Journal Article 1 Mention
Impact of herpes zoster vaccination on incident dementia: A retrospective study in two patient cohorts
Jeffrey F. Scherrer2021
Joanne SalasTimothy L. Wiemken
Top 2% · 98th Percentile
83 citations · Epidemiology
Open Access

TLDR

Older adults who received a shingles shot were less likely to be diagnosed with memory loss later. The result was similar in two large healthcare groups, but it does not prove the shot prevents memory loss.

Summary

1 Study Aim

The authors examined whether herpes zoster (HZ; shingles) vaccination was associated with fewer new dementia diagnoses among adults aged 65 or older. They also tested whether age, race, HZ infection, or antiviral treatment changed this association. A secondary aim assessed Alzheimer’s disease (AD; the most common dementia type). The study asked whether a shingles shot might be linked with fewer later memory-loss diagnoses.

2 Study Design

The study used a retrospective cohort design (following existing records over time). Researchers analyzed Veterans Health Administration (VHA) records for 136,016 patients and MarketScan claims for 172,790 patients. Participants were at least 65 years old, had no dementia during the previous two years, and had at least three well visits. Vaccination status was measured at 2011 or 2012 index dates. New dementia required diagnosis codes on two separate days. Propensity scores (estimated vaccination probabilities) and inverse probability of treatment weighting (IPTW; rebalancing groups statistically) addressed differences between vaccinated and unvaccinated patients. VHA models accounted for death, while MarketScan used Cox proportional-hazards models (comparing risks over time). The researchers compared two large groups using existing healthcare records over several years.

3 Findings

The study reports lower dementia risk after vaccination in both cohorts: 31% lower overall in the combined analysis, with hazard ratios (HRs; relative risks over time) of 0.69 in VHA and 0.65 in MarketScan. Vaccination was also linked to 25% lower AD risk in VHA and 30% lower risk in MarketScan. Later HZ infection or antiviral treatment did not explain the association. MarketScan participants aged 65–69 showed no association, while VHA participants aged 70–74 had the weakest association. Effects did not differ by race. The authors suggest immune effects beyond preventing shingles might protect the brain. They recommend prospective studies and clinical trials, because retrospective research cannot prove causation. A shingles shot was linked with fewer later memory-loss diagnoses, but more research is needed to show whether it truly prevents them.

Abstract

BACKGROUND: Herpes zoster (HZ) infection increases dementia risk, but it is not known if herpes zoster vaccination is associated with lower risk for dementia. We determined if HZ vaccination, compared to no HZ vaccination, is associated with lower risk for incident dementia. METHODS AND FINDINGS: Data was obtained from Veterans Health Affairs (VHA) medical records (10/1/2008-9/30/2019) with replication in MarketScan® commercial and Medicare claims (1/1/2009-12/31/2018). Eligible patients were ≥65 years of age and free of dementia for two years prior to baseline (VHA n = 136,016; MarketScan n = 172,790). Two index periods (either start of 2011 or 2012) were defined, where patients either had or did not have a HZ vaccination. Confounding was controlled with propensity scores and inverse probability of treatment weighting. Competing risk (VHA) and Cox proportional hazard (MarketScan) models estimated the association between HZ vaccination and incident dementia in all patients and in age (65-69, 70-74, ≥75) and race (White, Black, Other) sub-groups. Sensitivity analysis measured the association between HZ vaccination and incident Alzheimer's dementia (AD). HZ vaccination at index versus no HZ vaccination throughout follow-up. VHA patients mean age was 75.7 (SD±7.4) years, 4.0% were female, 91.2% white and 20.2% had HZ vaccination. MarketScan patients mean age was 69.9 (SD±5.7) years, 65.0% were female and 14.2% had HZ vaccination. In both cohorts, HZ vaccination compared with no vaccination, was significantly associated with lower dementia risk (VHA HR = 0.69; 95%CI: 0.67-0.72; MarketScan HR = 0.65; 95%CI:0.57-0.74). HZ vaccination was not related to dementia risk in MarketScan patients aged 65-69 years. No difference in HZ vaccination to dementia effects were found by race. HZ vaccination was associated with lower risk for AD. CONCLUSIONS: HZ vaccination is associated with reduced risk of dementia. Vaccination may provide nonspecific neuroprotection by training the immune system to limit damaging inflammation, or specific neuroprotection that prevents viral cytopathic effects.

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