{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T14:56:07Z","timestamp":1790607367590,"version":"4.1.0"},"reference-count":54,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2024,3,6]],"date-time":"2024-03-06T00:00:00Z","timestamp":1709683200000},"content-version":"unspecified","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,2,14]]},"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>This study sought to examine the relationship between <jats:italic>Toxoplasma gondii<\/jats:italic> seropositivity and cognitive function in older adults.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>An observational cross-sectional study.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>The National Health and Nutrition Examination Survey (NHANES) study took place at participants\u2019 homes and mobile examination centres.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>A total of 2956 older adults aged 60 and above from the NHANES from 2011 to 2014 were included in the study. Exposure of interest: participants had serum <jats:italic>Toxoplasma gondii<\/jats:italic> antibody analysed in the laboratory. A value&gt;33\u2009IU\/mL was categorised as seropositive for <jats:italic>Toxoplasma gondii<\/jats:italic> infection; &lt;27\u2009IU\/mL was categorised as seronegative for <jats:italic>Toxoplasma gondii<\/jats:italic> infection.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Primary and secondary outcome measures<\/jats:title>\n                  <jats:p>Cognitive tests included the Consortium to Establish a Registry for Alzheimer\u2019s Disease Word Learning subtest (CERAD-WL) for immediate and delayed memory, the Animal Fluency Test (AFT), and the Digit Symbol Substitution Test (DSST).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>About half of the 2956 participants (mean age 70.0) were female (51.0%), non-Hispanic White (48.3%), and completed some college or above (48.3%). A total of 703 participants were positive for <jats:italic>Toxoplasma gondii<\/jats:italic> infection (23.8%). Adjusted linear regression showed that compared with participants with negative <jats:italic>Toxoplasma gondii<\/jats:italic> infection, those with positive <jats:italic>Toxoplasma gondii<\/jats:italic> infection had lower CERAD-WL immediate memory (beta (\u03b2) \u22120.16, 95% CI \u22120.25 to \u20130.07), CERAD-WL delayed memory (\u03b2 \u22120.15, 95%\u2009CI \u22120.24 to \u20130.06), AFT (\u03b2 \u22120.15, 95%\u2009CI \u22120.24 to \u20130.06), DSST (\u03b2 \u22120.34, 95%\u2009CI \u22120.43 to \u20130.26), and global cognition (\u03b2 \u22120.24, 95%\u2009CI \u22120.32 to \u20130.16) z-scores after controlling for the covariates.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>\n                     <jats:italic>Toxoplasma gondii<\/jats:italic> seropositivity is associated with worse immediate and delayed verbal learning, language proficiency, executive functioning, processing speed, sustained attention, working memory, as well as global cognition in older adults. Public health measures aiming at preventing <jats:italic>Toxoplasma gondii<\/jats:italic> infection may help preserve cognitive functioning in older adults.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-071513","type":"journal-article","created":{"date-parts":[[2024,3,6]],"date-time":"2024-03-06T00:40:14Z","timestamp":1709685614000},"page":"e071513","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["<i>Toxoplasma gondii<\/i> seropositivity and cognitive functioning in older adults: an analysis of cross-sectional data of the National Health and Nutrition Examination Survey 2011\u20132014"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3109-6477","authenticated-orcid":false,"given":"Ge","family":"Song","sequence":"first","affiliation":[{"name":"College of Sciences and Technology, University of Houston Downtown, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingxia","family":"Zhao","sequence":"additional","affiliation":[{"name":"School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1634-4310","authenticated-orcid":false,"given":"Hongyu","family":"Chen","sequence":"additional","affiliation":[{"name":"School of Nursing, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng","family":"Li","sequence":"additional","affiliation":[{"name":"Kentucky Department for Public Health, Infectious Disease Branch, Frankfort, Kentucky, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeyu","family":"Zhang","sequence":"additional","affiliation":[{"name":"Institute for Hospital Management, Tsinghua University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhe","family":"Qu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Respiratory, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Yang","sequence":"additional","affiliation":[{"name":"University of Texas MD Anderson Cancer Center, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuechun","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Huazhong University of Science and Technology, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weixia","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Courtney Rose","family":"Standlee","sequence":"additional","affiliation":[{"name":"College of Sciences and Technology, University of Houston Downtown, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,3,5]]},"reference":[{"key":"2025101812535990000_14.3.e071513.1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(18)30403-4"},{"key":"2025101812535990000_14.3.e071513.2","doi-asserted-by":"crossref","first-page":"2054","DOI":"10.1111\/acer.13861","article-title":"Alcohol use and cognitive functioning among Middle\u2010Aged and older adults in China: findings of the China health and retirement longitudinal study baseline survey","volume":"42","author":"Ge","year":"2018","journal-title":"Alcohol Clin Exp Res"},{"key":"2025101812535990000_14.3.e071513.3","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.bbi.2018.11.016","article-title":"The lack of association between herpes Simplex virus 1 or Toxoplasma Gondii infection and cognitive decline in the general population: an 11-year follow-up study","volume":"76","author":"Torniainen-Holm","year":"2019","journal-title":"Brain Behav Immun"},{"key":"2025101812535990000_14.3.e071513.4","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1001\/jamapsychiatry.2021.1590","article-title":"Association of Toxoplasma Gondii Seropositivity with cognitive function in healthy people: a systematic review and meta-analysis","volume":"78","author":"de Haan","year":"2021","journal-title":"JAMA Psychiatry"},{"key":"2025101812535990000_14.3.e071513.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.reprotox.2005.10.006"},{"key":"2025101812535990000_14.3.e071513.6","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(96)11105-3"},{"key":"2025101812535990000_14.3.e071513.7","doi-asserted-by":"publisher","DOI":"10.3201\/eid0901.020160"},{"key":"2025101812535990000_14.3.e071513.8","first-page":"13","article-title":"Tracking trends of Toxoplasma Gondii transmission from environment to animal to human","volume":"8","author":"Rahman","year":"2020","journal-title":"JAP"},{"key":"2025101812535990000_14.3.e071513.9","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1111\/j.1550-7408.1988.tb04144.x","article-title":"Fatal Toxoplasmosis and Enteroepithelial stages of Toxoplasma Gondii in a Pallas cat (Felis Manul) 1","volume":"35","author":"Dubey","year":"1988","journal-title":"J Protozool"},{"key":"2025101812535990000_14.3.e071513.10","doi-asserted-by":"crossref","first-page":"295","DOI":"10.4269\/ajtmh.2005.72.295","article-title":"Toxoplasma Gondii infection in rural Guatemalan children","volume":"72","author":"Jones","year":"2005","journal-title":"Am J Trop Med Hyg"},{"key":"2025101812535990000_14.3.e071513.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijpara.2008.03.007"},{"key":"2025101812535990000_14.3.e071513.12","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0097775","article-title":"A meta analysis on risks of adverse pregnancy outcomes in Toxoplasma Gondii infection","volume":"9","author":"Li","year":"2014","journal-title":"PLoS ONE"},{"key":"2025101812535990000_14.3.e071513.13","doi-asserted-by":"publisher","DOI":"10.1097\/nmd.0000000000000166"},{"key":"2025101812535990000_14.3.e071513.14","doi-asserted-by":"publisher","DOI":"10.1017\/S0031182014001577"},{"key":"2025101812535990000_14.3.e071513.15","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0148435","article-title":"Is Toxoplasma Gondii infection related to brain and behavior impairments in humans? evidence from a population-representative birth cohort","volume":"11","author":"Sugden","year":"2016","journal-title":"PLoS One"},{"key":"2025101812535990000_14.3.e071513.16","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.actatropica.2019.05.015","article-title":"Toxoplasma Gondii infection and risk of Parkinson and Alzheimer diseases: A systematic review and meta-analysis on observational studies","volume":"196","author":"Bayani","year":"2019","journal-title":"Acta Trop"},{"key":"2025101812535990000_14.3.e071513.17","doi-asserted-by":"crossref","DOI":"10.3390\/nu9060564","article-title":"Toxoplasma Gondii moderates the association between multiple folate-cycle factors and cognitive function in US adults","volume":"9","author":"Berrett","year":"2017","journal-title":"Nutrients"},{"key":"2025101812535990000_14.3.e071513.18","doi-asserted-by":"publisher","DOI":"10.1017\/s0031182015000505"},{"key":"2025101812535990000_14.3.e071513.19","unstructured":"NHANES . Toxoplasma Gondii antibody - serum (surplus) (Sstoxo_G). 2016. Available: https:\/\/wwwn.cdc.gov\/Nchs\/Nhanes\/2011-2012\/SSTOXO_G.htm"},{"key":"2025101812535990000_14.3.e071513.20","unstructured":"Johnson CL , Paulose-Ram R , Ogden CL , et al . National health and nutrition examination survey. Analytic Guidelines, 1999-2010 2013."},{"key":"2025101812535990000_14.3.e071513.21","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbj052"},{"key":"2025101812535990000_14.3.e071513.22","unstructured":"Bio-Rad . PLATELIA, Available: http:\/\/www.bio-rad.com\/webroot\/web\/pdf\/inserts\/CDG\/en\/Literature\/inserts\/72841_881043_GB.pdf"},{"key":"2025101812535990000_14.3.e071513.23","doi-asserted-by":"crossref","DOI":"10.3390\/microorganisms10010115","article-title":"The Association of Toxoplasma Gondii IgG antibody and chronic kidney disease biomarkers","volume":"10","author":"Babekir","year":"2022","journal-title":"Microorganisms"},{"key":"2025101812535990000_14.3.e071513.24","doi-asserted-by":"crossref","first-page":"1371","DOI":"10.3201\/eid0911.030098","article-title":"Toxoplasma Gondii infection in the United States, 1999\u20132000","volume":"9","author":"Jones","year":"2003","journal-title":"Emerg Infect Dis"},{"key":"2025101812535990000_14.3.e071513.25","unstructured":"NHANES . 2011-2012 data documentation, Codebook, and frequencies. 2017. Available: https:\/\/wwwn.cdc.gov\/Nchs\/Nhanes\/2011-2012\/CFQ_G.htm"},{"key":"2025101812535990000_14.3.e071513.26","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.jalz.2007.08.005","article-title":"Consortium to establish a Registry for Alzheimer\u2019s disease (CERAD): the first twenty years","volume":"4","author":"Fillenbaum","year":"2008","journal-title":"Alzheimer\u2019s & Dementia"},{"key":"2025101812535990000_14.3.e071513.27","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1080\/09084280701280502","article-title":"A compendium of neuropsychological tests: administration, norms, and commentary","volume":"14","author":"Carone","year":"2007","journal-title":"Appl Neuropsychol"},{"key":"2025101812535990000_14.3.e071513.28","article-title":"Development of the WAIS-III: a brief overview, history, and description","volume":"1","author":"Silva","year":"2008","journal-title":"Graduate J Counsel Psychol"},{"key":"2025101812535990000_14.3.e071513.29","doi-asserted-by":"publisher","DOI":"10.1097\/JCP.0000000000000941"},{"key":"2025101812535990000_14.3.e071513.30","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.41.4.479"},{"key":"2025101812535990000_14.3.e071513.31","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2001.016009606.x"},{"key":"2025101812535990000_14.3.e071513.32","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbi.2013.11.019"},{"key":"2025101812535990000_14.3.e071513.33","doi-asserted-by":"publisher","DOI":"10.1097\/WAD.0000000000000133"},{"key":"2025101812535990000_14.3.e071513.34","doi-asserted-by":"publisher","DOI":"10.1242\/jeb.074153"},{"key":"2025101812535990000_14.3.e071513.35","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0023866","article-title":"The Neurotropic parasite Toxoplasma Gondii increases dopamine metabolism","volume":"6","author":"Prandovszky","year":"2011","journal-title":"PLoS One"},{"key":"2025101812535990000_14.3.e071513.36","doi-asserted-by":"publisher","DOI":"10.1017\/S0031182006000886"},{"key":"2025101812535990000_14.3.e071513.37","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0004801","article-title":"A unique dual activity amino acid hydroxylase in Toxoplasma Gondii","volume":"4","author":"Gaskell","year":"2009","journal-title":"PLoS One"},{"key":"2025101812535990000_14.3.e071513.38","doi-asserted-by":"publisher","DOI":"10.1016\/S0301-0082(02)00011-4"},{"key":"2025101812535990000_14.3.e071513.39","doi-asserted-by":"publisher","DOI":"10.1523\/JNEUROSCI.16-23-07768.1996"},{"key":"2025101812535990000_14.3.e071513.40","doi-asserted-by":"publisher","DOI":"10.1177\/026988119701100208"},{"key":"2025101812535990000_14.3.e071513.41","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1016\/j.neubiorev.2009.12.008","article-title":"Linking cognitive aging to alterations in dopamine neurotransmitter functioning: recent data and future avenues","volume":"34","author":"B\u00e4ckman","year":"2010","journal-title":"Neuroscience & Biobehavioral Reviews"},{"key":"2025101812535990000_14.3.e071513.42","doi-asserted-by":"publisher","DOI":"10.1016\/S0301-0082(03)00085-6"},{"key":"2025101812535990000_14.3.e071513.43","doi-asserted-by":"publisher","DOI":"10.1128\/IAI.00217-16"},{"key":"2025101812535990000_14.3.e071513.44","doi-asserted-by":"crossref","first-page":"00789","DOI":"10.1128\/IAI.00789-18","article-title":"Downregulation of the central noradrenergic system by Toxoplasma Gondii infection","volume":"87","author":"Alsaady","year":"2019","journal-title":"Infect Immun"},{"key":"2025101812535990000_14.3.e071513.45","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijpara.2008.08.002"},{"key":"2025101812535990000_14.3.e071513.46","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1007\/s11102-013-0480-6","article-title":"Investigation of Impulsivity in patients on dopamine agonist therapy for hyperprolactinemia: a pilot study","volume":"17","author":"Barake","year":"2014","journal-title":"Pituitary"},{"key":"2025101812535990000_14.3.e071513.47","doi-asserted-by":"crossref","DOI":"10.1128\/mBio.00935-19","article-title":"Infection-induced intestinal Dysbiosis is mediated by macrophage activation and nitrate production","volume":"10","author":"Wang","year":"2019","journal-title":"mBio"},{"key":"2025101812535990000_14.3.e071513.48","doi-asserted-by":"crossref","unstructured":"Borre YE , Moloney RD , Clarke G , et al . The impact of Microbiota on brain and behavior: mechanisms & therapeutic potential. In: Microbial endocrinology: The microbiota-gut-brain axis in health and disease. 2014: 373\u2013403. doi:10.1007\/978-1-4939-0897-4","DOI":"10.1007\/978-1-4939-0897-4_17"},{"key":"2025101812535990000_14.3.e071513.49","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/bs.irn.2016.08.008","article-title":"Toxoplasma Gondii\u2014a gastrointestinal pathogen associated with human brain diseases","volume":"131","author":"Severance","year":"2016","journal-title":"Int Rev Neurobiol"},{"key":"2025101812535990000_14.3.e071513.50","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.3233\/JAD-2010-100516","article-title":"Prediction of all-cause dementia using neuropsychological tests within 10 and 5 years of diagnosis in a community-based sample","volume":"22","author":"Tierney","year":"2010","journal-title":"JAD"},{"key":"2025101812535990000_14.3.e071513.51","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwu202"},{"key":"2025101812535990000_14.3.e071513.52","doi-asserted-by":"publisher","DOI":"10.1016\/j.pnpbp.2018.12.019"},{"key":"2025101812535990000_14.3.e071513.53","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0000000000001516"},{"key":"2025101812535990000_14.3.e071513.54","doi-asserted-by":"publisher","DOI":"10.1111\/apha.12458"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2022-071513","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T19:54:11Z","timestamp":1760817251000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2022-071513"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3]]},"references-count":54,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,3,5]]},"published-print":{"date-parts":[[2024,3]]}},"alternative-id":["10.1136\/bmjopen-2022-071513"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2022-071513","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3]]}}}