臺灣博碩士論文加值系統

近年來，由於人口老化的趨勢逐步上升，使得失智症的問題，開始受到大家的重視。 在國際衛生組織的統計發現，每年約有九百萬的失智症新病例產生，且估計在2020年，全球約有四千萬的為失智症人口。
失智症將帶來對社會與家庭巨大的負擔，倘若能早期發現致病的危險因子，將能延緩失智症的發生，或降低其嚴重度。牙周病是成年人常見的疾病，近年來有許多研究中發現牙周病與許多系統性疾病之相關性。
在此研究中，利用台灣的健保資料庫，探討牙周病與失智症的相關性。研究結果發現，在2002-2013年間，總共有112036患者參與研究，利用健保資料庫牙周病與失智症之診斷碼與治療碼(ICD-9)，統計分析，研究結果發現，牙周病患者相較於無牙周病的患者，較易產生失智症之風險（HR=1.79 95% confident interval1.67-1.93)。

According to the world health organization (WHO), the ageing problem has been noted all over the world, and the prevalence of dementia increased in a fast speed. Dementia caused huge impact for every family and society. Dementia will cause brain cell degeneration and memory loss will be followed. Several risk factors for dementia has been was investigated, however there are still a lot remain unknown. Periodontal disease was caused by specific pathogen and was related to host immune system and environmental risk factors.
The relationship between periodontal disease and systemic disease was studied. Periodontal destruction is associated with several systemic disease, such as diabetes, cardiovascular disease, osteoporosis and cancer. The possible pathway for linking the systemic disease and periodontitis is proinflammatory cytokine and infection. Recently, lots of studies were conducted and the relationship between periodontitis and dementia had been investigated.
The purpose of the study is to verify the relationship between periodontitis and dementia in a retrospective cohort study based on Taiwan’s national health insurance database(NHID).
In this retrospective match cohort study, a total of 112036 subjects were enrolled. The eligible study subjects were 56018 persons in the periodontitis cohort and 560181 persons in the non-periodontitis cohort. The corresponding hazard ratio of periodontitis associated with dementia was 1.79(95% confident interval1.67-1.93). Totals of 2246 (2.00%) and 1343 (1.20%) patients were diagnosed with dementia in the periodontitis and non-periodontitis cohorts.
In conclusion, we identified an independent association between periodontitis and risk of dementia after controlling for traditional dementia risk factors with a population-based longitudinal cohort. Our data suggest a need for regular dental care for early prevention of dementia.

目錄 II

考試委員審定書 V

論文書目同意公開申請書 VI

保密同意書與及簽到表 VII

致謝 VIII

中文摘要 IX

英文摘要（Abstract） X

表目錄 XII

圖目錄 XIII

第一章 緒論（Introduction） 1

第二章 文獻回顧（Literature Review） 3
2.1牙周病與失智症可能的連結
（Possible linkage between periodontitis and dementia） 3
2.2牙周病與失智症的關係
（The relationship between periodontitis and dementia） 4

第三章 研究目的（Aim） 7

第四章 研究材料與方法（material and methods） 9
4.1 實驗設計與樣本(Study design and sample ) 9
4.2 實驗要求與定義(Criteria and definition ) 10
4.3 統計方法(Statistics analysis ) 12

第五章 研究結果（Results） 13

第六章 討論（Discussion） 15

第七章 結論（Conclusion） 18

第八章 表格（Tables） 19
Table.1 Possible risk factors for dementia from Kamer 2008 19

Table.2 Dementia ICD-9-CM Codes 20
Table.3 Define the true periodontics patients by treatment codes 21
Table.4 Sociodemographic, coexisting medical conditions, and dementia in people with and without periodontal disease 22

Table.5 Incidence and Risk of Dementia for Cohorts with and without Periodontal. Disease 23

第九章 圖片（Figures） 25
Figure.1 The model of periodontal pathogens accelerate the inflammation in the brain 25

Figure.2: Flow chart of the study 26
Figure.3 The incidence of dementia in different age group in present study (Incidence: per 1000 person-years) 27
Figure.4 The possible pathway between periodontitis and Alzheimers’ disease. 28

References 29

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