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Association of herpes zoster with dementia and effect of antiviral therapy on dementia: a population-based cohort study

Abstract

We investigated the association between herpes zoster (HZ) and dementia, and the effects of antiviral therapy on the risk of dementia. We used the National Health Insurance Service-National Sample Cohort in South Korea to identify individuals that were followed from January 1, 2002, to December 31, 2013. Occurrences of HZ and dementia were identified using the relevant diagnostic codes. Dementia was defined as the presence of diagnostic codes and history of anti-dementia drug prescription. Propensity score matching (1:1) was carried out among HZ patients according to antiviral therapy. A total of 229,594 individuals aged ≥50 years were analyzed. The incidences of the first-diagnosed HZ and dementia were 16.69 and 4.67 per 1000 person-years (PY), respectively. HZ patients had a higher risk of dementia (incidence rate ratio [IRR], 1.94 [95% CI 1.83–2.06]; adjusted hazard ratio [HR], 1.12 [95% CI 1.05–1.19]). Of the 34,505 patients with HZ, 28,873 (84%) had received antiviral treatment. The crude incidence rates of subsequent dementia in the treated and untreated groups were 7.79 and 12.27 per 1000 PY, respectively, resulting in an IRR of 0.64 (95% CI 0.56–0.72) and covariate-adjusted HR of 0.79 (95% CI 0.69–0.90). After propensity score matching, the treated group showed a significantly lower risk of dementia (HR 0.76; 95% CI 0.65–0.90). In this large population-based cohort study, HZ was associated with a higher risk of dementia. The use of antiviral agents in HZ patients was associated with lower risks of dementia.

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Funding

This study was supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health and Welfare, Republic of Korea (grant no. HI15C1763).

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All authors critically revised the manuscript for important intellectual content. SHK, SYK, JHW, YSK, SHC, and SOL contributed to the study conception and design. Acquisition, analysis, and interpretation of data was performed by SCY, SB, WY, and MCK. SB and JSL drafted the manuscript. SCY carried out the statistical analysis. SB and SCY equally contributed to the work. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

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Correspondence to Sung-Han Kim.

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All authors have completed the ICMJE uniform disclosure form at https://www.icmje.org/coi_disclosure.pdf and declare: support from the Ministry of Health and Welfare, Republic of Korea; no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

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Bae, S., Yun, SC., Kim, MC. et al. Association of herpes zoster with dementia and effect of antiviral therapy on dementia: a population-based cohort study. Eur Arch Psychiatry Clin Neurosci 271, 987–997 (2021). https://doi.org/10.1007/s00406-020-01157-4

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  • DOI: https://doi.org/10.1007/s00406-020-01157-4

Keywords

  • Dementia
  • Herpes zoster
  • Herpesviridae
  • Antiviral therapy