Infectious burden and cognitive decline in the northern Manhattan study
Open accessAbstract
OBJECTIVES: To determine whether infectious burden (IB) is associated with worse performance and decline on a battery of neuropsychological tests. DESIGN: Prospective cohort study (Northern Manhattan Study (NOMAS)). SETTING: Community. PARTICIPANTS: A subsample of 588 stroke-free NOMAS participants with IB and cognitive data (mean age 71 ± 8, 62% female, 14% white, 16% black, 70% Hispanic) and 419 with repeat cognitive testing. MEASUREMENTS: Samples used for IB data were collected at baseline. Two waves of neurocognitive assessments occurred during follow-up. Participants underwent a neuropsychological battery and had repeated testing (mean time span 6 ± 2 years). Using factor analysis-derived domain-specific Z scores for language, memory, executive function, and processing speed, associations between a quantitative stroke risk-weighted IB index (IBI), based on five common infections (Chlamydia pneumoniae, Helicobacter pylori, cytomegalovirus, herpes simplex viruses 1 and 2), and cognitive performance and decline in each domain was examined. RESULTS: Adjusting for demographic characteristics, socioeconomic status, crystallized cognitive abilities, and vascular risk factors, the IBI was inversely associated with executive function at baseline (beta = -0.10, P = .01) but not with baseline language, memory, or processing speed performance in adjusted analyses. The IBI was associated with cognitive decline in the memory domain, adjusting for demographic and vascular risk factors (P = .02). CONCLUSION: A quantitative stroke risk-weighted measure of IB explained variability in baseline executive function performance and associated with decline in memory. Past exposure to common infections may contribute to vascular cognitive impairment and warrants further study.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
A higher infectious burden of five infections, including CMV, was related to worse executive function at baseline and cognitive decline in memory.
“Among stroke-free participants with repeated cognitive testing on a subset, a higher infectious burden of five infections, including CMV, was related to worse executive function at baseline and cognitive decline in memory [58].”
From What would it take to prove that a chronic infection is a causal agent in Alzheimer’s disease? (2025) · cites this paper as [58]
In a large multi-ethnic cohort, an elevated infectious burden, defined as a composite serologic measure of exposure to five specific common pathogens, was associated with cognitive impairment as assessed by the mini-mental state examination.
“In a large multi-ethnic cohort, an elevated infectious burden, defined as a composite serologic measure of exposure to five specific common pathogens (e.g. cytomegalovirus, Helicobacter pylori and herpes simplex virus), was associated with cognitive impairment as assessed by the mini-mental state examination (461, 462).”
From Signalling cognition: The gut microbiota and hypothalamic-pituitary-adrenal axis (2023) · cites this paper as [462]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Silent Brain Infarcts and White Matter Lesions Increase Stroke Risk in the General Population
Vermeer, S. E., Hollander, M., van Dijk, E. J., Albert Hofman, D., Koudstaal, P. J., & Breteler, M. M. B. (2003) · Stroke · doi:10.1161/01.str.0000068408.82115.d2 · Cited by 883 · see citing works
The Protective Effect of Moderate Alcohol Consumption on Ischemic Stroke
Sacco, R. (1999) · JAMA · doi:10.1001/jama.281.1.53 · Cited by 525 · see citing works
Self-citationIdentification and localization of Chlamydia pneumoniae in the Alzheimer's brain
Balin, B. J., Gérard, H. C., Arking, E. J., Appelt, D. M., Branigan, P. J., Abrams, J. T., Whittum-Hudson, J. A., & Hudson, A. P. (1998) · Medical Microbiology and Immunology · doi:10.1007/s004300050071 · Cited by 506 · see citing works
Duff, K. (2012) · Archives of Clinical Neuropsychology · doi:10.1093/arclin/acr120 · Cited by 452 · see citing works
Letenneur, L., Pérès, K., Fleury, H., Garrigue, I., Barberger-Gateau, P., Helmer, C., Orgogozo, J.-M., Gauthier, S., & Dartigues, J.-F. (2008) · PLoS ONE · doi:10.1371/journal.pone.0003637 · Cited by 252 · see citing works
del Ser, T., González-Montalvo, J. I., Martı́nez-Espinosa, S., Delgado-Villapalos, C., & Bermejo, F. (1997) · Brain and Cognition · doi:10.1006/brcg.1997.0877 · Cited by 242 · see citing works
Cardiovascular risk factors and Alzheimer’s disease
Luchsinger, J. A., & Mayeux, R. P. (2004) · Current Atherosclerosis Reports · doi:10.1007/s11883-004-0056-z · Cited by 238 · see citing works
Relationship between Helicobacter pylori infection and Alzheimer disease
Kountouras, J., Tsolaki, M., Gavalas, E., Boziki, M. K., Zavos, C., Karatzoglou, P., Chatzopoulos, D., & Venizelos, I. (2006) · Neurology · doi:10.1212/01.wnl.0000203644.68059.5f · Cited by 221 · see citing works
Race and ethnic standards for Federal statistics and administrative reporting.
Kk, W., & Hodgdon, J. A. (1977) · PubMed · Cited by 220 · see citing works
The Influence of Latent Viral Infection on Rate of Cognitive Decline over 4 Years
Aiello, A. E., Haan, M. N., Blythe, L., Moore, K., Gonzalez, J. M., & Jagust, W. (2006) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2006.00796.x · Cited by 210 · see citing works
Homocysteine and the Risk of Ischemic Stroke in a Triethnic Cohort
Sacco, R. L., Anand, K., Lee, H. S., Boden-Albala, B. M., Stabler, S. P., Allen, R. H., & Paik, M. C. (2004) · Stroke · doi:10.1161/01.str.0000142374.33919.92 · Cited by 210 · see citing works
Self-citationTotal Homocysteine Is Associated With White Matter Hyperintensity Volume
Wright, C. B., Paik, M. C., Brown, T. R., Stabler, S. P., Allen, R. H., Sacco, R. L., & DeCarli, C. S. (2005) · Stroke · doi:10.1161/01.str.0000165923.02318.22 · Cited by 190 · see citing works
Self-citationInfectious Burden and Risk of Stroke
Elkind, M. S. V. (2009) · Archives of Neurology · doi:10.1001/archneurol.2009.271 · Cited by 177 · see citing works
Self-citationChlamydia pneumoniae and the Risk of First Ischemic Stroke
Elkind, M. S. V., Lin, I., Grayston, J. T., & Sacco, R. L. (2000) · Stroke · doi:10.1161/01.str.31.7.1521 · Cited by 165 · see citing works
Self-citationImmunohistological detection of Chlamydia pneumoniae in the Alzheimer's disease brain
Hammond, C. J., Hallock, L. R., Howanski, R. J., Appelt, D. M., Little, C. S., & Balin, B. J. (2010) · BMC Neuroscience · doi:10.1186/1471-2202-11-121 · Cited by 156 · see citing works
Infectious burden and cognitive function: The Northern Manhattan Study
Katan, M., Moon, Y. P., Paik, M. C., Sacco, R. L., Wright, C. B., & Elkind, M. S. V. (2013) · Neurology · doi:10.1212/wnl.0b013e3182896e79 · Cited by 141 · see citing works
Self-citationStrandberg, T. E., Pitkälä, K. H., Linnavuori, K. H., & Tilvis, R. S. (2003) · Stroke · doi:10.1161/01.str.0000086754.32238.da · Cited by 134 · see citing works
Physical activity and risk of ischemic stroke in the Northern Manhattan Study
Willey, J. Z., Moon, Y. P., Paik, M. C., Boden-Albala, B., Sacco, R. L., & Elkind, M. S. V. (2009) · Neurology · doi:10.1212/wnl.0b013e3181c34b58 · Cited by 122 · see citing works
Self-citationPHYSICAL ACTIVITY AND RISK OF ISCHEMIC STROKE IN THE NORTHERN MANHATTAN STUDY
Landau, W. M. (2010) · Neurology · doi:10.1212/wnl.0b013e3181e03150 · Cited by 110 · see citing works
Infectious Burden and Carotid Plaque Thickness
Elkind, M. S. V., Luna, J. M., Moon, Y. P., Boden-Albala, B. M., Liu, K. M., Spitalnik, S. L., Rundek, T., Sacco, R. L., & Paik, M. C. (2010) · Stroke · doi:10.1161/strokeaha.109.571299 · Cited by 89 · see citing works
Self-citationCytomegalovirus Is Present in a Very High Proportion of Brains from Vascular Dementia Patients
Lin, W., Wozniak, M. A., Wilcock, G. K., & Itzhaki, R. F. (2002) · Neurobiology of Disease · doi:10.1006/nbdi.2001.0465 · Cited by 72 · see citing works
Seropositivity to Chlamydia pneumoniae Is Associated With Risk of First Ischemic Stroke
Elkind, M. S. V., Tondella, M. L., Feikin, D. R., Fields, B. S., Homma, S., & Tullio, M. R. D. (2006) · Stroke · doi:10.1161/01.str.0000202624.89869.e9 · Cited by 71 · see citing works
Self-citationDoes Helicobacter pylori Infection Increase Incidence of Dementia? The Personnes Agées QUID Study
Baudron, C. R., Letenneur, L., Langlais, A., Buissonnière, A., Mégraud, F., Dartigues, J., Salles, N., & Study, F. T. P. A. Q. (2012) · Journal of the American Geriatrics Society · doi:10.1111/jgs.12065 · Cited by 66 · see citing works
Lipids and carotid plaque in the Northern Manhattan Study (NOMAS)
Gardener, H. E., Della‐Morte, D., Elkind, M. S. V., Sacco, R. L., & Rundek, T. (2009) · BMC Cardiovascular Disorders · doi:10.1186/1471-2261-9-55 · Cited by 61 · see citing works
Self-citationRichards, S. S., Emsley, C. L., Roberts, J., Murray, M. D., Hall, K. S., Gao, S., & Hendrie, H. C. (2000) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2000.tb04777.x · Cited by 59 · see citing works
Elkind, M. S. V., Luna, J. M., Coffey, C. S., McClure, L. A., Liu, K. M., Spitalnik, S. L., Paik, M. C., Roldan, A., White, C. L., Hart, R. G., et al. (2010) · International Journal of Stroke · doi:10.1111/j.1747-4949.2010.00420.x · Cited by 52 · see citing works
Self-citationMarquine, M. J., Attix, D. K., Goldstein, L. B., Samsa, G. P., Payne, M. E., Chelune, G. J., & Steffens, D. C. (2010) · Stroke · doi:10.1161/strokeaha.110.587717 · Cited by 44 · see citing works
Transfer across Form and Modality in Implicit and Explicit Memory
Berry, D. C., Banbury, S. P., & Henry, L. A. (1997) · The Quarterly Journal of Experimental Psychology Section A · doi:10.1080/713755685 · Cited by 44 · see citing works
Kargman, D. E., Sacco, R. L., Boden-Albala, B. M., Paik, M. C., Hauser, W. A., & Shea, S. (1999) · Neuroepidemiology · doi:10.1159/000026209 · Cited by 42 · see citing works
Self-citationItzhaki, R. F., & Wozniak, M. A. (2010) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2009.07.136 · Cited by 25 · see citing works
Siedlecki, K. L., Rundek, T., Elkind, M. S. V., Sacco, R. L., Stern, Y., & Wright, C. B. (2011) · Journal of the International Neuropsychological Society · doi:10.1017/s135561771100155x · Cited by 14 · see citing works
Self-citationInfectious Burden and its Role in Cerebrovascular Disease and Cognitive Impairment
Mira, K., & Elkind, M. S. V. (2013) · Future Virology · doi:10.2217/fvl.13.74 · Cited by 6 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Stroke risk factors, genetics, and prevention
Boehme, A. K., Esenwa, C., & Elkind, M. S. V. (2017) · Circulation Research · doi:10.1161/circresaha.116.308398 · Cited by 1,952 · see citing works
Self-citationSignalling cognition: The gut microbiota and hypothalamic-pituitary-adrenal axis
Rusch, J. A., Layden, B. T., & Dugas, L. R. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1130689 · Cited by 415 · see citing works
<i>Helicobacter pylori</i> and Extragastric Diseases
Franceschi, F., Tortora, A., Gasbarrini, G., & Gasbarrini, A. (2014) · Helicobacter · doi:10.1111/hel.12159 · Cited by 173 · see citing works
Warren‐Gash, C., Cadogan, S. L., Nicholas, J. M., Breuer, J. M., Shah, D., Pearce, N., Shiekh, S., Smeeth, L., Farlow, M. R., Mori, H., et al. (2022) · Annals of Clinical and Translational Neurology · doi:10.1002/acn3.51669 · Cited by 11 · see citing works
What would it take to prove that a chronic infection is a causal agent in Alzheimer’s disease?
Brutkiewicz, R. R., Cao, W., Morgan, D., Reis, R. S. D., Suryadevara, V., Willette, A. A., Willette, S. A., Wyatt-Johnson, S. K., & Duggan, M. R. (2025) · Trends in Neurosciences · doi:10.1016/j.tins.2025.05.009 · Cited by 3 · see citing works
- Authors
- Wright, C. B., Gardener, H., Dong, C., Yoshita, M., DeCarli, C., Sacco, R. L., Stern, Y., & Elkind, M. S. V.
- Affiliations
- University of Miami (US)
- National Hospital Organization Hokuriku Hospital (JP)
- University of California Davis Medical Center (US)
- Columbia University Irving Medical Center (US)
- Corresponding author
- Wright, Clinton B.
- ORCID
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2015-08
- Volume
- 63
- Issue
- 8
- Pages
- 1540-1545
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- PMC
- PMC4878014
- OpenAlex
- W2100571939
- Cited by
- 52
- References
- 32
- Citations by year
- 2026: 8 · 2025: 4 · 2024: 1 · 2023: 4 · 2022: 4 · 2021: 7 · 2020: 4 · 2019: 9 · 2018: 3 · 2017: 4 · 2016: 1 · 2015: 2 · 2014: 1
- FWCI
- 2.69
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Columbia Academic Commons (Columbia University)
- Funders
- National Institutes of Health (R01 HL 108623, R37 NS 29998)
- National Institute of Neurological Disorders and Stroke (R37 NS 29993, R01 NS 48134)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Life Sciences › Immunology and Microbiology › Virology › HIV Research and Treatment
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Cognitive Abilities and Testing
- Keywords
- infectious burden, cognitive decline, vascular cognitive impairment, executive function, memory, Chlamydia pneumoniae, Helicobacter pylori, cytomegalovirus, herpes simplex virus, stroke risk, older adults, Northern Manhattan Study
- MeSH terms
- Adult, Aged, Cognition, Cognition Disorders, Female, Follow-Up Studies, Humans, Infections, Male, Memory, Mental Status Schedule, Middle Aged, Neuropsychological Tests, New York City, Prognosis, Prospective Studies, Risk Factors, Urban Population, Cost of Illness, Stroke, Executive Function
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
