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If you’ve been hesitating about having a shingles vaccine, new findings that it might reduce your risk of developing dementia by 20% may just swing it for you.
The latest study is based on the health records of 280,000 people aged 70 and over who received a shingles vaccine in Wales after it was introduced in 2013. The research, published in Nature, is being seen as the strongest evidence yet that the vaccine may be protective against dementia.
Shingles is a painful rash caused by the herpes zoster virus, the same virus as chickenpox. It stays dormant in the body but can reactivate decades later.
Half of all cases of shingles occur in people aged 60 or more, and older adults are also at risk of complications such as the painful nerve condition post-herpetic neuralgia.
The shingles vaccine reduces your chances of getting shingles and the likelihood of you having serious complications if you do develop it.
The vaccine is currently recommended for people who turned 65 after 1 September 2023, those aged 70 to 79 plus those over 50 with a severely weakened immune system.
You will be offered two doses of the vaccine between six and 12 months apart.
Researchers from Stanford University in the US analysed the electronic health records of people in Wales who weren’t eligible for the vaccine because they were born before 2 September 1933, and compared them to those who were eligible for the vaccine (born on or after 2 September 1933). The vaccine criteria neatly divided the population into two and allowed doctors to compare dementia rates in people who in some cases were born only weeks apart.
The study found that receiving the herpes zoster vaccine reduced the probability of receiving a new dementia diagnosis by 20% over a seven year follow-up period. The association was stronger in women than in men.
Although the research applied to people given the older shingles vaccine Zostavax – the one previously given by the NHS – research carried out by the University of Oxford, published last year on the newer vaccine Shingrix, found similar results. The Oxford team concluded that having the vaccine was associated with a 17% reduction in developing dementia during a six year follow-up period.
Paul Harrison, professor of psychiatry at Oxford University and one of the authors of the Oxford study, says although neither study establishes cause and effect, the quality of the evidence is strong and accumulating.
“The results are quite impressive, given that by the time you get into your seventies we imagine you’re fairly far into the pathological process that’s going to lead you to being diagnosed with dementia,” says Professor Harrison.
“The question is what is the vaccine doing? The answer is that it is probably slowing down or partially reversing whatever these processes are that are causing so-called pre-clinical dementia when your brain is being affected but you don’t have memory symptoms diagnosed yet.”
Professor Harrison says that are several possible mechanisms for how the vaccine may protect against dementia.
“There’s been evidence for a while that the herpes family of viruses (which cause shingles and chicken pox as well as cold sores) might be one of the factors contributing to dementia. So, if you have a vaccine against reactivation of that virus, it makes sense that if that’s true, that it would slow down or reduce your risk of dementia,” explains Professor Harrison.
“There’s also evidence that other types of vaccine can protect against dementia too, although the shingles vaccines appear to be better at it.
“Also, the newer shingles vaccine works better than the old one. That might be partly because it’s a better vaccine, or it could be due to other ingredients called adjuvants that are added to the vaccine to provoke a stronger immune response in older people.”
“Given that we don’t have anything else beyond lifestyle factors to slow down or reduce the risk of dementia and given that shingles is a horrible disease and can cause complications in some people, I’d say these are good reasons to have the shingles vaccine if it’s offered to you,” he says.
He adds that the shingles vaccine is licensed for all people over 50 and is available privately to buy from pharmacies (£460 for both doses at Boots, £459 at Superdrug).
Professor Harrison points out that the effect of the vaccine is potentially considerably greater than the effects of the new dementia drugs.
“In my opinion everyone should have this vaccine if they are offered it unless they have an allergy to it. This is such an easy thing to do. I’m not aware of anything else you could do in your seventies that would have apparently such a big effect.”
Chris Fox, professor of psychiatry at the University of Exeter and an old age psychiatrist, agrees. “I’d even say people should be having a shingles vaccine in their fifties and even younger.
“I think this is the most exciting thing on the potential pathway for treatment at the moment, because we know that current medications for dementia cost an estimated £50,000 a year. NICE [the government’s drugs advisory body] has not recommended them, and the effect is a modest effect – perhaps a 30% reduction in progression.”
Professor Fox is applying for funding for a trial investigating using another cheaper shingles vaccine and lifestyle measures among people who are at higher risk of dementia or already have some symptoms.
Read our article to find out who is eligible for the shingles vaccine on the NHS.
Fourteen modifiable lifestyle factors were identified by the Lancet Commission on Dementia Prevention in 2024 that may reduce the risk of developing dementia. These are:
Addressing all 14 could reduce all future dementia cases by 45%.
Katie Puckering, information manager at the charity Alzheimer’s Research UK, says: “There are three main pillars in terms of lifestyle prevention for dementia. The first is love your heart – because we know what is good for the heart is also good for the brain. You can do this by checking and treating raised blood pressure and LDL cholesterol and having it monitored, watching your weight, being physically active, limiting alcohol to the recommended limits of no more than 14 units a week, and not smoking.
“The second is to keep connected socially by building social activity into your daily life and the third is keeping your brain sharp – the brain is a hungry muscle and wants to keep learning and being challenged. You can do this through work, or if you are retired through hobbies such as learning a new language, attending a Bridge club or doing puzzles and crosswords.”
“It’s true that blueberries and walnuts are rich sources of polyphenols – really high-quality antioxidants, but it’s about your dietary pattern overall,” says Katie Puckering. “Just eating blueberries on their own won’t be enough to cancel a diet that that is high in fat, sugar, salt, red meat and processed foods.
“The Mediterranean Diet with high quality grains, lots of fruit and vegetables, nuts and seeds, oily fish, small amounts of meat, olive oil, and quality dairy products has the most evidence behind it for having a protective effect on the brain.
“Make sure you eat high quality grains that are full of fibre, and fruits and vegetables – they don’t have to be the exotic kind – a banana is 16p and four apples £1.50 so it doesn’t have to be expensive.”
“We now know that all vaccines including those given to older people such as the flu and pneumonia vaccines are associated with a lower risk of dementia,” says Puckering.
“People who have these vaccines on the whole have been shown to have less risk of dementia. This may be because they have fewer infections and this helps build the brain’s resilience against Alzheimer’s disease, we don’t know for sure yet.”
New research from University College London published this week in the Journals of Gerontology has found that older adults who live in highly polluted areas may be worse at spelling, grammar and comprehension tests.
Researchers examined exposure to air pollution levels in the 10 years prior to testing 1,127 adults aged at least 65, and found that long term exposure to high levels of nitrogen dioxide and fine particulate matter may affect the part of the brain used for language and fluency.
Professor Fox says sleep is yet to be added to the list of modifiable risk factors for dementia – but the evidence is building.
“One theory is that if you don’t get enough sleep at night your brain doesn’t have enough time to do the clearing out, but there’s also a time clock theory that you may be sleeping at the wrong time of day (such as a cat nap).
“It could be that you are having too much sleep – the estimate for optimum sleep is 6 to 8 hours a night. My advice is to stop cat napping and concentrate on trying to get a solid block of 6 to 8 hours of sleep a night.”
Uncorrected hearing loss is a recent addition to the Lancet’s list of modifiable risk factors, but one of the single most important ones – it seems to increase the risk of developing dementia by 7%.
12 million people in the UK have hearing loss. It affects 70% of over 70s and 40% of over 40s, but only around half wear a hearing aid.
Puckering says: “I think uncorrected hearing loss has been massively overlooked, and we get lots of questions about this on our helpline. People are much quicker to get an eye test and wear glasses than they are to get their hearing tested and wearing a hearing aid.
“Being able to hear keeps you connected to the world and if you can’t hear your brain won’t be getting the stimuli it needs. So it’s really one to watch.”
Health insurance for people over 50 that provides a quicker route to diagnosis and planned medical treatment in a private facility.
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