Tooth loss and cognitive impairment.

OBJECTIVES: Chronic subclinical inflammation may elevate the risk of cognitive impairment. Periodontitis is associated with subclinical inflammation and accounts in part for tooth loss. The hypothesis was tested that periodontitis and tooth loss as a proxy of chronic periodontitis is associated with cognitive impairment in the elderly. SUBJECTS AND METHODS: The population-based Study of Health in Pomerania comprises 1336 subjects (60-79 years). Cognitive impairment was assessed with the Mini-Mental Status Examination (MMSE). Tobit regression analyses were adjusted for potential confounders. RESULTS: A decreased number of teeth was associated with lower MMSE scores in females (p<0.001) and males (p=0.007) in age-adjusted models. In the fully adjusted models, tooth loss was associated with cognitive impairment in females (p=0.002) but not in males (p=0.825). CONCLUSIONS: A significant association between tooth loss and cognitive impairment was found in females that was not accounted for by potential confounders. Former periodontitis may account for this association as periodontitis was frequently the cause for tooth extractions.

No association of seropositivity for anti-Borrelia IgG antibody with mental and physical complaints.

Undiagnosed chronic Lyme disease caused by Borrelia burgdorferi is considered a differential diagnoses in medically unexplained symptoms like arthralgias, distal paresthesias, depressive symptoms, lack of concentration and fatigue. The aims of the study were to assess the association of mental and physical complaints with seropositivity for anti-Borrelia IgG in a general population sample. Seropositivity indicated an infection with Borrelia in the past. The Study of Health in Pomerania was conducted in a community living in a region with endemic Lyme disease. Mental and physical complaints were assessed on 38 items with the von Zerssen's complaint scale. IgG antibodies to Borrelia were determined by ELISA in 4264 individuals. Seropositivity was analyzed applying two cut-off scores (>5 and >10 IU/ml). IgG antibodies to Borrelia were found positive in 388 subjects (9.1%) applying the >5 IU/ml cut-off and in 130 subjects (3.0%) applying the >10 IU/ml cut-off. In multivariate analyses (MANCOVA), both definitions of seropositivity were not associated with increased mental or physical complaints while adjusting for gender, age, employment status, rural residency, physical activity, diabetes mellitus and number of chronic diseases. In the general population, seropositivity for anti-Borrelia IgG antibodies was not associated with an increase of self-rated mental or physical complaints or impairments. Therefore, clinicians should not overvalue seropositivity for anti-Borrelia IgG as a medical cause for unexplained mental or physical complaints.

Alexithymia and personality in relation to dimensions of psychopathology.

OBJECTIVE: The authors examined the capacity of alexithymia to predict a broad range of psychiatric symptoms relative to that of other personality dimensions, age, and gender. METHOD: The Toronto Alexithymia Scale, the Temperament and Character Inventory, and the SCL-90-R were administered to 254 psychiatric patients. Multivariate linear regression analyses were performed. RESULTS: The difficulties identifying feelings factor of the Toronto Alexithymia Scale significantly predicted all SCL-90-R subscale scores and was particularly effective, relative to the personality dimensions of the Temperament and Character Inventory, in predicting somatization. The Temperament and Character Inventory dimensions emerged as distinct and conceptually meaningful predictors for the different SCL-90-R subscales. CONCLUSIONS: A broad range of current psychopathology is associated with difficulties in cognitively processing emotional perceptions. Further research needs to clarify whether alexithymia represents a risk factor for mental illness and poorer outcome.

Interhemispheric transfer in alexithymia: a transcallosal inhibition study.

OBJECTIVE: This study investigates the hypothesis that alexithymia is associated with an interhemispheric transfer deficit via the corpus callosum (CC). METHOD: The transcallosal inhibition paradigm was used to assess interhemispheric transfer. Transcranial magnetic stimulation (TMS) and peripheral electromyographic recordings were performed in 10 right-handed male and 10 female students with Toronto Alexithymia Scale (TAS-20) scores of > or = 61 and controls (TAS-20 scores of < 61). The transcallosal conduction time (TCT) reflects the TMS-induced inhibitory cortical activity that is mediated via the CC. RESULTS: There was a significant interaction between gender and alexithymia (Wilks lambda = 0.89; F = 3.4; d.f. = 2, 57; p = 0.04) indicating that alexithymic males had shorter bidirectional TCTs than controls and a significantly shorter left to right TCT than controls (p = 0.002). However, the left to right TCT was not significantly different from the right to left TCT in alexithymic males (p = 0.39). Alexithymic females were not different from controls. CONCLUSION: Our results clearly stand in contrast to the hypothesis of a transfer deficit due to a dysfunction of the CC in alexithymia. Facilitated, bidirectional transcallosal inhibition of the contralateral motor activity is associated with alexithymia in males. Facilitated cortical inhibition may be a neurobiological correlate of alexithymia.

Specific somatoform disorder in the general population.

The authors assessed the validity of the recently proposed diagnosis for specific somatoform disorder in the general population. German versions of the DSM-IV adapted Composite International Diagnostic Interview were administered to a representative sample of 4075 individuals. Multivariate analyses were used to compare impairment, life satisfaction, and use of health care. A total of 803 of 4075 subjects (19.7%) with undifferentiated somatization disorder were identified, which included 51 subjects (1.3%) who met criteria for specific somatoform disorder. Subjects with specific somatoform disorder were more impaired, had lower life satisfaction, and had higher use of health care than subjects with undifferentiated somatization disorder only. The proposed diagnosis of specific somatoform disorder demonstrated a high validity independent of comorbid depressive and anxiety disorders.

Somatoform pain disorder in the general population.

BACKGROUND: Chronic pain disorder is assumed to represent a frequent and disabling condition. However, data on the prevalence of somatoform pain symptoms and somatoform pain disorder in the community are limited to date. METHODS: German versions of the Composite International Diagnostic Interview were administered to a representative national sample of 4,075 people. Somatoform pain disorder was diagnosed by standardized diagnostic algorithm based on the DSM-III-R criteria (absence of adequate physical findings). One subgroup was identified as also meeting the DSM-IV criterion B for 'significant distress or psychosocial impairment due to the somatoform pain'. RESULTS: A lifetime prevalence rate of somatoform pain disorder according to DSM-III-R of 33.7% and a 6-month rate of 17.3% was found. When applying the DSM-IV B criterion, the prevalence rate dropped to 12.3 and 5.4%, respectively. In both groups more than 95% of the probands had contacted their doctor because of the pain. In 25% of the probands the pain was positively assigned to psychological factors. A female:male ratio of 2:1 was found. CONCLUSIONS: Somatoform pain disorder (DSM-III-R) is a frequent condition. However, only about one third of these subjects is severely distressed or impaired by the pain. A clear operationalized concept of the DSM-IV criterion C 'psychological factors are judged to have an important role in the onset, severity, exacerbation or maintenance of the pain' should be provided in the further development of the diagnosis 'pain disorder' in order to make this diagnosis suitable for general population surveys.