The shingles vaccine may reduce the risk of dementia
economist.com
economist.com
When the vaccine came out in the UK, they included a hard age cutoff: Above a certain age, you weren't eligible. Below that age, you were eligible.
They looked at the probability of a dementia diagnosis over the 7 years after the vaccine was introduced.
People who were born in the "can get the vaccine" group have markedly lower rates of dementia. People in the "too old" group have higher rates. It's cut and dry. The researchers didn't separate out the people who actually got the vaccine.
It's one of those studies where you don't even need to look at the p-value to see the difference between the cohorts.
But I wonder if that's just a statistical artifact. The overall trend looks the same in both groups if you ignore a couple points (ages) on either side of introducing the vaccine.
A single line appears to fit all the points well, except two points on either side of the divide.
Both the scatter plot and also the probability graph seem to be curving upwards w.r.t age, i.e. the incidence of dementia cases seems to accelerate with age. Which at least makes a lot of intuitive sense, and would forbid just plotting in a regression line.
Having a more or less circumstantial point to arbitrarily cut your regression line in half also just begs for introducing Simpson's Paradox.
My older neighbour also had it a few years ago, but in her case wasn't aware it was shingles, just some rash on her face. Doctors said if they hadn't stopped it within the next few days she'd have lost her sight.
Get the shot. You probably won't need it, but if you do then you'll really need it.
Their P value is 0.02, which is good but certainly not definitive. Also the effect is kind of small, 3.5% reduction in diagnoses.
Sure, I could wait 7 or 8 years until I qualify via insurance, but is that really worth the risk for what is an easily absorbed cost to me? Especially when I have a friend in her late 30s who just went through a very rough bout of shingles?
It makes sense to have targets like age 50 for population-wide public health recommendations. But it can and does infect people of much earlier ages.
Recent articles like this make me think I'll go ahead.
(I don't like this logic and if I had the option of just going to Walgreens and getting vaccinated, I'd do that this afternoon. I'm just saying, there's a logic to it.)
I tried to go private (also not 50), but everyone just refused. Pharmacy, GP, private GP.
Currently I'm arranging it in the third country because WTAF.
(UK becoming the dirtiest and sickest country of Europe one more time)
Big Yawn
> [1] Of the reported 22,289 bathing waters across Europe (EU-27, Albania and Switzerland) in 2025, 84% were rated excellent quality. This share reached 85% at the EU level.
[1] https://www.eea.europa.eu/en/analysis/publications/european-...
> [2] In 2025, 297 bathing waters in England (66.1 per cent) met the Excellent standard
Note the sharply increasing amount of "Poor" waters.
And that's despite the methodology allowing to presence of untreated sewage and human faeces in the "excellent" waters: https://www.theferret.scot/scottish-beaches-excellent-pollut...
[2] https://www.gov.uk/government/statistics/bathing-water-quali...
With treatment waiting times, dental treatment availability and deaths while waiting for the ambulance I don't think I need to get into gory details.
Of course I got shingles when I was 64. Caught early and got anti-virals and had no lasting effects.
I'm glad you didn't have any lasting effects.
But if I couldn't I could still go to Mexico and buy brand name Shingrix.
¹ The vaccine strain tends to be much more mild than the wild strain, and indeed it was quite unpleasant, but not extremely painful for me. The wild strain is considerably more painful and linked to a greater incidence rate of complications. Please do not skip chickenpox vaccinations for your kids, the minor risk of latent infection from attenuated vaccine is far less harmful than the consequences of not vaccinating. Most important of all, if you have a cluster of blisters or rash on one side of your body that keep popping up, make sure to see a doctor and get on antivirals within the first 72 hours for best results.
Stress and sleep deprivation are known triggers for the virus, which lies dormant in the nervous system for life after initial infection, and can be dormant for decades at a time between reactivations.
It is the memory B cells that produce them that last years.
https://en.wikipedia.org/wiki/Memory_B_cell
https://www.quora.com/What-is-the-lifespan-of-an-antibody-in...
I know people who've had shingles and it is not only a major PITA but can be life-threatening, can blind you, etc., just bad stuff. Don't delay taking advised precautions, including injections.
And you can absolutely get Shingles before 50 (in some cases)
I think the age 50 target is dated. With reduced childhood incidence of chicken pox, we're all exposed to varicella zoster less, and it seems like the ages of incidence of shingles is falling. Public health recommendations are slow to catch up with research (especially for vaccinations, these days).
People (well, Americans and Canadians at least) in their 40s now generally didn't get vaccinated as children, as their parents didn't have the option. It will be different for the next generation.
https://www.gov.uk/government/news/free-chickenpox-vaccinati...
My research at the time led me to the same conclusion: Since we've basically eradicated chickenpox, we're not exposed to the varicella zoster virus as much as previous generations (via children that have chickenpox). Without exposure our antibodies / resistance fade out.
Since we had chickenpox, the virus is already in us and dormant. When it wakes up and decides to do its thing, our bodies have forgotten how to fight it effectively compared to previous generations - and as a result, the incidence of shingles is increasing in younger populations compared to previous generations.
My doctor said vaccination for under 50 is only indicated after multiple occurrences of shingles... so here's to hoping I'm good til the guidelines change.
I had shingles in my 30s. It was the sickest I've ever been.
We even have anabolic steroids that were approved for muscle wasting in cancer patients, but if you can find a doctor willing to write the prescription and a pharmacy that won’t question it, anyone can have pharmacy grade Anavar for the gym, completely legal. In theory the doctor writing the prescription is putting their license at risk, but enforcement is so lax that there are “anti-aging” clinics all over that will prescribe testosterone and Anavar to anyone with a credit card.
So with a documented history of shingles you should have no problem getting a prescription written. It would be worth a quick check with your insurance company because it might even be covered if your doctor will fill out the form and attach evidence of the past diagnosis.
Is that not usually true in other countries?
A doctor must sign off on these but that step is mostly performative outside of some narrow exceptions. My impression is that this type of medical care is much more accessible in the US than most other developed countries.
Some countries are even more open. You can walk up to pharmacies in some countries and ask for most medications without a prescription. Up until 10-20 years ago you could walk into pharmacies in some countries and get abusable drugs, too, but that became enough of a problem that they cracked down on it.
The unique thing about the US is that we have access to almost everything first, and you can find a doctor willing to prescribe it to you if you look hard enough. In many other countries doctors don't want to stray far from the government prescribing guidelines. You may also not be allowed certain treatments unless your doctor can prove you meet the government requirements.
In the US, the enforcement is on the backend, if at all. There have been many cases of doctors getting the bright idea of turning their prescription pad into a money printer and writing prescriptions for scheduled medications to anyone willing to pay cash. Some of them make millions before the DEA catches up and goes after them. The smarter ones have moved into spaces where the enforcement brings less attention. Prescribing opioids is out, but I can't even turn on the radio without getting ads for doctors who will write me a prescription for testosterone to "get an edge in the gym".
Medications are different. Need prescription for that, although $$ and a zoom call can solve that problem.
Usually just most, except some in your organs where your immune response is different, out of necessity.
Then, if your immune functionality drops below a certain threshold that they can replicate inhibited, and leave the fort, you’re dealing with a systemic infection again.
It's stupid too, because the question I answered "wrong" wasn't clear. It basically sounded like they were asking me if I currently had a cold or covid.
https://www.cdc.gov/shingles/hcp/vaccine-considerations/inde...
I tell me patients this to increase uptake, so we can reduce alzheimer's prevalence.
(I'm a doctor)
To be clear, I would get those vaccines regardless for their stated effectiveness, it just feels like so many observational conclusions ("moderate red wine is good for you!") have been proven to be non-causitive correlations when examined more closely.
Edit: Actually, the youtube link posted above talks about tons of vaccines where observational studies show reduced Alzheimer's risk: https://youtu.be/qlTnnQytOJ0?t=340
They also activate the immune system in generaly, which could probably go either way in terms of longevity.
In general I don't think vaccines are preventing so much as delaying dementia, but if they stop chronic infection they might be.
edit: Sorry this is the follow up study but the 40% study is linked within
I was vaccinated in the early 70s when it was a single dose. With measles in the news recently, I asked my doc to add a measles antibodies test to my blood draw. Came back negative. No immunity. I went to the local pharmacy and got an MMR booster the next day.
https://www.health.harvard.edu/diseases-and-conditions/some-...
If you're not sure, get tested. It's a simple blood draw.
But I am with you. My personal bet is we'll know more about this by the time that becomes an issue.
The earliest cohorts of vaccinated children are approaching their 30s, so we should learn about long term efficacy this decade.
Vaccines don't really last in your system more than a few days (although some cells get dragged off to the lymph nodes and get harshly interrogated for longer than that). It is the T-cell and B-cell responses that are persistent for years.
> and that subsequent doses may be less effective
They should activate B cells that you already have and produce high-affinity mature antibodies.
https://youtu.be/qlTnnQytOJ0?is=XJ0c5pWVV6Lg0IMs
As per one of the slides around 7 minutes in, there are many vaccines that show a 20-40% reduction in mortality and dementia.
The talk above basically says that “observational studies” may show great results, like the so-called protective action of the shingles vaccine against dementia. However when brought to a well designed RCT all those benefits don’t actually show up. And the speaker shows later on that the shingles vaccines shows a marked benefit for shingles but nothing for dementia.
The study looked at the effect of being eligible for a vaccine and the results were clear. (see chart below the fold here: https://erictopol.substack.com/p/the-shingles-vaccine-and-re...)
There was a hard age cutoff in the UK study. Above a certain age, you weren't eligible. Below it, you were. People who were born in the "can get the vaccine" group have markedly lower rates of dementia. People in the "too old" group have higher rates. It's one of those studies where you don't even need to look at the p-value to see the difference.
I'm very open to being wrong about this!
But in your summary:
> People who were born in the "can get the vaccine" group have markedly lower rates of dementia. People in the "too old" group have higher rates.
I would change "people" to "women". I thought it was very interesting that the benefit of the Shingles vaccine eligibility for Alzheimer's was largely confined to women - men showed no such benefit per the graph in that substack article.
FWIW Eric Topol is an extremely unreliable source. He has “fame” but most of his stories end up being wrong because of his poor analysis like the review above. I subscribed to him during the pandemic when he migrated to substack but ended my subscription after countless bad articles.
The mechanism is that people with the shingles vaccine are less likely to visit the hospital (because they don't get shingles). Because they have fewer hospital visits they are less likely to receive an incidental diagnosis of dementia from a hospital.
There's countless treatments and countless diseases. It is very much worth combing data to find treatments with potential off-label uses, but with that many combinations of treatments and diseases, much more care needs to go into eliminating not just non-causative correlations, but straight-up random correlations that have a very small probability of happening on their own, but are likely to happen in a large enough group of comparisons.
It turns out that "pain management" is more art than science and almost all the pharma options out there come with significant risks and concerns. I ended up turning to kratom to manage the pain, which it does, but it's come at significant cost as well (addiction being one of them). I'm now going to try peptides (ARA-290 and BPC-157) to see if maybe that can help but it's all a crap shoot.
I share this as a warning/advice: get the vaccine if you can, even if insurance resists, push back. It may be worth it out of pocket IMHO. If you can't, remember to get access to antivirals immediately if you can.
I just asked The Goog and it said the answer is effectively "possibly, but nuanced". So you may be right but not completely ;-).
I'd still suggest doing it as its likely to have a positive risk/reward ratio. But better still is to get the vaccine.
Infections generally increase the risk of future dementia. Like the more colds you have throughout life.
"association" undersells it a bit, because the data is better than the typical cohort study, which has issues like "what if people who got the vaccine are also richer and care about their health more?". There's quasi-randomization going on. From the more in depth article that's linked:
>Research is also revealing unexpected interventions that help to keep ageing minds sharp. One of the most promising derives from an analysis by Pascal Geldsetzer of Stanford University and his team of a natural experiment in Wales. In 2013 the British region started offering people aged 70-79 free vaccinations through the public-health system. This change resembled an RCT, in that a large number of people were separated almost at random into two groups: those who had already turned 80 in the weeks before the programme started, and so were not eligible to be jabbed; and those who turned 80 in the weeks after, roughly half of whom were duly vaccinated.
Whoa wait what? This is the first time I’ve heard of this - is this actually common knowledge?
When I learned it, it was in the context of the influenza and similar common viruses.
It's actually more nuanced than that. If you want to read more: https://www.openevidence.com/ask/bccc3cc2-e15d-4fb0-a0c5-16f...
There was a study that showed that people who had severe influenza (they were hospitalized) were 3 times more likely to develop dementia. And there are mouse models that show that frequency respiratory virus infections can increase may contribute to brain aging (in mice).
>someone who worked in daycare and often got sick with the flu or similar, has a higher risk of dementia (statistically-speaking).
I can't find any evidence of this being true. I can find evidence that primary school teachers have lower rates of dementia. Pediatricians also have lower rates of dementia, so I find this highly doubtful.
That’s not “extrapolating some.” That’s just making stuff up.
The study you cited is from Taiwan and merely states that “Physicians who were older, specialized in pediatrics and worked at local hospitals and clinics had a higher prevalence for dementia than their counterparts did.”
“physicians who are older are more likely to have dementia”
But beyond that, pediatricians or doctors who work in hospitals or clinics covers most doctors who aren’t work from home radiologists.
The discussion is very low-yield though, since infections are already a minor point re: dementia, and none of the evidence is conclusive.
>Among physicians, pediatricians seemed to have higher rates.
Not just pediatricians, but physicians that work at hospitals and clinics.
Which is nearly all of them.
I think what you’re dealing with is a low quality, low effort survey study from Taiwan, which was poorly written, so there is no point trying to figure out what they meant.
But looking at the specific data the naive ratio for pediatricians is lower than several other specialities. It was only higher when they adjusted for confounding factors. But the list of confounders was limited by the data available.
In addition they found that for some reason working at a large hospital was protective, but they didn’t adjust for hospital size when comparing specialities. In general pediatricians are less likely to work at large hospitals than the average specialty (wife is a pediatrician).
The result is essentially a cherry picked result that only adjust for some confounders. Add to that only 19 cases of dementia among pediatricians. Then the CI for pedestrians overlaps every other listed speciality. The study is essentially meaningless for your purposes.
Also the paper is actually saying that older doctors are more likely to have dementia than younger doctors, not that doctors develop dementia later than the general population.
Academic and ongoing challenging education results in greater number of connections between nerves. In normal population, as plaque accumulates, it causes loss of transmission and deterioration of nerve connections.
In physicians, because they have more "density" and more pathways in which nerves are connected than the general population, dementias like Alzheimer's show no symptoms until there's even more plaque accumulated, because they can compensate with extra pathways, similar to the study on nuns who showed no signs of alzheimer's at an old age because they kept so active, even though post-mortem they had horrible alzheimer's on biopsy. At the late stage physicians finally manifest the dementia, it's stronger and progresses quicker. It's like "catching it late" for doctors.
But that’s not what the study is saying. It’s literally just saying that older doctors are more likely than younger doctors to have dementia.
Also that study only looks at dementia and Alzheimer’s only accounts for ~2/3 of cases.
It reminds me that we didn't look at vaccine efficacy at the individual level until SARS-CoV-2. People were getting upset that SARS-CoV-2 vaccines only have a moderate chance to stop you getting the virus, and usually lessen its impact if you do get it, and calling this an ineffective vaccine. But the truth is, we have no idea whether every previous vaccine was also like that, because we only ever looked at the population level: when lots of people get the vaccine, the virus dies out.
Because courts of law have recognized covid mRNA injections as therapeutic treatments, they cannot be mandated.
'The plaintiffs alleged that the vaccines do not prevent someone from becoming infected with COVID-19 and characterized it as a treatment rather than a “traditional vaccine.”'
https://calmatters.org/education/2024/06/covid-vaccine-manda...
The reason the case was dismissed was because the requirement was removed.
The case was reopened on appeal due to the rules being temporarily re-established.
Anything else is nonsense. This is spelled out in the article but wrapped with a bunch of whatifs and maybes and possiblies.
If your hypothesis was correct, then NOTHING is a vaccine.
And similar questions about obesity "causing" many diseases, sunburns causing skin cancer (although that sounds somewhat plausible) etc.
(You should very much want to avoid any chance of getting shingles, though; it's a nightmare.)
I did have chicken pox as a kid, but have not had shingles nor the vaccine (yet). A co-worker was laid up for a week after his shingles vaccine, but that's obviously just one data point.
But, I've been considering getting the Shingrix series even if I have to pay for it. I turn 60 this year. Shingles doesn't sound fun.
I also understand that a third of the elderly will have shingles by their 80s if unvaccinated.
Unfortunately the apparent anti-dementia effect of this old vaccine (Zostavax) recently turned out to be a statistical illusion: https://youtube.com/watch?v=qlTnnQytOJ0
It is not clear whether the effect from Shingrix (the new one) is real or not. We currently don't have a case-control study which could prove causation.
I recall seeing a few discussions on HN comments hypothesizing that immune system stimulation via the vaccine might be the root cause. Now that the Amyloid hypothesis is on the wane, hopefully we'll explore other paths.
Oh? What did I miss?
TL;DR A lot of evidence supporting the Amyloid hypothesis is suspect.
Don't get chickenpox.
1. Not getting chickenpox at all. Highly desirable.
2. Getting chickenpox as a kid.
3. Getting chickenpox as an adult.
Sadly it came back positive for antibodies. I was really hoping I had somehow evaded it, and could get the vaccine as an adult.
or third. fifteenth.
We don’t track reinfection well.
We don’t really define infection well (especially in a context where you’re waiting 2-6 weeks for an appointment to get bloodwork ordered, by which point the blood is often irrelevant to the complaint 2-6 weeks prior).
Not in practice, anyway.
It's weird that they kinda gloss over the very real and open questions here, because the idea that the AS01 adjuvant is involved in the dementia protection is very much alive and an ongoing topic. A paper from last year[1] looked into it and found that the Shingrix shingles vaccine and the RSV vaccine are about the same in their risk reduction for dementia (with a bunch of caveats).
I believe the current evidence point to the shingles vaccine helping, but also a protective effect happening from the AS01 adjuvant on its own.
I'm not a researcher but my layman's take is that the Economist whiffed it here, and there's a more interesting and complicated story to be told beyond this clickbait-adjacent science journalism.
The lesson is to be extremely suspicious of findings of causation based on observational studies.
Why couldn't both these factors contribute to the result of the study?
She's seen her Dr and swabs are being processed. She's on antivirals and painkillers and has a nasty fever.
Now I am horrified about how awful it can be, after reading all the comments in here.
Hoowee, it made me sick, but only for a day (twice, as you get a booster, six months later).
Had chickenpox (and measles, at the same time), when I was a kid. That was fun.
My mother used to get recurring bouts of the shingles. Definitely not fun.
You would go round the nation taking samples from every sick person you could find, then inactivate them with radiation, then inject it as a vaccine.
I want folks to get it but - I feel "Just Get It" admonitions carry a vibe that the cost is negligible.
The earlier you start the better.
Injecting people with a shingles vaccine is far easier than the others you listed, which is why it stands out.
This means addressing hearing loss, e.g. via hearing aids.
https://www.psychologytoday.com/us/blog/living-single/202504...
while there are probably lots of accessible "natural" demetia remedies
that you can do without having to resort to experimental drugs that may cause more problems and cost more
Did I do it right?
Edit: I just learned all the dementia patients have undiagnosed shingles. Please ignore my comment now. :-|