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NEW YORK The elderly woman had stopped by the Jewish Community Center in the Canarsie area of Brooklyn and was shuffling away, leaning heavily on her walker, when a young man punched her in the head as he walked past, knocking her to the ground.

When she returned to the center for help, the staff called for an ambulance, vigilant that this might have been another example of the "knockout game," a social media trend that had young people punching out random individuals on the street last year. Since that November incident, the neighborhood hasn't had any other anti-Semitic assaults, but that doesn't mean the victim has healed, said Rabbi Avrohom Hecht, executive director of the center, who helped the woman after the assault.

"People should realize when they do this to someone there are emotional and mental scars they leave on people," Hecht said. "I know this woman is still suffering."

Though the knockout game was widely condemned by New York leaders, it still contributed to a threefold increase in anti-Semitic assaults in New York City last year 21 compared to five in 2012, according to an annual audit by the Anti-Defamation League, a nonprofit that fights anti-Semitism.

Nationwide, there were 31 assaults on Jews or those who were perceived as Jewish in 2013, up from 17 the year before, the report released Tuesday said.

They included an incident that targeted a 12-year-old girl who had a bottle thrown at her by a group of girls, one of whom called her a "dirty Jew"; an attack on a 24-year-old Jewish man wearing a yarmulke; and an assault on a man in Los Angeles who was surrounded by a group of men who hit him and shouted "Heil Hitler!"

"Even if there's one incident of hate, that's too many," said Evan Bernstein, the New York regional director of the Anti-Defamation League. "We have to do a better job of trying to prevent it from happening."

Overall nationwide, anti-Semitic incidents declined 19% from 2012 to 2013, the audit shows. There were 315 vandalism incidents, down from 440 in 2012, and 405 incidents of harassment and threats, down from 470 the year before.

New York had the highest number of anti-Jewish incidents last year, according to the audit. And the increase in assaults represents a worrying surge in a city and state known as a melting pot for cultures and ethnicities from around the world.

"It's been a real increase, and we are concerned about it," said Hecht, the Canarsie rabbi.

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Attacks on Jews show a troubling increase