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Objective: Oral frailty is associated with an increased risk of cognitive decline, yet practical tools for early identification remain limited. The Oral Frailty 5-item Checklist (OF-5), recently standardized in Japan, does not account for severe tooth loss, which is a known risk factor for brain atrophy. We developed a revised version of the OF-5 that includes the criterion of having nine or fewer teeth. This study aimed to validate the revised OF-5 as a screening tool for detecting early brain structural changes related to dementia risk in cognitively unimpaired older adults. Methods: We analyzed 732 cognitively unimpaired participants from a population-based Japanese cohort (baseline 2016–2018). Oral frailty was assessed using both the original OF-5 and the revised OF-5. Brain volumes were measured by MRI and processed with FreeSurfer. Associations between oral frailty status and regional brain volumes were tested using multivariable-adjusted models, with further adjustment for nutrient intake and food consumption. Results: The revised OF-5, which adds severe tooth loss (≥9 teeth) as a criterion, showed greater sensitivity in detecting dementia-related brain changes than the original version. With the original OF-5, oral frailty was associated only with reduced fusiform gyrus volume (1.088% vs. 1.109% of estimated total intracranial volume [eTIV]; p < 0.05). In contrast, the revised OF-5 detected broader changes: orally frail participants showed significantly higher white matter hyperintensity (WMH) volume (0.366% vs. 0.302% of eTIV; p < 0.05) and smaller volumes in the medial temporal lobe (1.824% vs. 1.856%), pars triangularis (0.401% vs. 0.412%), and fusiform gyrus (1.080% vs. 1.111%)—all p < 0.05 (FWE-corrected). These associations persisted after adjusting for nutrient intake and food consumption. Conclusions: The revised OF-5 improves identification of pre-symptomatic brain changes in cognitively healthy older adults, independent of nutrition. It may serve as a simple and practical tool for early screening of dementia risk in clinical and community settings.

Background Adult hypophosphatasia is an uncommon inherited disorder of mineral homeostasis affecting bone. It arises from mutations within the Alkaline Phosphatase, Biomineralization Associated ( ALPL ) gene, which encodes tissue-nonspecific alkaline phosphatase. Because of its low prevalence and non-specific clinical manifestations, underdiagnosis and misdiagnosis are frequent, particularly in Asian populations. Case presentation We present a case of a 38-year-old Japanese male diagnosed with adult hypophosphatasia following consecutive tooth loss during orthodontic treatment. Genetic analysis revealed a compound heterozygous mutation within the ALPL gene. The patient remained asymptomatic until orthodontic treatment, suggesting that increased mechanical stress overwhelmed residual enzyme activity, triggering the hypophosphatasia symptoms. Asfotase Alfa enzyme replacement therapy improved healing following tooth extraction. Conclusion This case highlights the significance of including adult hypophosphatasia in the differential diagnosis for obscure dental complications arising during orthodontic procedures, particularly in Asian patients where certain ALPL variants may be more prevalent. Effective diagnosis and management of adult hypophosphatasia necessitate collaboration between orthodontic practitioners and medical specialists. Improved awareness and a multidisciplinary approach are crucial for timely diagnosis and successful intervention.

Social isolation and poor nutrition are recognized risk factors for cognitive decline in older adults. However, the relationship between solitary eating, brain structure, and dietary patterns remains unclear. This study investigated the relationship between solitary eating, brain structure, and diet in healthy older Japanese adults. A total of 727 cognitively normal participants (mean age 70.32 years) underwent MRI and dietary assessments. Results showed that individuals who frequently eat alone have reduced brain volumes in regions critical for cognitive function, particularly the medial temporal lobe and hippocampus. These individuals also demonstrated less healthy dietary patterns, characterized by higher sugar and alcohol consumption, with lower intake of proteins, vitamins, and minerals. Analysis revealed that the difference in hippocampal volume between solitary and social eaters diminished when accounting for dietary factors, suggesting that nutritional factors primarily drive this relationship. However, the difference in medial temporal lobe volume remained significant after dietary adjustment, indicating that other factors, such as reduced social interaction, may affect this region. These findings emphasize the importance of social eating for maintaining brain health in older adults, suggesting that both social and nutritional aspects of eating are crucial. This research provides insights for developing healthy aging strategies that address both social and nutritional dimensions of eating behavior.