memory clinics	Baseline: 2002–2004 N=106 (AD=61, other dementia (OD)=26, no dementia=19) M=37, F=69 Followup: ~1 year later N = 77 (AD=49, other dementia=15, no dementia=13) M=28, F=49 Mean age: 81.9 (no information on age range)	MMSE Dementia criteria: ICD- 10 AD vs. other dementia vs. no dementia	Oral evaluation in home NIDR criteria for coronal and root decayed surfaces and filled surfaces, gingival recession. Calculated Adjusted Caries and filling Increments (ADJCIs) Number of teeth present, dental prostheses	Demographic, functional, social variables from structured questionnaire	No statistically significant differences for decayed and filled coronal and root surfaces, although rates higher for AD, OD, than for nondemented. ADJCIs higher for age 80+, but not always significant. No difference for MMSE <24 vs ≥24. Predicting coronal caries AD: OR 0.64 (0.09–4.50) OD: OR 4.13 (0.44–39.05) Predicting root caries AD: OR 0.08 (0.01–0.79) OD: OR 1.01 (0.11–9.56)
Chen et al., 201024 St. Paul, Minnesota USA Geriatric dental clinic affiliated with U Minnesota School of Dentistry, for age 55+ , persons with disabilities, community and nursing home residents.	Study years: 10/1999- 12/2006, followup 1–90 months, mean 38.8 months N = 491 Dementia N=119 M=30, F=89 Mean age: 81.5±9.2 Range: 49–102 No dementia (propensity score matched) N=372 M=110, F=262 Mean age: 73.8±10.7 Range: 44–103 New patients, dentate after initial treatment, returned for routine care at least once.	Medical history from dental records; diagnosis of AD, other dementia, CBS, or ICD- 9CM-R codes 290.x, 294.1, 331.2 Medical, cognitive, functional assessment from dental records	From dental records Followup treatment focused on continued treatment as needed	Charlson comorbidity index Anticholinergic drug scale (ADS), to measure medication- related anticholinergic burden	Fully adjusted models No. teeth lost: HR 0.92 (0.59–1.63) P=0.99 Rate of tooth loss: P=0.52, slightly higher in dementia patients, but difference NS

^aIf there was no indication of race, or of number of men or women, the information was not mentioned in the paper.

Psychological measures for which results are not reported have been excluded to reduce space.

All abbreviations in the table have been spelled out below, together with references where appropriate.

^bValues in parentheses in this column indicate 95% confidence interval

3MS = Modified Mini-Mental State Examination: Teng EL, Chui HC. The Modified Mini-Mental State (3MS) Examination. J Clin Psychiatry 1987;48:314–318.

AD = Alzheimer’s disease

ADJCI = Adjusted Caries Increment, determined as CCI (crude caries increment [number of surfaces] (1-examiner reversals/examiner reversals + x [decayed/recurrent/filled/filled unsatisfactory/root sound])

ADL = activities of daily living: Katz S, Ford AB, Moskowitz RW et al. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial functioning. J Am Med Assoc 1963;185:914–919.

ADS = Anticholinergic drug scale: Carnahan RM, Lund BC, Perry PJ et al. The Anticholinergic Drug Scale as a measure of drug-related anticholinergic burden: association with serum anticholinergic activity. J Clin Pharmacol 2006;46:1481–1486.

Anticholinergic drug scale: Carnahan RM, Lund BC, Perry PJ, Pollock BG, Culp KR. The anticholinergic drug scale as a measure of drug-related anticholinergic burden: associations with serum anticholinergic activity. J Clin Pharmacol 2006;46:1481–1486.

APOE = Apolipoprotein E

BentonVisual Retention Test: Benton AL. Manuel pour l’application du test de retention visuelle. Applications cliniques et expérimentales. 2e edition franaise. Paris, Centre de Psycholgie Appliquée, 1965.

BMI = body mass index (weight[kg]/height[m²])

Braak staging: Braak H, Braak E. Neuropathological stageing of Alzheimer-related changes. Acta Neuropathol (Berl) 1991;82:239–59.

CBS = chronic brain syndrome

CCI = crude caries increment

CERAD: Morris JC, Heyman A, Mohs RC et al. The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD). Part 1. Clinical and Neuropsychological Assessment of Alzheimer’s Disease. Neurology 1989;39:1159–1165.

CES-D = Center for Epidemiologic Studies-Depression Scale: Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. J Appl Psychol Meas 1977;1:385–401.

Charlson comorbidity index: Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 1987;40:373–383.

CHD = coronary heart disease

CPI = Community Periodontal Index: World Health Organization, Community Periodontal Index (CPI) in Oral Health Surveys – Basic methods, World Health Organization, Editor. 1997: Geneva. Pp.36–38.

CVD = cerebrovascular disease

Debris Index: Green JC, Vermillion JR. The oral hygiene index: a method for classifying oral hygiene status. J Am Dent Assoc 1957;61:171–179.

DSST = Digital Symbol Substitution Test

Digit symbol test: Wechsler D. WAIS-R Manual. New York, Psychological Corporation, 1981.

EQ-5D = Quality of life: The EuroQol Group. EuroQol-a new facility for the measurement of healthrelated quality of life. Health Policy 1990;16:199–208. See http://www.euroqol.org/ for most recent information. Accessed October 21, 2014

GDS = Global Deterioration Scale: Reisberg B, Ferris SH, DeLeon MJ, et al. The Global Deterioration Scale (GDS): an instrument for the assessment of primary degenerative dementia. Am J Psychiatry 1982;139:1136–1139.

Gingival Index: Loe H. The Gingival Index, the Plaque Index and the Retention Index systems. J Periodontol 1967;38:610–616.

HBP = High blood pressure

HR = Hazard ratio, analysis in which time to an event is taken into account

IADL = instrumental activities of daily living

IL-6 = interleukin-6, an inflammatory marker

Katz criteria for root caries: Katz RV. Assessing root caries in populations: the evolution of the root caries index. J Pub Hlth Dent 1980; 40:7–16.

L-B = Lawton MP, Brody E. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontotogist 1969;9:179–186.

MMSE: Folstein MF, Folstein SE, McHugh PR. ‘Mini-Mental State’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198.

NCI = net caries increment

NIDR = National Institute of Dental Research

NINCDS-ADRDA = National Institute of Neurological, Communicative Disorders, and Stroke-Alzheimer’s Disease and Related Disorders Association

NSAID = Non-steroidal anti-inflammatory drug

OR = Odds ratio, analysis concerned with whether an event has taken place

VA = Veterans Administration

VA-DLS = Veterans Administration Dental Longitudinal Study

VAMC = Veterans Administration Medical Center

Verbal Fluency: Isaacs B, Kennie AT. The Set Test as an aid to detecting dementia in old people. J Psychiatry 1973;123:467–470.

Visuo-spatial attention: Zazzo R. Test des deux barrages. Actualités pédagogique et psychologiques, vol 7. Neuchâtel, Delachaux et Nestlé, 1974.

Wechsler Paired Associates: Wechsler D. A standardized scale for clinical use. J Psychol 1945;19:87–95.

Zarit Burden Scale: Zarit SH, Reever KE, Bach-Peterson J. Relatives of the impaired elderly: correlates of feelings of burden. Gerontologist 1980;20:649–655.