Herpes Simplex Virus Type 1 and Cognition in Different Stages of Life


study by Tarter et al [1], who reported that herpes simplex virus type 1 (HSV-1) seropositivity was associated with im-paired reading and visuospatial reasoning in children, impaired attention in middle-aged adults, and impaired immediate memory in older adults. They also found that cytomegalovirus (CMV) sero-positivity was associated with slower cod-ing speed and with impaired learning and recall among middle-aged adults in their adjusted analysis. I applaud the use of a US representative sample to investigate, perhaps for the first time, the relationship between the viral infections and cognitive impairment throughout different stages of life. However, while these findings are of public health importance, I am con-cerned that the study did not consider important covariates. Visual impairment was not taken into account, especially in the relationship of HSV-1 with reading, visual-spatial pro-cessing, and attention impairments, de-spite the fact that data on trouble seeing were available from the National Health and Nutrition Examination Survey (NHANES). Visuospatial processing was assessed with the block design test, which requires children to assemble blocks of different colors according to a given pat-tern, and attentionwas evaluated using the Symbol-Digit Substitution Test (SDST), which consists of matching various sym-bols with numerical digits [2, 3]. As for reading, performance on the block digit test and SDST could be affected by visual problems [4]; Wood et al demonstrated that simulated visual impairment may alter performance on some cognitive tests, including the SDST among young adults [5]. HSV-1 is the main infectious cause of ocular diseases, includin

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