{"id":{"repo_id":"utmb","oai_identifier":"oai:utmb-ir.tdl.org:2152.3/12712"},"canonical_url":"https://search.dev.ndltd.org/etd/utmb/oai:utmb-ir.tdl.org:2152.3/12712","repository":{"repo_id":"utmb","name":"University of Texas Medical Branch","base_url":"https://utmb-ir.tdl.org/server/oai/request"},"display":{"title":"Investigation of Infectious Disease Associations with Cognitive Impairment using Electronic Medical Records","abstract":"Although infection-driven neurocognitive deterioration has been postulated for decades, definitive population-level evidence is scarce. We therefore undertook a multi-center electronic health record study to quantify the association between six clinically important infections—Herpes simplex virus (HSV), syphilis, Chlamydia trachomatis, coronavirus disease 2019 (COVID-19), cytomegalovirus (CMV), and human immunodeficiency virus (HIV)—and subsequent cognitive impairment. On June 12, 2025, we queried the global TriNetX network for encounters containing both diagnostic codes (ICD10-CM) and confirming laboratory results (LOINC) for each pathogen, constructing sex stratified cohorts of up to 1,932,669 exposed patients that maximized diagnostic certainty. A comparator cohort was derived from encounters coded Z00 (routine examination) after excluding any of the target infections by diagnosis or laboratory evidence totaling up to 131,5694 control patients. Baseline demographic characteristics were assessed using TriNetX’s Compare Outcomes module, which balanced age, race, and sex distributions through propensity score matching before survival analysis. Kaplan–Meier curves and matched measures of association were then used to estimate infection-specific hazard ratios for cognitive decline given a five-year follow-up window. Across pathogens, we observed heterogeneous, infection-dependent elevation in risk, indicating that certain infections may be nontrivial contributors to neurodegenerative trajectories. While there are inherent limitations to utilizing real-world data such as lack of biomarkers and neuropsychological testing as well as potential outcome misclassification and left censoring of comorbidities due to structural features of TriNetX, our results imply that renewed investment in sexually transmitted infection screening, treatment completion, and partner notification programs could be feasible targets to lessen the impact of cognitive impairment.","abstract_html":"Although infection-driven neurocognitive deterioration has been postulated for decades, definitive population-level evidence is scarce. We therefore undertook a multi-center electronic health record study to quantify the association between six clinically important infections—Herpes simplex virus (HSV), syphilis, Chlamydia trachomatis, coronavirus disease 2019 (COVID-19), cytomegalovirus (CMV), and human immunodeficiency virus (HIV)—and subsequent cognitive impairment. On June 12, 2025, we queried the global TriNetX network for encounters containing both diagnostic codes (ICD10-CM) and confirming laboratory results (LOINC) for each pathogen, constructing sex stratified cohorts of up to 1,932,669 exposed patients that maximized diagnostic certainty. A comparator cohort was derived from encounters coded Z00 (routine examination) after excluding any of the target infections by diagnosis or laboratory evidence totaling up to 131,5694 control patients. Baseline demographic characteristics were assessed using TriNetX’s Compare Outcomes module, which balanced age, race, and sex distributions through propensity score matching before survival analysis. Kaplan–Meier curves and matched measures of association were then used to estimate infection-specific hazard ratios for cognitive decline given a five-year follow-up window. Across pathogens, we observed heterogeneous, infection-dependent elevation in risk, indicating that certain infections may be nontrivial contributors to neurodegenerative trajectories. While there are inherent limitations to utilizing real-world data such as lack of biomarkers and neuropsychological testing as well as potential outcome misclassification and left censoring of comorbidities due to structural features of TriNetX, our results imply that renewed investment in sexually transmitted infection screening, treatment completion, and partner notification programs could be feasible targets to lessen the impact of cognitive impairment.","abstract_has_math":false,"creators":["Littleton, Tehya Marie"],"institution":"The University of Texas Medical Branch at Galveston","degree_name":"Biochemistry and Molecular Biology (Masters)","degree_level":null,"degree_discipline":null,"degree_department":null,"school":null,"contributors":[],"advisors":["Golovko, George (gegolovk@utmb.edu)"],"committee_chairs":[],"committee_members":["Kamil Khanipov (kakhanip@utmb.edu)","Cristiana Rastellini (ccrastel@utmb.edu)"],"year":2025,"date_issued":"2025-08","date_published":"2025-08","updated_at":"2026-07-24T05:51:01Z","subjects":[],"languages":[],"rights":[],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"https://hdl.handle.net/2152.3/12712","outbound_label":"Handle","outbound_source":"dc:identifier.uri"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor.advisor","label":"Advisor","values":["Golovko, George (gegolovk@utmb.edu)"]},{"key":"dc:contributor.committeemember","label":"Committee Member","values":["Kamil Khanipov (kakhanip@utmb.edu)","Cristiana Rastellini (ccrastel@utmb.edu)"]},{"key":"dc:creator","label":"Author","values":["Littleton, Tehya Marie"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date.accessioned","label":"Dc Date Accessioned","values":["2025-07-23T13:48:37Z"]},{"key":"dc:date.issued","label":"Date","values":["2025-08"]},{"key":"dc:type","label":"Dc Type","values":["Thesis"]},{"key":"thesis:degree_name","label":"Degree Name","values":["Biochemistry and Molecular Biology (Masters)"]},{"key":"thesis:institution_name","label":"Thesis Institution Name","values":["The University of Texas Medical Branch at Galveston"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier.uri","label":"Identifier URI","values":["https://hdl.handle.net/2152.3/12712"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["Although infection-driven neurocognitive deterioration has been postulated for decades, definitive population-level evidence is scarce. We therefore undertook a multi-center electronic health record study to quantify the association between six clinically important infections—Herpes simplex virus (HSV), syphilis, Chlamydia trachomatis, coronavirus disease 2019 (COVID-19), cytomegalovirus (CMV), and human immunodeficiency virus (HIV)—and subsequent cognitive impairment. On June 12, 2025, we queried the global TriNetX network for encounters containing both diagnostic codes (ICD10-CM) and confirming laboratory results (LOINC) for each pathogen, constructing sex stratified cohorts of up to 1,932,669 exposed patients that maximized diagnostic certainty. A comparator cohort was derived from encounters coded Z00 (routine examination) after excluding any of the target infections by diagnosis or laboratory evidence totaling up to 131,5694 control patients. Baseline demographic characteristics were assessed using TriNetX’s Compare Outcomes module, which balanced age, race, and sex distributions through propensity score matching before survival analysis. Kaplan–Meier curves and matched measures of association were then used to estimate infection-specific hazard ratios for cognitive decline given a five-year follow-up window. Across pathogens, we observed heterogeneous, infection-dependent elevation in risk, indicating that certain infections may be nontrivial contributors to neurodegenerative trajectories. While there are inherent limitations to utilizing real-world data such as lack of biomarkers and neuropsychological testing as well as potential outcome misclassification and left censoring of comorbidities due to structural features of TriNetX, our results imply that renewed investment in sexually transmitted infection screening, treatment completion, and partner notification programs could be feasible targets to lessen the impact of cognitive impairment."]},{"key":"dc:format.mimetype","label":"Dc Format Mimetype","values":["application/pdf"]},{"key":"dc:title","label":"Title","values":["Investigation of Infectious Disease Associations with Cognitive Impairment using Electronic Medical Records"]}]}],"canonical_facts":{"dc:contributor.advisor":["Golovko, George (gegolovk@utmb.edu)"],"dc:contributor.committeemember":["Kamil Khanipov (kakhanip@utmb.edu)","Cristiana Rastellini (ccrastel@utmb.edu)"],"dc:creator":["Littleton, Tehya Marie"],"dc:date.accessioned":["2025-07-23T13:48:37Z"],"dc:date.issued":["2025-08"],"dc:description.abstract":["Although infection-driven neurocognitive deterioration has been postulated for decades, definitive population-level evidence is scarce. We therefore undertook a multi-center electronic health record study to quantify the association between six clinically important infections—Herpes simplex virus (HSV), syphilis, Chlamydia trachomatis, coronavirus disease 2019 (COVID-19), cytomegalovirus (CMV), and human immunodeficiency virus (HIV)—and subsequent cognitive impairment. On June 12, 2025, we queried the global TriNetX network for encounters containing both diagnostic codes (ICD10-CM) and confirming laboratory results (LOINC) for each pathogen, constructing sex stratified cohorts of up to 1,932,669 exposed patients that maximized diagnostic certainty. A comparator cohort was derived from encounters coded Z00 (routine examination) after excluding any of the target infections by diagnosis or laboratory evidence totaling up to 131,5694 control patients. Baseline demographic characteristics were assessed using TriNetX’s Compare Outcomes module, which balanced age, race, and sex distributions through propensity score matching before survival analysis. Kaplan–Meier curves and matched measures of association were then used to estimate infection-specific hazard ratios for cognitive decline given a five-year follow-up window. Across pathogens, we observed heterogeneous, infection-dependent elevation in risk, indicating that certain infections may be nontrivial contributors to neurodegenerative trajectories. While there are inherent limitations to utilizing real-world data such as lack of biomarkers and neuropsychological testing as well as potential outcome misclassification and left censoring of comorbidities due to structural features of TriNetX, our results imply that renewed investment in sexually transmitted infection screening, treatment completion, and partner notification programs could be feasible targets to lessen the impact of cognitive impairment."],"dc:format.mimetype":["application/pdf"],"dc:identifier.uri":["https://hdl.handle.net/2152.3/12712"],"dc:title":["Investigation of Infectious Disease Associations with Cognitive Impairment using Electronic Medical Records"],"dc:type":["Thesis"],"thesis:degree_name":["Biochemistry and Molecular Biology (Masters)"],"thesis:institution_name":["The University of Texas Medical Branch at Galveston"]},"updated_at":"2026-07-24T05:51:01Z"}