The DOI matches its Crossref record.
Herpes Zoster and Dementia: A Nationwide Population-Based Cohort Study
Abstract
OBJECTIVE: Some infectious diseases have been found to be associated with cognitive impairment and dementia. However, the relationship between herpes zoster and dementia has received little attention. This study aimed to investigate this association as well as associations of antiviral treatments for herpes zoster and incident dementia using a large national sample. METHODS: Cases were identified from the Taiwan National Health Insurance Research Database with a new diagnosis of herpes zoster (ICD-9-CM code: 053) between 1997 and 2013. Each identified individual with a case of herpes zoster was compared with 1 sex-, age-, and residence-matched control subject. Both groups were followed until the first diagnosis of dementia (ICD-9-CM codes: 290.0 to 290.4, 294.1, 331.0 to 331.2, and 331.82), withdrawal from the registry, or the end of 2013. Cox regression analyses and competing risk model were applied, adjusting for sex, age, residence, depression, autoimmune disease, ischemic stroke, traumatic brain injury, alcohol use disorder, and antiviral treatments for herpes zoster to evaluate the risk of interest. RESULTS: A total of 39,205 cases with herpes zoster were identified. Of the 78,410 study and comparison subjects, 4,204 were diagnosed as having dementia during a mean (SD) follow-up period of 6.22 (4.05) years. Herpes zoster was associated with a slightly increased risk of dementia in the fully adjusted model (hazard ratio [HR] = 1.11; 95% CI, 1.04-1.17). Prescriptions of antiviral therapy were associated with a reduced risk of developing dementia following the diagnosis of herpes zoster (HR = 0.55; 95% CI, 0.40-0.77). CONCLUSIONS: Herpes zoster was associated with an increased risk of dementia, independent of potential confounding factors. Antiviral treatment might be protective in preventing dementia in patients with herpes zoster.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
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?
In the citing paper
“Studies using electronic health records have found a link between VZV and risk of all-cause dementia, AD, vascular dementia, with antivirals decreasing all-cause dementia risk [23,36–40].”
From What would it take to prove that a chronic infection is a causal agent in Alzheimer’s disease? (2025) · cites this paper as [37]
In the citing paper
“A second study demonstrated a very slight increased risk of developing all-cause dementia after zoster infection (HR 1.12).”
From Alzheimer Disease: An Update on Pathobiology and Treatment Strategies (2019) · cites this paper as Chen et al., 2018
In the citing paper
“Again, a significant decrease in dementia risk was observed in patients that received antiherpetic treatment (HR 0.47) (Chen et al., 2018).”
From Alzheimer Disease: An Update on Pathobiology and Treatment Strategies (2019) · cites this paper as Chen et al., 2018
Citations
Cited by
Sorted by citations
Items 101–151 of 151
Zhu, L., Hu, C., Yu, M., et al. (2024) · Brain and Behavior · doi:10.1002/brb3.3407 · Cited by 7
Herpes Zoster and Risk of Incident Parkinson's Disease in US Veterans: A Matched Cohort Study
Tunnicliffe, L., Weil, R. S., Breuer, J., et al. (2024) · Movement Disorders · doi:10.1002/mds.29701 · Cited by 6
“National studies from Korea on HZ and incident dementia risk show con-fl icting results, 18,19 whereas studies using the Taiwan NHIRD have suggested an association between HZ and both dementia 20,21 and PD. 9,10 Differences in those studies ’ fi ndings may re fl ect differing methodological approaches.”
ResultUntersteiner, H., Wurm, R., Reichardt, B., Goeschl, S., Berger–Sieczkowski, E., König, T., Parvizi, T., Silvaieh, S., & Stögmann, E. (2024) · The Journal of Prevention of Alzheimer s Disease · doi:10.14283/jpad.2024.92 · Cited by 5
Yin, Y., Deng, J., & Liu, J. (2025) · Journal of Alzheimer s Disease · doi:10.1177/13872877251351593 · Cited by 7
“7 Furthermore, elderly people are particularly vulnerable to both dementia and HZ, disproportionally leading to severe health outcomes.”
Could routine vaccinations prevent dementia?
Poynton-Smith, E., Orrell, M., Morley, J., & Scherrer, J. F. (2023) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.5978 · Cited by 3
Anti-herpetic treatment reduces dementia risk: A systematic review and meta-analysis
Chang, S.-T., Wu, H., Chiu, Y., & Chuang, Y. (2025) · Journal of Alzheimer s Disease · doi:10.1177/13872877251409323 · Cited by 5
“Lastly, all studies included assessment of all cause dementia, 13,15,16,20 – 27 with four studies also investigating the association between dementia subtypes such as AD or VaD and anti-herpetic medications.”
InfluentialYang, J., & Jiang, J. (2026) · Journal of Alzheimer s Disease · doi:10.1177/13872877251411573 · Cited by 6
“26 29 However, results from different studies are not entirely consistent, 30 which may be related to differences in study design, population characteristics, treatment regimens, and other factors.”
Zhang, J., Wang, M., Wang, D., Deng, L., & Yao, P. (2025) · Hereditas · doi:10.1186/s41065-024-00358-4 · Cited by 4
Shen, Z., Song, Q., Zhang, G., et al. (2025) · Journal of Medical Virology · doi:10.1002/jmv.70458 · Cited by 4
“The disease burden of deaths from VZVI is higher in the 65 – 95 years age group, which may be linked to the prevalence of chronic diseases in the elderly that increase the severity of infections [24, 25].”
Hospitalization and Socio-Health Care for Dementia in Spain
Llanes-Álvarez, C., de Llano, J. M. A., Álvarez-Navares, A. I., Roncero, C., Pastor-Hidalgo, M. T., Garmendia-Leiza, J. R., Alberola, I. A., & Franco, M. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9123875 · Cited by 4
Herpesvirus initiation of dementias and autoimmune diseases
Roe, K. (2025) · Journal of NeuroVirology · doi:10.1007/s13365-025-01265-8 · Cited by 3
James, L. M., Stratigopoulos, G., & Georgopoulos, A. P. (2025) · Scientific Reports · doi:10.1038/s41598-025-10102-1 · Cited by 5
Varicella zoster virus and the central nervous system
Ogunjimi, B., Warren‐Gash, C., Ouwendijk, W. J. D., Breuer, J., Mogensen, T. H., & Koelle, D. M. (2026) · Nature Reviews Microbiology · doi:10.1038/s41579-026-01289-9 · Cited by 7
Lin, H.-S., Lin, Y., Tsai, Y., Chang, P., & Chi, C. (2024) · Dermatologica Sinica · doi:10.4103/ds.ds-d-24-00055 · Cited by 3
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
Varicella zoster virus infection
Bubak, A. N., Warren‐Gash, C., Tommasi, C., Breuer, J., Mahalingam, R., Srikanth, P., & Nagel, M. A. (2026) · Nature Reviews Disease Primers · doi:10.1038/s41572-026-00735-5 · Cited by 2
Tan, S., Kelty, E. A., Page, A. T., Etherton‐Beer, C., Sanfilippo, F. M., & Almeida, O. P. (2024) · Journal of Alzheimer s Disease · doi:10.3233/jad-240391 · Cited by 2
Dementias Caused by Persistent Pathogens and the Protective Role of HLA Against them
James, L. M., & Georgopoulos, A. P. (2020) · Journal of Neurology and Neuromedicine · doi:10.29245/2572.942x/2019/1.1260 · Cited by 2
Alghamdi, A., Balafas, S. E., Bos, J., Munster, B. C. V., Rafie, K., Dolga, A. M., & Hak, E. (2026) · BMJ Open · doi:10.1136/bmjopen-2025-114033 · Cited by 1
Niemeyer, C. S., Nagel, M. A., Restrepo, D., & Bubak, A. N. (2026) · Journal of Neurovirology · doi:10.1007/s13365-026-01323-9
Herpes simplex virus reactivation and the relationship with Alzheimer's disease: A countering view
Fluegge, K. (2019) · Clinical and Experimental Neuroimmunology · doi:10.1111/cen3.12532 · Cited by 1
“extension to this hypothesis, antiviral therapy has been postulated to reduce dementia risk.(16) Proximate use of oral antivirals in acute Herpes zoster”
BackgroundChen, V. C., Kao, K., Chen, Y., Wu, S., Lee, M., & Gossop, M. (2022) · Frontiers in Medicine · doi:10.3389/fmed.2021.787745 · Cited by 2
Self-citationRasmi, Y., Farnamian, Y., Boras, M. M., İnandıklıoğlu, N., Shirima, C. A., & Jalali, L. (2025) · Future Virology · doi:10.1080/17460794.2025.2480963 · Cited by 1
Herpes Zoster Cerebral Vasculopathy in a Case of Cognitive Decline
Mizoguchi, R. (2019) · Biomedical Journal of Scientific & Technical Research · doi:10.26717/bjstr.2019.20.003390 · Cited by 1
Cellular metabolism changes in bilateral hippocampi in patients with herpes zoster.
Wang, J., Yuan, Y., Liu, H., Zhang, Y., & Yan, Y. (2022) · PubMed Central · Cited by 1
Pain management and stroke prevention in HHV-3-associated infection
Kolokolov, O. V., Bakulev, A. L., Shuldyakov, A. A., Сергеевич, М. Н., Ситкали, И. В., Михайловна, К. А., & Kravchenya, S. S. (2019) · Journal of clinical practice · doi:10.17816/clinpract10274-84
Repurposed Agents in Alzheimer’s Disease Drug Development
Ballard, C. G., & Sultana, J. (2022) · Cambridge University Press eBooks · doi:10.1017/9781108975759.006
Eisen, J. S. (2018) · Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature · doi:10.3410/f.734259403.793552075
Varicella zoster infection as a risk factor for dementia: a scoping review
Mori, Y., Ono, Y., & Shimohata, T. (2025) · Rinsho Shinkeigaku · doi:10.5692/clinicalneurol.cn-002047
Li, Q., Mao, Y., He, Y., Liu, S., Yu, M., Ren, C., & Chen, G. (2025) · Brain Connectivity · doi:10.1177/21580014251362857
“Available evidence suggests that HZ is associated with multiple emotional disorders, such as anxiety, depression, or both, as well as an increased risk of dementia and Parkinson ’ s disease (Chen et al, 2018; Cheng et al., 2020; Denkinger et al., 2014).”
The Relationship Between Dermatologic Diseases and Dementia; A Review
Yıldırım, H. B., & Hocaoğlu, Ç. (2025) · Uludağ Üniversitesi Tıp Fakültesi Dergisi · doi:10.32708/uutfd.1638089
RNA virus and DNA virus initiations of autoimmune diseases and/or dementias
Roe, K. (2025) · Drug Discovery Today · doi:10.1016/j.drudis.2025.104481
Islam, M. M., Foraker, R. E., Hossain, M. S., Arnold, W. D., Dandachi, D., & Mosa, A. S. M. (2026) · JMIR Formative Research · doi:10.2196/83028
Lophatananon, A., Carr, M., McMillan, B., Dobson, C. B., Itzhaki, R. F., Parisi, R., Ashcroft, D. M., & Muir, K. R. (2024) · Figshare · doi:10.6084/m9.figshare.26621926
Lophatananon, A., Carr, M., McMillan, B., Dobson, C. B., Itzhaki, R. F., Parisi, R., Ashcroft, D. M., & Muir, K. R. (2024) · Figshare · doi:10.6084/m9.figshare.26621896
Lophatananon, A., Carr, M., McMillan, B., Dobson, C. B., Itzhaki, R. F., Parisi, R., Ashcroft, D. M., & Muir, K. R. (2024) · Figshare · doi:10.6084/m9.figshare.26621908
Lophatananon, A., Carr, M., McMillan, B., Dobson, C. B., Itzhaki, R. F., Parisi, R., Ashcroft, D. M., & Muir, K. R. (2024) · Figshare · doi:10.6084/m9.figshare.26621893
Lophatananon, A., Carr, M., McMillan, B., Dobson, C. B., Itzhaki, R. F., Parisi, R., Ashcroft, D. M., & Muir, K. R. (2024) · Figshare · doi:10.6084/m9.figshare.26621902
Lophatananon, A., Carr, M., McMillan, B., Dobson, C. B., Itzhaki, R. F., Parisi, R., Ashcroft, D. M., & Muir, K. R. (2024) · Figshare · doi:10.6084/m9.figshare.26621923
Lophatananon, A., Carr, M., McMillan, B., Dobson, C. B., Itzhaki, R. F., Parisi, R., Ashcroft, D. M., & Muir, K. R. (2024) · Figshare · doi:10.6084/m9.figshare.26621920
Lophatananon, A., Carr, M., McMillan, B., Dobson, C. B., Itzhaki, R. F., Parisi, R., Ashcroft, D. M., & Muir, K. R. (2024) · Figshare · doi:10.6084/m9.figshare.26621899
Lophatananon, A., Carr, M., McMillan, B., Dobson, C. B., Itzhaki, R. F., Parisi, R., Ashcroft, D. M., & Muir, K. R. (2024) · Figshare · doi:10.6084/m9.figshare.26621917
Lophatananon, A., Carr, M., McMillan, B., Dobson, C. B., Itzhaki, R. F., Parisi, R., Ashcroft, D. M., & Muir, K. R. (2024) · Figshare · doi:10.6084/m9.figshare.26621905
Lophatananon, A., Carr, M., McMillan, B., Dobson, C. B., Itzhaki, R. F., Parisi, R., Ashcroft, D. M., & Muir, K. R. (2024) · Figshare · doi:10.6084/m9.figshare.26621911
Lophatananon, A., Carr, M., McMillan, B., Dobson, C. B., Itzhaki, R. F., Parisi, R., Ashcroft, D. M., & Muir, K. R. (2024) · Figshare · doi:10.6084/m9.figshare.26621914
Qin, J., Xu, X., & Zou, Y. (2026) · Journal of Alzheimer s Disease · doi:10.1177/13872877261438524
“Large registry cohorts have begun to examine antiviral treatment and dementia endpoints, 8,9 and similar infrastructures could be used to evaluate pragmatic care pathways at scale.”
Linard, M. (2021) · theses.fr (ABES) · doi:10.70675/792b3731z2670z4aedza18ezcd3259857759
Herpes zóster, vacunación y riesgo de demencia: una oportunidad inesperada para la Atención Primaria
Montero, A. A., & Barra, M. P. M. (2026) · Medicina de Familia SEMERGEN · doi:10.1016/j.semerg.2026.102758
Zheng, B., Cao, W., Zhang, L., et al. (2026) · BMC Public Health · doi:10.1186/s12889-026-28485-9
The importance of varicella-zoster virus reactivation in adult central nervous system diseases
Yoshikawa, T. (2026) · Rinsho Shinkeigaku · doi:10.5692/clinicalneurol.cn-002290
Metadata
- Authors
- Chen, V. C.-H., Wu, S.-I., Huang, K.-Y., Yang, Y.-H., Kuo, T.-Y., Liang, H.-Y., Huang, K.-L., & Gossop, M.
- Affiliations
- Chang Gung University (TW)
- Mackay Memorial Hospital (TW)
- Ministry of Health and Welfare (TW)
- National Taiwan University (TW)
- Chang Gung Memorial Hospital (TW)
- King's College London (GB)
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2018-02-21
- Volume
- 79
- Issue
- 1
- Pages
- 16m11312
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W2773840635
- Cited by
- 142
- References
- 0
- Citations by year
- 2026: 14 · 2025: 16 · 2024: 20 · 2023: 13 · 2022: 20 · 2021: 21 · 2020: 21 · 2019: 14 · 2018: 3
- FWCI
- 8.14
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Herpesvirus Infections and Treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Epidemiology › Cytomegalovirus and herpesvirus research
- Keywords
- herpes zoster, dementia, antiviral therapy, cognitive impairment, dementia risk, neurodegeneration
- MeSH terms
- Age Factors, Aged, Aged, 80 and over, Antiviral Agents, Dementia, Female, Herpes Zoster, Humans, Male, Middle Aged, Retrospective Studies, Risk Factors, Sex Factors, Taiwan, Cohort Studies, Comorbidity, Incidence, Proportional Hazards Models, Case-Control Studies
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
