Herpes Zoster Does Not Increase the Risk of Neurodegenerative Dementia: A Case-Control Study

Choi, Hyo Geun; Park, Bum Jung; Lim, Jae Sung; Sim, Song Yong; Jung, Yoon Jung; Lee, Suk Woo

doi:10.1177/15333175211006504

Cited by 21 publications

(33 citation statements)

References 32 publications

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“…Previous population-based studies report both decreased 12 and increased [13][14][15] risks of dementia after HZ infection. A case-control study from the National Health Insurance Service-National Sample Cohort in South Korea found lower odds of prior HZ (OR 0.91; 95% CI 0.84-0.97) among 11,445 people aged 60 years or older with dementia compared with 45,780 matched controls without dementia.…”

Section: Discussionmentioning

confidence: 99%

Incident Herpes Zoster and Risk of Dementia

et al. 2022

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Background and Objectives:Herpes zoster is caused by reactivation of the neurotrophic varicella-zoster virus. Zoster may contribute to development of dementia through neuroinflammation, cerebral vasculopathy, or direct neural damage, but epidemiological evidence is limited. We used data from linked nationwide Danish registries to conduct a cohort study of the association between zoster and dementia during 1997 to 2017. As secondary aims, we examined if associations were more pronounced for zoster involving cranial nerves (mainly ophthalmic zoster) or the central nervous system and Alzheimer’s disease as an outcome.Methods:We included people aged ≥40 years with zoster and a general population comparison cohort matched 5:1 by sex and birth year. We identified zoster and dementia in the registries using prescription records in the community and hospital diagnoses. We used Cox regression to compute confounder-adjusted hazard ratios (HR) with 95% confidence intervals (CIs) for dementia associated with zoster during 0–1 year and 1–21 years of follow-up. We compared the cumulative incidence of dementia, inverse probability-weighted for confounders.Results:The study included 247,305 people with zoster and 1,235,890 matched general population comparators (median age 64 years; 61% female). The HR of all-cause dementia was 0.98 (95% CI: 0.92–1.04) during the first year and 0.93 (95% CI: 0.90–0.95) thereafter in people with zoster versus matched comparators. Dementia was diagnosed in 9.7% of zoster patients and 10.3% of matched comparators by end of follow-up. We observed no increased long-term risk of dementia in subgroup analyses, except possibly in people with central nervous system infection (HR 1.94; 95% CI: 0.78–4.80). Analyses of Alzheimer’s disease as a separate outcome showed similar results.Discussion:Herpes zoster is not associated with increased risk of dementia, and contrary to expectation we found a small decrease in risk. The explanation for this finding is unclear, and systematic errors should be considered. Patients with central nervous system involvement had almost two-fold increased relative risk of dementia. The population attributable fraction of dementia due to this rare complication is estimated at 0.014%. Therefore, universal vaccination against varicella-zoster virus in the elderly is unlikely to reduce dementia risk.

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Section: Discussionmentioning

confidence: 99%

Incident Herpes Zoster and Risk of Dementia

et al. 2022

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“…12,13 Recent results from a Korean case control study showed no evidence for an association. 14 Subgroup analyses from a multi-centre Northern European cohort focussed on antiviral medication use after herpes viruses also failed to support these findings. 15 It is unclear whether differences between populations or within population subgroups could explain the contrasting findings.…”

Section: Introductionmentioning

confidence: 99%

No evidence that herpes zoster is associated with increased risk of dementia diagnosis

Warren‐Gash

Williamson

Shiekh

et al. 2022

Ann Clin Transl Neurol

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Objective: To investigate whether herpes zoster (HZ) was associated with subsequent increased risk of dementia diagnosis. Methods: We conducted a historical cohort study using primary care electronic health records from the Clinical Practice Research Datalink in the United Kingdom. Individuals with incident HZ aged ≥40 years from 2000 to 2017 were matched with up to four individuals without HZ by age, sex, primary care practise and calendar time. The primary outcome was a new diagnosis of all-cause dementia. We used the Cox proportional hazards regression adjusting for demographic, lifestyle and clinical confounders to assess any association between HZ and dementia. We investigated interactions with sex, frailty index and antiviral treatment and conducted various sensitivity analyses. Results: The cohort comprised 177,144 individuals with HZ and 706,901 matched unexposed individuals (median age 65 years (IQR 55.1-75.0), 40% male) followed for a median duration of 4.6 years (IQR 2.0-8.1). In total, 26,585 (3%) patients had an incident dementia diagnosis recorded and 113,056 patients died (12.8%). HZ was associated with a small reduction in dementia diagnosis (adjusted HR 0.92 (95% CI 0.89-0.95)), occurring predominantly in frail individuals and females. For patients who were fit (578,115, 65%), no association was seen (adjusted HR 0.97, 95% CI 0.92-1.02). There was no association between HZ and a composite outcome of dementia or death (adjusted HR 1.00, 95% CI 0.99-1.02). Dementia risk did not vary by prescription of antiviral agents. Sensitivity analyses showed consistent results. Interpretation: HZ was not associated with increased dementia diagnosis in a UK primary care-based cohort.

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“…Other research (4) has supported these findings. However, in a case-control study, Choi et al found that HZ did not raise the incidence of dementia (5).…”

Section: Abstract Background/αim: the Relationship Of Herpes Viruses And Herpes Zoster (Hz) With Dementia Andmentioning

confidence: 92%