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Cross sectional association between cytomegalovirus seropositivity, inflammation and cognitive impairment in elderly cancer survivors



The higher prevalence of cognitive impairment/ dementia among cancer survivors is likely multifactorial. Since both exposures to cytomegalovirus (CMV) and inflammation are common among elderly cancer survivors, we evaluated their contribution towards dementia.


Data from 1387 cancer survivors and 7004 participants without cancer in the 2016 wave of the Health and Retirement Study (HRS) was used in this study. Two inflammatory biomarkers, C-reactive protein (CRP) and neutrophil–lymphocyte ratio (NLR), were used to create an inflammation score. We used survey logistic regression adjusted for survey design parameters.


CMV seropositivity was not associated with cognitive impairment among cancer survivors (p = 0.2). In addition, inflammation was associated with elevated odds of cognitive impairment (OR = 2.2, 95% CI [1.2, 4.2]). Cancer survivors who were both CMV seropositive and had increased inflammation had the highest odds of cognitive impairment compared to those who were CMV seronegative and had low inflammation (OR = 3.8, 95% CI [1.5, 9.4]). The stratified analysis among cancer survivors showed this association was seen only among cancer survivors in whom the cancer was diagnosed within three years of measurement of inflammation score and CMV serostatus (OR = 18.5; 95% CI [6.1, 56.1]).


The CMV seropositivity and high inflammation was associated with higher cognitive impairment among cancer survivors. The stronger associations seen among cancer survivors diagnosed within the last three years suggest that strategies to reduce CMV activation and inflammation during or immediately after cancer treatment may be important in reducing the prevalence of cognitive impairment/ dementia among cancer survivors.

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Data availability

Data used in this manuscript are accessed from Health and Retirement Study website ( Cognition and basic demographic data used in this study is publicly available to registered members of Health and Retirement Study. The venous blood biomarker data is under sensitive health data and can be accessed by submitting sensitive health data order form (


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This work was supported by the National Institute on Aging (R01 AG AG060110). The Health and Retirement Study is supported by NIA U01 AG009740.

Author information




SV, BT and HHN designed the study. SV completed the statistical analysis and wrote the manuscript. BT developed the hypothesis, oversaw statistical analysis and manuscript preparation. HHN also provided critical feedback to the analysis strategy and comments to the manuscript. AEP, JF and EC reviewed the manuscript and suggested specific analysis for this project.

Corresponding author

Correspondence to Bharat Thyagarajan.

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There is no competing financial or non-financial interests in relation to this manuscript. The authors declare no conflict of interest.

Ethical approval

All study participants in HRS were consented for study participation and the study was approved by the Institutional Review Board at the University of Michigan, Ann Arbor.

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There is no individually identifiable data in this manuscript. All HRS participants consented to study participation and to use their data and samples for additional analysis.

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Vivek, S., Nelson, H.H., Prizment, A.E. et al. Cross sectional association between cytomegalovirus seropositivity, inflammation and cognitive impairment in elderly cancer survivors. Cancer Causes Control (2021).

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  • CMV seropositivity
  • Cancer survivor
  • Dementia
  • Inflammation
  • Older adults