If these findings are confirmed, ‘this would be groundbreaking,’ an expert said
The shingles vaccine was not designed or optimized to prevent dementia, so the incidental finding that it might lower dementia risk has researchers cautiously optimistic. A common vaccine meant to ward off shingles may be doing something even more extraordinary: protecting the brain.
Earlier this year, researchers reported that the shingles vaccine cuts the risk of developing dementia by 20 percent over a seven-year period. A large follow-up study has found that shingles vaccination may protect against risks at different stages of dementia — including for people already diagnosed. The research, published Dec. 2 in the journal Cell, found that cognitively healthy people who received the vaccine were less likely to develop mild cognitive impairment, an early symptomatic phase before dementia. Crucially, the study suggests that the shingles vaccine — two doses of which are recommended for adults 50 and older or those 19 and older with a weakened immune system — may help people who already have dementia. Those who got the vaccine were almost 30 percent less likely to die of dementia over nine years, suggesting the vaccine may be slowing the progression of the neurodegenerative syndrome. “It appears to be protective along the spectrum or the trajectory of the disease,” said Anupam Jena, a professor of health care policy at Harvard Medical School and a physician at Massachusetts General Hospital who reviewed the paper. There are few effective treatments for dementia and no preventive measures outside lifestyle changes. “These findings are promising because they suggest that something can be done,” said Alberto Ascherio, a professor of epidemiology and nutrition at the Harvard School of Public Health and a professor of medicine at Harvard Medical School. “Obviously, the vaccine was not designed or optimized to prevent dementia, so this is sort of an incidental finding. In some ways, we are being lucky.”If these findings are confirmed, “then this would be groundbreaking for dementia,” said Maxime Taquet, an associate professor at Oxford University who has conducted research into shingles vaccination and dementia risk. “I think there’s no other word for it.”Research has linked common vaccines, including for shingles, to lower dementia risk. For these observational studies, there is a “healthy vaccine bias,” said Ascherio, who wasn’t involved in the study. “People who get vaccines tend to be healthier in general than people who don’t” because they may have different health-related behaviors. Because randomized controlled trials — the gold standard in medical research — aren’t often feasible in the real world, scientists who conducted the research published Tuesday took advantage of a historical quirk in how Wales rolled out its shingles vaccination program in 2013. Only Welsh adults born on or after Sept. 2, 1933, were eligible for the vaccine. Those born right before were ineligible, meaning the public health policy effectively set up a “natural experiment” comparing two near-identical groups of people who either met the vaccine eligibility cutoff or missed it. “The question then is: Where do you start with this vaccine during the disease course? And does it have benefits for those who already have the condition?” said Pascal Geldsetzer, an assistant professor of medicine at the Stanford University School of Medicine and a senior author of the research. The vaccine was not only associated with a 20 percent reduction of dementia diagnoses, but also a 3.1 percent reduction in diagnoses of mild cognitive impairment over nine years. “It suggests that from a clinical public health perspective, we should be providing this potentially at early stages, maybe on a regular basis,” Geldsetzer said. There doesn’t seem to be a time when it’s too late in the disease progression to derive benefits, he added.During the nine-year follow-up period, almost half of the 14,350 individuals who had dementia in the study sample died of dementia, meaning it was recorded as the underlying cause on their death certificate. “Bad dementia can lead you to aspirate and have respiratory arrest,” said Jena, who wasn’t involved in the study. “Bad dementia can lead you to be unable to care for yourself.” The shingles vaccine decreased deaths due to dementia by 29.5 percent. Even when looking at all-cause mortality, the shingles vaccine was associated with a 22.7 percent reduction. These results “suggest that there is a slowing of this degenerative process,” which seems to be “striking good luck that the vaccine designed for something else would slow a degenerative process,” Ascherio said. The magnitude of the effects is “almost too good to be true,” said Taquet, who wasn’t involved in the study. “If those effect sizes really pan out in randomized control trials, then this would be perhaps one of the best treatments we’ve had for dementia in a while, which is the reason why we need to be quite cautious with interpretation,” he said. “That’s why we need the randomized control trials, but I think they really provide the strongest possible push for randomized control trials.”For one, the study looked at the older shingles vaccine using a weakened version of the live varicella-zoster herpes virus. That vaccine has been discontinued in the United States, as well as in the European Union and Australia, and has been replaced with the Shingrix vaccine, which is more effective at preventing shingles and may also be associated with a lower risk of dementia. However, it’s unknown whether the newer vaccine is also associated with a reduced risk for mild cognitive impairment or death due to dementia, researchers said. Despite its strengths, and its being as close to a randomized controlled trial without being one, the study is still correlational and cannot get at causation. Still, experts unanimously encourage eligible people to get the vaccine, which reduces the reactivation of the varicella-zoster virus. The virus causes chicken pox in childhood and remains dormant in neuron clusters within the spinal cord. When reactivated in adulthood, the varicella-zoster virus manifests as shingles, which is characterized by a burning, painful rash and can sometimes cause lifelong chronic pain conditions or serious complications in a subset of people.San Diego family struggles with all-too-familiar cycle of mental illnessThe Centers for Disease Control and Prevention recommends two doses of a shingles vaccine for adults 50 and older or those 19 and older with a weakened immune system. But uptake has been relatively low: In 2022, 34.4 percent of eligible Americans, including those with weakened immune systems, had received at least one dose of a shingles vaccine in their lifetime. In the meantime, researchers are pushing for randomized controlled trials as well as studies to understand why the vaccine is protective, which can teach us something fundamental about dementia and help develop better treatments. “It’s very important that we understand what it is that we’re targeting, because it might allow us to design even more precise therapies,” said Taquet, who is considering running these studies. Geldsetzer is working to raise money for a randomized controlled trial to directly test the older shingles vaccine on dementia risk, which he said should require less investment because it’s known to be safe and have other benefits. There’s a lot of excitement to work on this from other researchers, he said, but he’s had no luck getting the money. “They’d be thrilled to do this if there’s the funding to do so,” Geldsetzer said. “Just excitement unfortunately is not enough.”San Diego bids farewell to USS Nimitz as ‘coolest’ carrier in the Navy ends 50 years of servicePadres notes: Relievers to stay where they are; A.J. Preller extension talksSan Diego State defensive coordinator Rob Aurich hired by NebraskaExperience discourages use of public transit
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