Aging-Associated Oral Microbiota Dysbiosis and Hypofunction: Their Role in Alzheimer's Disease Pathogenesis
Abstract
Alzheimer's disease (AD), a multifactorial neurodegenerative condition, imposes a major burden on societies with aging populations. Recent research indicates that oral cavity health is a critical factor influencing AD pathology, making proactive investigation of this modifiable risk factor essential. This review proposes that aging-related oral microecological dysbiosis and oral hypofunction may promote AD progression by inducing or exacerbating systemic inflammation and disrupting the homeostasis of the "oral-gut-brain" axis. Moreover, each factor may worsen damage through distinct biological pathways: oral microbiota dysbiosis allows direct invasion of the central nervous system by oral pathogens, promoting amyloid β-protein (Aβ) deposition and Tau hyperphosphorylation, while chronic sensory deprivation from oral dysfunction triggers neuronal degeneration and adverse remodeling in key cognitive brain regions. This review aims to systematically elucidate the roles of oral microbiota dysbiosis and oral hypofunction in AD pathogenesis in the context of aging, clarify their underlying biological mechanisms, and explore the potential value of integrating oral cavity health management into comprehensive AD prevention and treatment strategies.
Keywords: Alzheimer's disease, Aging, Oral cavity, Dysbiosis, Review
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SCHELTENS P, De STROOPER B, KIVIPELTO M, et al. Alzheimer's disease. Lancet, 2021, 397(10284): 1577-1590. doi: 10.1016/s0140-6736 (20)32205-4.
ZHI N, REN R, QI J, et al. The China Alzheimer Report 2025. Gen Psychiatr, 2025, 38(4): e102020. doi: 10.1136/gpsych-2024-102020.
GONZALES M M, GARBARINO V R, POLLET E, et al. Biological aging processes underlying cognitive decline and neurodegenerative disease. J Clin Invest, 2022, 132(10):e158453. doi: 10.1172/JCI158453.
National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, National Health Commission Capacity Building and Continuing Education Center, et al. Blue paper on Alzheimer′s disease in China(simplified version). Chin Med J, 2024, 104(29): 2701-2727. doi: 10. 3760/cma.j.cn12137-20240416-00883.
LARVIN H, GAO C, KANG J, et al. The impact of study factors in the association of periodontal disease and cognitive disorders: systematic review and meta-analysis. Age Ageing, 2023, 52(2):afad015. doi: 10.1093/ageing/afad015.
WADIA R. Periodontal health and links with cognitive impairment. Br Dent J, 2024, 237(8): 639. doi: 10.1038/s41415-024-8031-2.
WANG W, TAO Y, ZHU W, et al. Periodontitis and Subgingival Plaque Microbiota Associated With Brain Grey Matter Volume and Cognitive Impairment. J Clin Periodontol, 2025, 52(9): 1327-1337. doi: 10.1111/jcpe.14196.
QI X, LUO H, XU Z, et al. Accelerated biological aging mediates the association between periodontal disease and cognitive function in older adults. Innov Aging, 2025, 9(9): igaf086. doi: 10.1093/geroni/igaf086.
DIBELLO V, CUSTODERO C, CAVALCANTI R, et al. Impact of periodontal disease on cognitive disorders, dementia, and depression: a systematic review and meta-analysis. Geroscience, 2024, 46(5): 5133-5169. doi: 10.1007/s11357-024-01243-8.
BAKER J L, MARK WELCH J L, KAUFFMAN K M, et al. The oral microbiome: diversity, biogeography and human health. Nat Rev Microbiol, 2024, 22(2): 89-104. doi: 10.1038/s41579-023-00963-6.
REN Y, CHEN M, WANG Z, et al. Oral microbiota in aging and diseases. Life Med, 2024, 3(3): lnae024. doi: 10.1093/lifemedi/lnae024.
YANG I, ARTHUR R A, ZHAO L, et al. The oral microbiome and inflammation in mild cognitive impairment. Exp Gerontol, 2021, 147: 111273. doi: 10.1016/j.exger.2021.111273.
LI N, YE Y, WU Y, et al. Alterations in histology of the aging salivary gland and correlation with the glandular inflammatory microenvironment. iScience, 2023, 26(5): 106571. doi: 10.1016/j.isci.2023.106571.
EBERSOLE J L, GRAVES C L, GONZALEZ O A, et al. Aging, inflammation, immunity and periodontal disease. Periodontol 2000, 2016, 72(1): 54-75. doi: 10.1111/prd.12135.
MIZUNO H, KAWAMOTO S, UEMURA K, et al. B cell senescence promotes age-related changes in oral microbiota. Aging Cell, 2024, 23(12): e14304. doi: 10.1111/acel.14304.
ZHENG X, TIZZANO M, REDDING K, et al. Gingival solitary chemosensory cells are immune sentinels for periodontitis. Nat Commun, 2019, 10(1): 4496. doi: 10.1038/s41467-019-12505-x.
XU F, GUO Y, THOMAS S C, et al. Succinate modulates oral dysbiosis and inflammation through a succinate receptor 1 dependent mechanism in aged mice. Int J Oral Sci, 2025, 17(1): 47. doi: 10.1038/s41368-025-00376-6.
LARSSON A, ERICSON U, JÖNSSON D, et al. New connections of medication use and polypharmacy with the gut microbiota composition and functional potential in a large population. Sci Rep, 2024, 14(1): 23723. doi: 10.1038/s41598-024-71571-4.
SARAFIDOU K, ALEXAKOU E, TALIOTI E, et al. The oral microbiome in older adults –a state-of-the-art review. Archives of Gerontology and Geriatrics Plus, 2024, 1(4): 100061. doi: 10.1016/j.aggp.2024.100061.
LI Y C, LIU Y, CHEN F, et al. Relationship between Oral Microbiota and Alzheimer's Disease. J Sichuan Univ (Med Sci), 2022, 53(2): 194-200. doi: 10.12182/20220360304.
MA G W, WANG F, KONG L W Y. Neuroimmune: New insights into oral-brain axis for periodontal disease and Alzheimer's disease. J Oral Sci Res, 2023, 39(10): 857-861. doi: 10.13701/j.cnki.kqyxyj.2023.10.001.
BELTRAN-VELASCO A I, CLEMENTE-SUÁREZ V J. Impact of Peripheral Inflammation on Blood-Brain Barrier Dysfunction and Its Role in Neurodegenerative Diseases. Int J Mol Sci, 2025, 26(6): 2440. doi: 10. 3390/ijms26062440.
HUANG X, HUSSAIN B, CHANG J. Peripheral inflammation and blood-brain barrier disruption: effects and mechanisms. CNS Neurosci Ther, 2021, 27(1): 36-47. doi: 10.1111/cns.13569.
PARK J H, HWANG J W, LEE H J, et al. Lomerizine inhibits LPS-mediated neuroinflammation and tau hyperphosphorylation by modulating NLRP3, DYRK1A, and GSK3α/β. Front Immunol, 2023, 14: 1150940. doi: 10.3389/fimmu.2023.1150940.
ZHANG Y, LIANG X, BAO X, et al. Toll-like receptor 4 (TLR4) inhibitors: Current research and prospective. Eur J Med Chem, 2022, 235: 114291. doi: 10.1016/j.ejmech.2022.114291.
YAMADA C, AKKAOUI J, HO A, et al. Potential Role of Phosphoglycerol Dihydroceramide Produced by Periodontal Pathogen Porphyromonas gingivalis in the Pathogenesis of Alzheimer's Disease. Front Immunol, 2020, 11: 591571. doi: 10.3389/fimmu.2020.591571.
XI M, RUAN Q, ZHONG S, et al. Periodontal bacteria influence systemic diseases through the gut microbiota. Front Cell Infect Microbiol, 2024, 14: 1478362. doi: 10.3389/fcimb.2024.1478362.
VAVOUGIOS G D, MAVRIDIS T, ARTEMIADIS A, et al. Trained immunity in viral infections, Alzheimer's disease and multiple sclerosis: A convergence in type Ⅰ interferon signalling and IFNβ-1a. Biochim Biophys Acta Mol Basis Dis, 2022, 1868(9): 166430. doi: 10.1016/j.bbadis. 2022.166430.
DONG L, JI Z, HU J, et al. Oral microbiota shifts following tooth loss affect gut health. BMC Oral Health, 2025, 25(1): 213. doi: 10.1186/s12903-025-05581-7.
LU J, ZHANG S, HUANG Y, et al. Periodontitis-related salivary microbiota aggravates Alzheimer's disease via gut-brain axis crosstalk. Gut Microbes, 2022, 14(1): 2126272. doi: 10.1080/19490976.2022. 2126272.
SALMINEN A. Activation of aryl hydrocarbon receptor (AhR) in Alzheimer's disease: role of tryptophan metabolites generated by gut host-microbiota. J Mol Med (Berl), 2023, 101(3): 201-222. doi: 10.1007/s00109-
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