Reviewing the Role of Oral Microbiota in Cognitive Impairment from Microbiota Homeostasis and Pathogenic Bacteria
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Keywords

Cognitive impairment
Oral microbiota
Alzheimer’s disease
Neurodegenerative diseases

DOI

10.26689/jcnr.v9i6.10962

Submitted : 2025-06-03
Accepted : 2025-06-18
Published : 2025-07-03

Abstract

Cognitive impairment is a common symptom of various neurodegenerative diseases. In recent years, an increasing body of research has focused on the relationship between oral microbiota and cognitive impairment. This review aims to explore the microbial homeostasis of oral microbiota and its interactions and mechanisms with the host, as well as the impact of specific pathogenic bacteria on cognitive function. By summarizing existing studies, this review aims to provide a theoretical basis for the pathogenesis, risk assessment, and early intervention and treatment strategies for cognitive impairment.

References

World Health Organization, 2021, Global Status Report on the Public Health Response to Dementia: Executive Summary, World Health Organization, Geneva.

Gong W, Yu H, You W, et al., 2025, The Oral Microbiota: New Insight Into Intracranial Aneurysms. Ann Med, 57(1): 2451191.

Li P, Zhang H, Chen L, et al., 2025, Oral and Fecal Microbiota as Accurate Non-Invasive Tools for Detection of Pancreatic Cancer in the Chinese Population. Cancer Lett, 612: 217456.

Tangon N, Kumfu S, Chattipakorn N, et al., 2025, Links Between Oropharyngeal Microbiota and IgA Nephropathy: A Paradigm Shift From Isolated Microbe to Microbiome. Microbiol Res, 292: 128005.

Nakamura T, Zou K, Shibuya Y, et al., 2021, Oral Dysfunctions and Cognitive Impairment/Dementia. J Neurosci Res, 99(2): 518–528.

Daly B, Thompsell A, Sharpling J, et al., 2017, Evidence Summary: The Relationship Between Oral Health and Dementia. British Dental Journal, 223(11): 846–853.

Kilian M, Chapple IL, Hannig M, et al., 2016, The Oral Microbiome – An Update for Oral Healthcare Professionals. Br Dent J, 221(10): 657–666. https://doi.org/10.1038/sj.bdj.2016.865

Thayumanavan T, Harish BS, Subashkumar R, et al., 2025, Streptococcus Mutans Biofilms in the Establishment of Dental Caries: A Review. 3 Biotech, 15(3): 62. https://doi.org/10.1007/s13205-025-04227-3

Jing X, Huang X, Haapasalo M, et al., 2019, Modeling Oral Multispecies Biofilm Recovery After Antibacterial Treatment. Sci Rep, 9(1): 804. https://doi.org/10.1038/s41598-018-37170-w

Taylor ZA, Chen P, Noeparvar P, et al., 2024, Glycerol Metabolism Contributes to Competition by Oral Streptococci Through Production of Hydrogen Peroxide. J Bacteriol, 206(9): e0022724. https://doi.org/10.1128/jb.00227-24

Asp ME, Ho Thanh MT, Gopinath A, et al., 2021, How Do Biofilms Feel Their Environment? BioRxiv, 2021: 1–12.

Bardow A, Moe D, Nyvad B, et al., 2000, The Buffer Capacity and Buffer Systems of Human Whole Saliva Measured Without Loss of CO2. Archives of Oral Biology, 45(1): 1–12. https://doi.org/https://doi.org/10.1016/S0003-9969(99)00119-3

Marsh PD, Do T, Beighton D, et al., 2016, Influence of Saliva on the Oral Microbiota. Periodontology 2000, 70(1): 80–92. https://doi.org/https://doi.org/10.1111/prd.12098

Ptasiewicz M, Grywalska E, Mertowska P, et al., 2022, Armed to the Teeth – The Oral Mucosa Immunity System and Microbiota. Int J Mol Sci, 23(2): 882. https://doi.org/10.3390/ijms23020882

Wei Y, Tian A, 2024, Research Progress on Regulation of Macrophages Involvement in Periodontal Disease by Lactate/Lactation Modification. Journal of Oral Science Research, 40(7): 578–582.

Sureda A, Daglia M, Arguelles C, et al., 2020, Oral Microbiota and Alzheimer’s Disease: Do All Roads Lead to Rome? Pharmacological Research, 151: 104582. https://doi.org/https://doi.org/10.1016/j.phrs.2019.104582

Willis JR, Gabaldon T, 2020, The Human Oral Microbiome in Health and Disease: From Sequences to Ecosystems. Microorganisms, 8(2): 308. https://doi.org/10.3390/microorganisms8020308

Yu-chen L, Yuan L, Feng C, et al., 2022, Relationship Between Oral Microbiota and Alzheimer’s Disease. Journal of Sichuan University (Medical Science), 53(02): 194–200. https://doi.org/10.12182/20220360304

Riviere GR, Riviere KH, Smith KS, 2002, Molecular and Immunological Evidence of Oral Treponema in the Human Brain and Their Association With Alzheimer’s Disease. Oral Microbiol Immunol, 17(2): 113–118. https://doi.org/10.1046/j.0902-0055.2001.00100.x

Sundar S, Battistoni C, McNulty R, et al., 2020, An Agent-Based Model to Investigate Microbial Initiation of Alzheimer’s Via the Olfactory System. Theor Biol Med Model, 17(1): 5. https://doi.org/10.1186/s12976-020-00123-w

Dominy SS, Lynch C, Ermini F, et al., 2019, Porphyromonas gingivalis in Alzheimer’s Disease Brains: Evidence for Disease Causation and Treatment With Small-Molecule Inhibitors. Sci Adv, 5(1): 1–21. https://doi.org/10.1126/sciadv.aau3333

Laugisch O, Johnen A, Maldonado A, et al., 2018, Periodontal Pathogens and Associated Intrathecal Antibodies in Early Stages of Alzheimer’s Disease. J Alzheimers Dis, 66(1): 105–114. https://doi.org/10.3233/jad-180620

Hu Q, Wang S, Zhang W, et al., 2025, Unraveling Brain Aging Through the Lens of Oral Microbiota. Neural Regeneration Research, 20(7): 1930–1943. https://doi.org/10.4103/nrr.Nrr-d-23-01761

Hussain AA, Lee Y, Marshall J, 2020, Understanding the Complexity of the Matrix Metalloproteinase System and Its Relevance to Age-Related Diseases: Age-Related Macular Degeneration and Alzheimer’s Disease. Prog Retin Eye Res, 74: 100775. https://doi.org/10.1016/j.preteyeres.2019.100775

Olsen I, Singhrao SK, 2020, Interaction Between Genetic Factors, Porphyromonas gingivalis and Microglia to Promote Alzheimer’s Disease. J Oral Microbiol, 12(1): 1820834. https://doi.org/10.1080/20002297.2020.1820834

Xue L, Zou X, Yang XQ, et al., 2020, Chronic Periodontitis Induces Microbiota-Gut-Brain Axis Disorders and Cognitive Impairment in Mice. Exp Neurol, 326: 113176. https://doi.org/10.1016/j.expneurol.2020.113176

Ignacio LS, Cascales E, 2021, Molecular Strategies Underlying Porphyromonas gingivalis Virulence. J Mol Biol, 433(7): 166836. https://doi.org/10.1016/j.jmb.2021.166836

Wang YX, Kang XN, Cao Y, et al., 2019, Porphyromonas gingivalis Induces Depression Via Downregulating p75NTR-Mediated BDNF Maturation in Astrocytes. Brain Behav Immun, 81: 523–534. https://doi.org/10.1016/j.bbi.2019.07.012

Feng YK, Wu QL, Peng YW, et al., 2020, Oral P. gingivalis Impairs Gut Permeability and Mediates Immune Responses Associated With Neurodegeneration in LRRK2 R1441G Mice. J Neuroinflammation, 17(1): 347. https://doi.org/10.1186/s12974-020-02027-5

Wei SS, Chen L, Yang FY, et al., 2023, The Role of Fibronectin in Multiple Sclerosis and the Effect of Drug Delivery Across the Blood-Brain Barrier. Neural Regen Res, 18(10): 2147–2155. https://doi.org/10.4103/1673-5374.369102

Tsimpiris A, Tsolianos I, Grigoriadis A, et al., 2023, Association of Chronic Periodontitis With Multiple Sclerosis: A Systematic Review and Meta-Analysis. Mult Scler Relat Disord, 77: 104874. https://doi.org/10.1016/j.msard.2023.104874

Lian J, Wu Z, 2022, Analysis of the Correlation Between Periodontitis and Alzheimer’s Disease Based on Oral Microbiota Chinese Journal of Gerontology. Chinese Journal of Gerontology, 42(19): 4708–4711. https://doi.org/10.3969/j.issn.1005-9202.2022.19.018

Dezfulian M, Shokrgozar MA, Sardari S, et al., 2008, Can Phages Cause Alzheimer’s Disease? Med Hypotheses, 71(5): 651–656. https://doi.org/10.1016/j.mehy.2008.07.005

Ranjan R, Abhinay A, Mishra M, 2018, Can Oral Microbial Infections Be a Risk Factor for Neurodegeneration? A Review of the Literature. Neurol India, 66(2): 344–351. https://doi.org/10.4103/0028-3886.227315

Li Y, Li Z, Li S, et al., 2023, Advances in the Research of Oral Microbiota and Cognitive Impairment. Stroke and Neurological Diseases, 30(06): 633–637. https://doi.org/10.3969/i.issn.1007-0478.2023.06.020

Miklossy J, 2011, Alzheimer’s Disease – A Neurospirochetosis. Analysis of the Evidence Following Koch’s and Hill’s Criteria. J Neuroinflammation, 8: 90. https://doi.org/10.1186/1742-2094-8-90

Miklossy J, 2011, Emerging Roles of Pathogens in Alzheimer Disease. Expert Rev Mol Med, 13: e30. https://doi.org/10.1017/s1462399411002006

Sureda A, Daglia M, Castilla SA, et al., 2020, Oral Microbiota and Alzheimer’s Disease: Do All Roads Lead to Rome? Pharmacol Res, 151: 104582. https://doi.org/10.1016/j.phrs.2019.104582

Golipoor M, Rafat Z, Saberi A, et al., 2024, Comparing the Frequency, Antifungal Susceptibility, and Enzymatic Profiles of the Oral Fungal Composition in Patients With and Without Alzheimer’s Disease Admitted to a Neurology Clinic. Front Cell Infect Microbiol, 14: 1477230. https://doi.org/10.3389/fcimb.2024.1477230

Gow NAR, Yadav B, 2017, Microbe Profile: Candida albicans: A Shape-Changing, Opportunistic Pathogenic Fungus of Humans. Microbiology (Reading), 163(8): 1145–1147. https://doi.org/10.1099/mic.0.000499

Pisa D, Alonso R, Rabano A, et al., 2015, Different Brain Regions Are Infected With Fungi in Alzheimer’s Disease. Sci Rep, 5: 15015. https://doi.org/10.1038/srep15015

Wu Y, Du S, Johnson JL, et al., 2019, Microglia and Amyloid Precursor Protein Coordinate Control of Transient Candida Cerebritis With Memory Deficits. Nat Commun, 10(1): 58. https://doi.org/10.1038/s41467-018-07991-4

Ito S, Misaki T, Naka S, et al., 2019, Specific Strains of Streptococcus mutans, a Pathogen of Dental Caries, in the Tonsils, Are Associated With IgA Nephropathy. Sci Rep, 9(1): 20130. https://doi.org/10.1038/s41598-019-56679-2

Watanabe I, Kuriyama N, Miyatani F, et al., 2016, Oral Cnm-Positive Streptococcus mutans Expressing Collagen Binding Activity Is a Risk Factor for Cerebral Microbleeds and Cognitive Impairment. Sci Rep, 6: 38561. https://doi.org/10.1038/srep38561

Akoudad S, Wolters FJ, Viswanathan A, et al., 2016, Association of Cerebral Microbleeds With Cognitive Decline and Dementia. JAMA Neurol, 73(8): 934–943. https://doi.org/10.1001/jamaneurol.2016.1017

Sato Y, Okamoto K, Kagami A, et al., 2004, Streptococcus mutans Strains Harboring Collagen-Binding Adhesin. J Dent Res, 83(7): 534–539. https://doi.org/10.1177/154405910408300705

Hosoki S, Hattori Y, Saito S, et al., 2022, Risk Assessment of Cnm-Positive Streptococcus Mutans in Stroke Survivors (RAMESSES): Protocol for a Multicenter Prospective Cohort Study. Front Neurol, 13: 816147. https://doi.org/10.3389/fneur.2022.816147

Nomura R, Naka S, Nemoto H, et al., 2013, Potential High Virulence for Infective Endocarditis in Streptococcus Mutans Strains With Collagen-Binding Proteins but Lacking PA Expression. Arch Oral Biol, 58(11): 1627–1634. https://doi.org/10.1016/j.archoralbio.2013.06.008

Iadecola C, 2017, The Neurovascular Unit Coming of Age: A Journey Through Neurovascular Coupling in Health and Disease. Neuron, 96(1): 17–42. https://doi.org/10.1016/j.neuron.2017.07.030