PDF(Pubmed)
Abstract：
BACKGROUND: Herpes zoster (HZ), commonly known as \"shingles,\" may contribute to cognitive decline through mechanisms such as neuroinflammation or direct neuronal injury. However, evidence on the longitudinal association between HZ and cognitive decline is conflicting and whether the risk differs by APOE ε4-carrier status has not been studied; prospective cohort studies on the association between HZ vaccination and cognitive decline are also lacking.
METHODS: We included 149,327 participants from three large cohorts-the Nurses\' Health Study (NHS), NHSII, and Health Professionals Follow-Up Study (HPFS)-to prospectively examine the association between HZ and subsequent subjective cognitive decline (SCD). Poisson regression was used to estimate the multivariable-adjusted relative risk (MVRR) of a 3-unit increment in SCD score according to years since HZ compared with participants with no history of HZ.
RESULTS: Compared with individuals with no history of HZ, the MVRR (95% CI) of a 3-unit increment in SCD score was significantly and independently higher among individuals with a history of HZ, but the duration of time since HZ when the elevated risk of SCD was statistically significant differed among the cohorts. In NHS, HZ was associated with higher long-term risk of SCD; compared with individuals with no history of HZ, the MVRR (95% CI) of a 3-unit increment in SCD score was 1.14 (1.01, 1.32) for ≥ 13 years since HZ. In NHS II, HZ was associated with higher risk of SCD in both the short-term [MVRR 1.34 (1.18, 1.53) for 1-4 years] and long-term [MVRR 1.20 (1.08, 1.34) for ≥ 13 years since HZ]. In HPFS, an elevated risk of SCD was suggested across all time points. Among the subset of participants with information on APOE ε4, there was a suggestion that the association differed by APOE ε4 carrier status, but the results were not consistent between women and men. Among the subset of women with information on HZ vaccination, there was a suggestion that the long-term risk of SCD may be greater among women who were not vaccinated against HZ.
CONCLUSIONS: Data from three large independent cohorts of women and men showed that HZ was associated with higher long-term risk of SCD, and the risk may differ by APOE ε4-carrier status.
METHODS: We included 149,327 participants from three large cohorts-the Nurses\' Health Study (NHS), NHSII, and Health Professionals Follow-Up Study (HPFS)-to prospectively examine the association between HZ and subsequent subjective cognitive decline (SCD). Poisson regression was used to estimate the multivariable-adjusted relative risk (MVRR) of a 3-unit increment in SCD score according to years since HZ compared with participants with no history of HZ.
RESULTS: Compared with individuals with no history of HZ, the MVRR (95% CI) of a 3-unit increment in SCD score was significantly and independently higher among individuals with a history of HZ, but the duration of time since HZ when the elevated risk of SCD was statistically significant differed among the cohorts. In NHS, HZ was associated with higher long-term risk of SCD; compared with individuals with no history of HZ, the MVRR (95% CI) of a 3-unit increment in SCD score was 1.14 (1.01, 1.32) for ≥ 13 years since HZ. In NHS II, HZ was associated with higher risk of SCD in both the short-term [MVRR 1.34 (1.18, 1.53) for 1-4 years] and long-term [MVRR 1.20 (1.08, 1.34) for ≥ 13 years since HZ]. In HPFS, an elevated risk of SCD was suggested across all time points. Among the subset of participants with information on APOE ε4, there was a suggestion that the association differed by APOE ε4 carrier status, but the results were not consistent between women and men. Among the subset of women with information on HZ vaccination, there was a suggestion that the long-term risk of SCD may be greater among women who were not vaccinated against HZ.
CONCLUSIONS: Data from three large independent cohorts of women and men showed that HZ was associated with higher long-term risk of SCD, and the risk may differ by APOE ε4-carrier status.
摘要：
背景：带状疱疹（HZ），俗称“带状疱疹”，“可能通过神经炎症或直接神经元损伤等机制导致认知下降。然而,关于HZ与认知减退之间的纵向关联的证据是相互矛盾的,并且尚未研究APOEε4携带者状态的风险是否不同;也缺乏关于HZ疫苗接种与认知减退之间关联的前瞻性队列研究.
方法：我们包括来自三个大型队列的149,327名参与者-护士健康研究（NHS），NHSII,和健康专业人员随访研究（HPFS）-前瞻性检查HZ与随后的主观认知能力下降（SCD）之间的关系。使用泊松回归来估计自HZ以来与没有HZ病史的参与者相比，SCD评分增加3个单位的多变量调整相对风险（MVRR）。
结果：与没有HZ病史的个体相比，在有HZ病史的个体中，SCD评分增加3个单位的MVRR(95%CI)显著且独立地更高，但是自HZ以来SCD风险升高的持续时间在队列中具有统计学意义。在NHS中，HZ与SCD的长期风险较高相关；与没有HZ病史的个体相比，自HZ以来≥13年,SCD评分增加3个单位的MVRR(95%CI)为1.14(1.01,1.32).在NHSII中，HZ在短期[MVRR1.34(1.18,1.53)持续1-4年]和长期[MVRR1.20(1.08,1.34)持续≥13年]均与较高的SCD风险相关。在HPFS中，所有时间点均提示SCD风险升高.在具有APOEε4信息的参与者子集中，有一个建议是，该关联因APOEε4携带者身份而异，但结果男女不一致.在有HZ疫苗接种信息的女性中，有一项研究表明,在未接种HZ疫苗的女性中,SCD的长期风险可能更大.
结论：来自三个独立的女性和男性大型队列的数据表明，HZ与SCD的长期风险较高有关，并且风险可能因APOEε4承运人状态而异。
方法：我们包括来自三个大型队列的149,327名参与者-护士健康研究（NHS），NHSII,和健康专业人员随访研究（HPFS）-前瞻性检查HZ与随后的主观认知能力下降（SCD）之间的关系。使用泊松回归来估计自HZ以来与没有HZ病史的参与者相比，SCD评分增加3个单位的多变量调整相对风险（MVRR）。
结果：与没有HZ病史的个体相比，在有HZ病史的个体中，SCD评分增加3个单位的MVRR(95%CI)显著且独立地更高，但是自HZ以来SCD风险升高的持续时间在队列中具有统计学意义。在NHS中，HZ与SCD的长期风险较高相关；与没有HZ病史的个体相比，自HZ以来≥13年,SCD评分增加3个单位的MVRR(95%CI)为1.14(1.01,1.32).在NHSII中，HZ在短期[MVRR1.34(1.18,1.53)持续1-4年]和长期[MVRR1.20(1.08,1.34)持续≥13年]均与较高的SCD风险相关。在HPFS中，所有时间点均提示SCD风险升高.在具有APOEε4信息的参与者子集中，有一个建议是，该关联因APOEε4携带者身份而异，但结果男女不一致.在有HZ疫苗接种信息的女性中，有一项研究表明,在未接种HZ疫苗的女性中,SCD的长期风险可能更大.
结论：来自三个独立的女性和男性大型队列的数据表明，HZ与SCD的长期风险较高有关，并且风险可能因APOEε4承运人状态而异。
