The study tested whether new eating or dental problems precede abrupt cognitive decline across CHARLS, ELSA, HRS and SHARE. It matched first reported transitions within cohort and wave among 219,047 participants and 722,637 person-waves. Eating difficulty had a 6-year dementia-indicator risk difference of 91.5 per 1000 (88.4 adjusted); tooth loss was near 0 adjusted. Risk was 105.1 per 1000 with another functional limitation and 202.1 per 1000 when reported at consecutive waves. Event-time models showed no abrupt acceleration, and low cognition predicted later eating difficulty. These observational estimates cannot show that eating difficulty causes cognitive decline.
Why it is interesting: Eating difficulty behaved as a marker of wider functional decline rather than an oral-specific signal. Structural dental status added little once other factors were accounted for.
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