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Cognitive Changes and Neural Correlates After Rehabilitation of Masticatory Function in Elderly -an Intervention Study

Primary Purpose

Chewing Problem, Cognitive Decline, Magnetic Resonance Imaging

Status
Recruiting
Phase
Not Applicable
Locations
Sweden
Study Type
Interventional
Intervention
Oral prosthetic rehabilitation
Sponsored by
Folktandvården Stockholms län AB
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Chewing Problem focused on measuring Magnetic resonance imaging, Chewing efficiency, Cognitive impairment, Masticatory dysfunction, Prosthetic rehabilitation

Eligibility Criteria

65 Years - 80 Years (Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • 65-80 years of age at start
  • Impaired chewing ability (Eichner index B2-B4, C1-C4)
  • Dental rehabilitation with fixed prosthodontics, implant and/or tooth supported (overdentures included) >10 occluding units
  • Mini Mental State Examination (MMSE) score >25

Exclusion Criteria:

  • Brain trauma or stroke <6 months
  • Neurological disease (stroke, dementia, Alzheimer disease, Parkinson disease).
  • Intellectual disability
  • Psychological disorders
  • Participants with chronic pain, depression or sleeping disorders
  • Daily analgesic medication that may affect cognitive and/or executive performance of the brain
  • Poor Swedish language skills, reading disabilities
  • Severely reduced hearing or vision
  • Prosthetic treatment with removable dentures (full or partial)

MRI exclusion criteria:

  • Claustrophobia
  • Difficulties in lying down in a supine position for about an hour, or any other difficulties related to the MRI head coil
  • Participants with metal or medical implants in the body contraindicating MRI scan

Sites / Locations

  • Eastmaninstitutet Folktandvården Stockholm ABRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Experimental group (EG), the immediate rehabilitation group

Control group (CG), the test-retest group

Arm Description

The experimental group will begin with the rehabilitation immediately after the first measurement of cognitive tests (pre-test). Three months after complete rehabilitation the first post-test (post-test 1) will be conducted on all participants. Participants will be recalled after about a year for a long-term follow up (post-test 2). The OHIP-14, chewing function test, saliva samples, neuropsychological assessments together with MRI assessments will also be recorded at different time points (i.e., pre-test, post-test 1 and post-test 2).

The control group will be tested with the cognitive tests two times (pre-test + post-test 1) at an interval of about three months or more inbetween tests and before the onset of the prosthodontic rehabilitation. Three months after complete rehabilitation the post-test (post-test 2) will be conducted on all participants. Further, participants will be recalled after about a year for a long-term follow up (post-test 3). The OHIP-14, chewing function test, saliva samples, neuropsychological assessments together with MRI assessments will also be recorded at these time points (i.e., pre-test, post-test 1, post-test 2 and post-test 3).

Outcomes

Primary Outcome Measures

Change in Brief Visuospatial Memory Test Revised (BVMT-R)
Measuring non-verbal episodic memory. Measured in correct answers. Score: 0-36. A high score indicates a better performance.

Secondary Outcome Measures

Change in Rey Auditory Verbal Learning Test (RAVLT).
Measuring verbal episodic memory. Measured in correct answers. Scale: 0-90. A high score indicates a better performance.
Change in Trail Making Test from Delis Kaplan Executive Function System (D-KEFS)
Measuring executive function. Measured in seconds and number of faults (maximum 150 seconds). A low score indicates a better performance.
Change in Digit-Span from Wechsler Adult Intelligence Scale (WAIS):IV
Measuring working memory. Measured in correct answers. Score: 0-48. A high score indicates better performance.
Change in Digit-symbol from Wechsler Adult Intelligence Scale (WAIS):IV
Measuring motor and mental speed. Measured in correct answers. Score: 0-135. A high score indicates better performance.
Change in Color-Word Interference Test from Delis Kaplan Executive Function System (D-KEFS word)
Measuring executive memory. Measured in seconds to complete test (maximum 90 seconds). Higher score indicates a poorer performance.
Change in verbal fluency from Delis Kaplan Executive Function System (D-KEFS-F)
Measuring executive memory. Measured in correct answer during a time limit (60 seconds). A high score indicates a better performance.
Title: Changes in blood perfusion in the brain tissue by measuring cerebral blood flow (CBF) in the brain over time with magnetic resonance imaging (MRI).
Measured with MRI using the Pseudo- Continuous Arterial Spin Labeling (pCASL) technique. The unit of measurement is ml of blood per 100 gram tissue per unit of time (ml/100g/min).
Changes in brain activity (BA) over time measured with magnetic resonance imaging (MRI).
Measuring changes in functional connectivity over time with MRI using the Blood Oxygen Level Dependent (BOLD) technique under resting state conditions.
Change of the masseter muscle volume (MMV) with magnetic resonance imaging (MRI).
Measured with MRI using a PD-weighted SPACE sequence to determine the pre- and post-muscle volume. Volume increase indicates volume increase in muscle masseter.
Change in mixing ability (MA) two-coloured chewing gum (Orophys chewing gum)
Two-coloured Orophys chewing gum. More mixed colour in the sample indicates better chewing ability.
Change in measure of cortisol level (CL) in saliva
Biological measures. Low level of cortisol indicate lower stress hormone levels.
Change in Oral Health Impact Profile, short version (OHIP-14).
Questionnaire measuring impact on daily life coast by oral problems. Scale: 0-56. Higher score indicates more impact or oral problems.
Change in psychological wellbeing the day of psychological assessment by using Hospital Anxiety and Depression scale (HAD).
Questionnaire measuring Depression and Anxiety. Scale: 0-42. A low score indicate a more positive outcome.

Full Information

First Posted
June 26, 2020
Last Updated
March 17, 2022
Sponsor
Folktandvården Stockholms län AB
Collaborators
Karolinska Institutet
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1. Study Identification

Unique Protocol Identification Number
NCT04458207
Brief Title
Cognitive Changes and Neural Correlates After Rehabilitation of Masticatory Function in Elderly -an Intervention Study
Official Title
Cognitive Changes and Neural Correlates After Rehabilitation of Masticatory Function in Older Adults - an Intervention Study
Study Type
Interventional

2. Study Status

Record Verification Date
March 2022
Overall Recruitment Status
Recruiting
Study Start Date
November 2, 2018 (Actual)
Primary Completion Date
December 30, 2024 (Anticipated)
Study Completion Date
December 30, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Folktandvården Stockholms län AB
Collaborators
Karolinska Institutet

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
Today in elderly tooth loss and loss of oral function is widespread, but it is an underexplored modifiable risk factor potentially contributing to the development of dementia. In this interventional study a "cause-effect" relationship between mastication and cognition in humans will be investigated. A total of eighty (80) participants, 65-80 years of age, indicated for prosthodontic rehabilitation will be randomly assigned to either the experimental or the control group. Participants will be randomized into two different groups, measurements are going to be conducted before and after prosthetic rehabilitation. The difference between the two groups is that the control group are going to do two measurements before undergoing the rehabilitation, this to control for the test-re-test effect. The aim with this study is to determine if the rehabilitation of chewing function will cause changes in the neurocognitive assessments of episodic memory and learning.
Detailed Description
Dementia is a general term of several neurodegenerative diseases that jointly affects approximately 7% of the general population older than 65 years, and 30% older than 80 years (O'Brien, 2003). Importantly, these statistics are expected to almost double every 20 years (Prince, 2013), making disorders of cognition a priority for healthcare (O'Brien, 2014). Animal and human studies have shown associations with mastication and cognitive function through the medial temporal lobe (i.e., hippocampus) and its role in learning and memory. (Ono, 2010. Weijenberg, 2011. Ohkubo, 2012. Teixeira, 2014. Klineberg, 2014) Although tooth loss and loss of oral function is widespread in older people, it is still an underexplored modifiable risk factor contributing to the development of dementia. The aim of this study is to conduct an intervention study on elderly people where rehabilitation of masticatory functions is performed and evaluated, with cognitive measures and brain imaging, to investigate a "cause-effect" relationship between mastication and cognition in humans. The hypothesis is that rehabilitation of masticatory function will improve cognition primarily in the performance of episodic memory and executive function tests along with the corresponding neural changes mainly in hippocampus and prefrontal cortex. A total of eighty (80) participants, 65-80 years of age, indicated for prosthodontic rehabilitation at Eastmaninstitutet (Stockholm, Sweden) will be randomly assigned to either the experimental or the control group. The difference between the groups is that the participants in the experimental group will begin with the rehabilitation immediately after the first measurement while the control group will do one more measurement before the onset of the rehabilitation procedure. The two measurements conducted before treatment in the control group are to rule out for test-retest effects. Three months and one year after completed prosthodontic treatment participants will conduct the last measurements, as a post-test to evaluate potential treatment effect. The neuropsychological assessments will be conducted together with MRI assessments, oral health-related quality of life instrument, chewing function test (two coloured chewing gum) and saliva samples recorded at different time points (i.e., pre-test, post-test 1, post-test 2, post-test 3) in both the groups. The data from the study will be entered in a Microsoft Excel sheet and exported to Statistics is a software package SPSS Inc, Statistica, StatSoft Inc (or similar advanced analytics software package for analysis). The result from the cognitive testing will be analysed as repeated measure Analysis of covariance (ANCOVAs) with groups (experimental and control) and time (pre- and post-rehabilitation) as factors. Group-by-time interaction, main effect of group, and main effect of time will be evaluated. To compare the magnitude of gains, the effect size (partial eta-square) will also be calculated. By using time-length between pre- and post-tests as a covariate of interest with aiming to better control group differences. Models that mainly predicts cognitive test measures (neuropsychological assessments) will by developed to predict the intervention outcomes. Predictive ability is defined as the amount of variance in the outcome that can be explained by pre-test cognitive status (slope method). Explained variance in outcome will be obtained by analysing linear regressions. Preprocessing and statistical analyses of MRI data will be performed with Statistical Parametric Mapping (SPM) run in Matlab (MathWorks). Movement correction will be performed by realign and unwarp to the first image in the series. To consider group-specific anatomical brain differences, all participants will be normalized to Monteral Neurological Institute (MNI) echoplanar-imaging template. Cortical thickness measures will not be normalized but rather used in their raw form. For cortical segmentation, a Freesurfer pipeline will be applied to the MRI images to produce regional cortical thickness and volumetric measures. To investigate rehabilitating-related changes repeated measures ANCOVAs will be performed with the groups (experimental and control) and time (pre- and post-rehabilitation) as factors. The Bonferroni-Holm method will be used to control for multiple comparisons.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Chewing Problem, Cognitive Decline, Magnetic Resonance Imaging, Degenerative; Dementia, Mastication Disorder, Neurocognitive Dysfunction
Keywords
Magnetic resonance imaging, Chewing efficiency, Cognitive impairment, Masticatory dysfunction, Prosthetic rehabilitation

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
Longitudinal randomized controlled trial. After screening and informed consent the participants are randomly allocated to exeperimental or control group. Both groups undergoing intervention but the participants in the control group undergo one more test before the intervention to rule out the test-retest effect.
Masking
None (Open Label)
Masking Description
The investigator doing the cognitve assements is not informed about the allocation of the participants.It is not possible to mask the participants during the neuropsycological assessements.
Allocation
Randomized
Enrollment
80 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Experimental group (EG), the immediate rehabilitation group
Arm Type
Experimental
Arm Description
The experimental group will begin with the rehabilitation immediately after the first measurement of cognitive tests (pre-test). Three months after complete rehabilitation the first post-test (post-test 1) will be conducted on all participants. Participants will be recalled after about a year for a long-term follow up (post-test 2). The OHIP-14, chewing function test, saliva samples, neuropsychological assessments together with MRI assessments will also be recorded at different time points (i.e., pre-test, post-test 1 and post-test 2).
Arm Title
Control group (CG), the test-retest group
Arm Type
Active Comparator
Arm Description
The control group will be tested with the cognitive tests two times (pre-test + post-test 1) at an interval of about three months or more inbetween tests and before the onset of the prosthodontic rehabilitation. Three months after complete rehabilitation the post-test (post-test 2) will be conducted on all participants. Further, participants will be recalled after about a year for a long-term follow up (post-test 3). The OHIP-14, chewing function test, saliva samples, neuropsychological assessments together with MRI assessments will also be recorded at these time points (i.e., pre-test, post-test 1, post-test 2 and post-test 3).
Intervention Type
Procedure
Intervention Name(s)
Oral prosthetic rehabilitation
Intervention Description
Individual treatment options will be discussed with the participants individually and rehabilitation will be provided as agreed by the dentist and the participant. The rehabilitation will include fixed prosthodontics. The procedures will involve a control phase involving scaling, root planing oral hygiene instructions etc., extractions and bone augmentation when needed and temporary removable dentures. Restoration of the lost vertical dimension (if needed) with occlusal splints, tooth preparations, placement of dental implants (if needed) and finally cementation of dental crowns. The rehabilitation phase is estimated to take approximately 3-18 months, or more.
Primary Outcome Measure Information:
Title
Change in Brief Visuospatial Memory Test Revised (BVMT-R)
Description
Measuring non-verbal episodic memory. Measured in correct answers. Score: 0-36. A high score indicates a better performance.
Time Frame
1: Baseline pre-test. 2: Change pre-test/post-test1, CG 3months after baseline, EG 3months after intervention (Int). 3: Change post-test1/post-test2, CG 3months after Int, EG 1year after Int. 4: Change post-test1/post-test2, CG 1year after Int.
Secondary Outcome Measure Information:
Title
Change in Rey Auditory Verbal Learning Test (RAVLT).
Description
Measuring verbal episodic memory. Measured in correct answers. Scale: 0-90. A high score indicates a better performance.
Time Frame
1: Baseline pre-test. 2: Change pre-test/post-test1, CG 3months after baseline, EG 3months after intervention (Int). 3: Change post-test1/post-test2, CG 3months after Int, EG 1year after Int. 4: Change post-test1/post-test2, CG 1year after Int.
Title
Change in Trail Making Test from Delis Kaplan Executive Function System (D-KEFS)
Description
Measuring executive function. Measured in seconds and number of faults (maximum 150 seconds). A low score indicates a better performance.
Time Frame
1: Baseline pre-test. 2: Change pre-test/post-test1, CG 3months after baseline, EG 3months after intervention (Int). 3: Change post-test1/post-test2, CG 3months after Int, EG 1year after Int. 4: Change post-test1/post-test2, CG 1year after Int.
Title
Change in Digit-Span from Wechsler Adult Intelligence Scale (WAIS):IV
Description
Measuring working memory. Measured in correct answers. Score: 0-48. A high score indicates better performance.
Time Frame
1: Baseline pre-test. 2: Change pre-test/post-test1, CG 3months after baseline, EG 3months after intervention (Int). 3: Change post-test1/post-test2, CG 3months after Int, EG 1year after Int. 4: Change post-test1/post-test2, CG 1year after Int.
Title
Change in Digit-symbol from Wechsler Adult Intelligence Scale (WAIS):IV
Description
Measuring motor and mental speed. Measured in correct answers. Score: 0-135. A high score indicates better performance.
Time Frame
1: Baseline pre-test. 2: Change pre-test/post-test1, CG 3months after baseline, EG 3months after intervention (Int). 3: Change post-test1/post-test2, CG 3months after Int, EG 1year after Int. 4: Change post-test1/post-test2, CG 1year after Int.
Title
Change in Color-Word Interference Test from Delis Kaplan Executive Function System (D-KEFS word)
Description
Measuring executive memory. Measured in seconds to complete test (maximum 90 seconds). Higher score indicates a poorer performance.
Time Frame
1: Baseline pre-test. 2: Change pre-test/post-test1, CG 3months after baseline, EG 3months after intervention (Int). 3: Change post-test1/post-test2, CG 3months after Int, EG 1year after Int. 4: Change post-test1/post-test2, CG 1year after Int.
Title
Change in verbal fluency from Delis Kaplan Executive Function System (D-KEFS-F)
Description
Measuring executive memory. Measured in correct answer during a time limit (60 seconds). A high score indicates a better performance.
Time Frame
1: Baseline pre-test. 2: Change pre-test/post-test1, CG 3months after baseline, EG 3months after intervention (Int). 3: Change post-test1/post-test2, CG 3months after Int, EG 1year after Int. 4: Change post-test1/post-test2, CG 1year after Int.
Title
Title: Changes in blood perfusion in the brain tissue by measuring cerebral blood flow (CBF) in the brain over time with magnetic resonance imaging (MRI).
Description
Measured with MRI using the Pseudo- Continuous Arterial Spin Labeling (pCASL) technique. The unit of measurement is ml of blood per 100 gram tissue per unit of time (ml/100g/min).
Time Frame
1: Baseline pre-test. 2: Change pre-test/post-test1, CG 3months after baseline, EG 3months after intervention (Int). 3: Change post-test1/post-test2, CG 3months after Int, EG 1year after Int. 4: Change post-test1/post-test2, CG 1year after Int.
Title
Changes in brain activity (BA) over time measured with magnetic resonance imaging (MRI).
Description
Measuring changes in functional connectivity over time with MRI using the Blood Oxygen Level Dependent (BOLD) technique under resting state conditions.
Time Frame
1: Baseline pre-test. 2: Change pre-test/post-test1, CG 3months after baseline, EG 3months after intervention (Int). 3: Change post-test1/post-test2, CG 3months after Int, EG 1year after Int. 4: Change post-test1/post-test2, CG 1year after Int.
Title
Change of the masseter muscle volume (MMV) with magnetic resonance imaging (MRI).
Description
Measured with MRI using a PD-weighted SPACE sequence to determine the pre- and post-muscle volume. Volume increase indicates volume increase in muscle masseter.
Time Frame
1: Baseline pre-test. 2: Change pre-test/post-test1, CG 3months after baseline, EG 3months after intervention (Int). 3: Change post-test1/post-test2, CG 3months after Int, EG 1year after Int. 4: Change post-test1/post-test2, CG 1year after Int.
Title
Change in mixing ability (MA) two-coloured chewing gum (Orophys chewing gum)
Description
Two-coloured Orophys chewing gum. More mixed colour in the sample indicates better chewing ability.
Time Frame
1: Baseline pre-test. 2: Change pre-test/post-test1, CG 3months after baseline, EG 3months after intervention (Int). 3: Change post-test1/post-test2, CG 3months after Int, EG 1year after Int. 4: Change post-test1/post-test2, CG 1year after Int.
Title
Change in measure of cortisol level (CL) in saliva
Description
Biological measures. Low level of cortisol indicate lower stress hormone levels.
Time Frame
1: Baseline pre-test. 2: Change pre-test/post-test1, CG 3months after baseline, EG 3months after intervention (Int). 3: Change post-test1/post-test2, CG 3months after Int, EG 1year after Int. 4: Change post-test1/post-test2, CG 1year after Int.
Title
Change in Oral Health Impact Profile, short version (OHIP-14).
Description
Questionnaire measuring impact on daily life coast by oral problems. Scale: 0-56. Higher score indicates more impact or oral problems.
Time Frame
1: Baseline pre-test. 2: Change pre-test/post-test1, CG 3months after baseline, EG 3months after intervention (Int). 3: Change post-test1/post-test2, CG 3months after Int, EG 1year after Int. 4: Change post-test1/post-test2, CG 1year after Int.
Title
Change in psychological wellbeing the day of psychological assessment by using Hospital Anxiety and Depression scale (HAD).
Description
Questionnaire measuring Depression and Anxiety. Scale: 0-42. A low score indicate a more positive outcome.
Time Frame
1: Baseline pre-test. 2: Change pre-test/post-test1, CG 3months after baseline, EG 3months after intervention (Int). 3: Change post-test1/post-test2, CG 3months after Int, EG 1year after Int. 4: Change post-test1/post-test2, CG 1year after Int.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
65 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: 65-80 years of age at start Impaired chewing ability (Eichner index B2-B4, C1-C4) Dental rehabilitation with fixed prosthodontics, implant and/or tooth supported (overdentures included) >10 occluding units Mini Mental State Examination (MMSE) score >25 Exclusion Criteria: Brain trauma or stroke <6 months Neurological disease (stroke, dementia, Alzheimer disease, Parkinson disease). Intellectual disability Psychological disorders Participants with chronic pain, depression or sleeping disorders Daily analgesic medication that may affect cognitive and/or executive performance of the brain Poor Swedish language skills, reading disabilities Severely reduced hearing or vision Prosthetic treatment with removable dentures (full or partial) MRI exclusion criteria: Claustrophobia Difficulties in lying down in a supine position for about an hour, or any other difficulties related to the MRI head coil Participants with metal or medical implants in the body contraindicating MRI scan
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Linn B Hedberg, DDS, PhDs
Phone
08-123 156 00
Ext
+46
Email
linn.hedberg@sll.se
First Name & Middle Initial & Last Name or Official Title & Degree
Mats Trulsson, Prof. DDS
Phone
08-524 880 36
Ext
+46
Email
mats.trulsson@ki.se
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Mats Trulsson, Prof. DDS
Organizational Affiliation
Karolinska Institutet, Stockholm, Sweden
Official's Role
Principal Investigator
Facility Information:
Facility Name
Eastmaninstitutet Folktandvården Stockholm AB
City
Stockholm
ZIP/Postal Code
11324
Country
Sweden
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Linn Hedberg, PhDs, DDS
Phone
08-12315600
Ext
+46
Email
linn.hedberg@sll.se
First Name & Middle Initial & Last Name & Degree
Pia Skott, PhD, DDS
Phone
08-123 166 00
Ext
+46
Email
pia.skott@sll.se

12. IPD Sharing Statement

Citations:
PubMed Identifier
12849265
Citation
O'Brien JT, Erkinjuntti T, Reisberg B, Roman G, Sawada T, Pantoni L, Bowler JV, Ballard C, DeCarli C, Gorelick PB, Rockwood K, Burns A, Gauthier S, DeKosky ST. Vascular cognitive impairment. Lancet Neurol. 2003 Feb;2(2):89-98. doi: 10.1016/s1474-4422(03)00305-3.
Results Reference
background
PubMed Identifier
23305823
Citation
Prince M, Bryce R, Albanese E, Wimo A, Ribeiro W, Ferri CP. The global prevalence of dementia: a systematic review and metaanalysis. Alzheimers Dement. 2013 Jan;9(1):63-75.e2. doi: 10.1016/j.jalz.2012.11.007.
Results Reference
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PubMed Identifier
25385509
Citation
O'Brien JT, Markus HS. Vascular risk factors and Alzheimer's disease. BMC Med. 2014 Nov 11;12:218. doi: 10.1186/s12916-014-0218-y.
Results Reference
background
PubMed Identifier
20236235
Citation
Ono Y, Yamamoto T, Kubo KY, Onozuka M. Occlusion and brain function: mastication as a prevention of cognitive dysfunction. J Oral Rehabil. 2010 Aug;37(8):624-40. doi: 10.1111/j.1365-2842.2010.02079.x. Epub 2010 Mar 2.
Results Reference
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PubMed Identifier
20547177
Citation
Weijenberg RA, Scherder EJ, Lobbezoo F. Mastication for the mind--the relationship between mastication and cognition in ageing and dementia. Neurosci Biobehav Rev. 2011 Jan;35(3):483-97. doi: 10.1016/j.neubiorev.2010.06.002. Epub 2010 Jun 12.
Results Reference
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PubMed Identifier
22624951
Citation
Ohkubo C, Morokuma M, Yoneyama Y, Matsuda R, Lee JS. Interactions between occlusion and human brain function activities. J Oral Rehabil. 2013 Feb;40(2):119-29. doi: 10.1111/j.1365-2842.2012.02316.x. Epub 2012 May 25.
Results Reference
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PubMed Identifier
24465167
Citation
Teixeira FB, Pereira Fernandes Lde M, Noronha PA, dos Santos MA, Gomes-Leal W, Ferraz Maia Cdo S, Lima RR. Masticatory deficiency as a risk factor for cognitive dysfunction. Int J Med Sci. 2014 Jan 10;11(2):209-14. doi: 10.7150/ijms.6801. eCollection 2014.
Results Reference
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PubMed Identifier
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Citation
Klineberg I, Palla S, Trulsson M. Contemporary relevance of occlusion and mastication. Int J Prosthodont. 2014 Sep-Oct;27(5):411-2. doi: 10.11607/ijp.2014.5.e. No abstract available.
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Citation
Hedberg L, Ekman U, Nordin LE, Smedberg JI, Skott P, Seiger A, Sandborgh-Englund G, Westman E, Kumar A, Trulsson M. Cognitive changes and neural correlates after oral rehabilitation procedures in older adults: a protocol for an interventional study. BMC Oral Health. 2021 Jun 9;21(1):297. doi: 10.1186/s12903-021-01654-5.
Results Reference
derived

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Cognitive Changes and Neural Correlates After Rehabilitation of Masticatory Function in Elderly -an Intervention Study

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