The relationships between television viewing in midlife and the development of Alzheimer’s disease in a case-control study
Introduction
Interest in the association of leisure and social activities with the development and progression of cognitive impairment in aging has been increasing. Numerous studies support the hypothesis that increased regular use of cognitive skills and higher levels of education are protective against the development of Alzheimer’s disease (AD) (Bowirrat et al., 1998, Coyle, 2003, Crowe et al., 2003, Evans et al., 1997, Fillit et al., 2002, Friedland, 1993, Friedland et al., 1997, Friedland et al., 2001, Hultsch et al., 1993, Hultsch et al., 1999, Katzman, 1993, Scarmeas et al., 2001, Schooler, 1984, Unverzagt et al., 1998, Verghese et al., 2003, Wilson et al., 2003, Zhang et al., 1993). Although the exact mechanism of this protection is unknown, increased synaptic complexity and neuronal reserve as a result of participation in intellectually stimulating activities may play a role (Bauer, 1996, Friedland et al., 2001, Mortimer, 1997, Mortimer and Graves, 1993).
Some leisure and social activities, especially those involving the use of cognitive skills and those that are intellectually stimulating, may be protective against the development and rapid progression of AD or other forms of dementia (Coyle, 2003, Crowe et al., 2003, Fillit et al., 2002, Gribbin et al., 1980, Mayeux, 2003, Scarmeas et al., 2001, Schaie, 1994, Verghese et al., 2003, Wilson et al., 2002, Wilson et al., 2003). However, some leisure and social activities may not be beneficial (Friedland, 1993, Friedland et al., 1997, Friedland et al., 2001, Hultsch et al., 1993, Hultsch et al., 1999, Schooler, 1984). We hypothesize that one of the most common leisure activities in the developed world, television viewing, may be associated with a greater likelihood of developing the disease. Television viewing may take the place of more intellectually stimulating activities that promote cognitive vitality with aging, and thus television viewing may be associated with increased risk of developing Alzheimer’s disease. To date, we know of no published reports that specifically consider the association of television viewing and subsequent development of AD.
Television was first introduced to the public as a novelty at the 1939 World’s Fair. Although the United States’ Federal Communications’ Commission issued the first television station license in 1941, commercial success of television broadcasting was hampered by the United States’ involvement in World War II. By 1950 approximately 9% of homes had a television set. However, by 1955 cumulative sales of television sets exceeded 42 million, and an estimated 65% of households had their own television sets (Steinberg, 1980). Steinberg cites industry estimates of daily household television viewing which show an increase from 5 h and 5 min per day in 1958 to 6 h and 10 min per day in 1978. Studies of television viewing among adults vary in the age groups considered and whether or not results are stratified by age. A recent study by the National Science Board indicates that, on average, adults over the age of 18 watch 2.95 h of television per day (National Science Board, 1998). A 1997 study analyzed data on the number of minutes per day spent on various activities for adults aged 18–64 (Comstock & Scharrer, 1999). Television viewing ranked third at 129 min per day behind night sleeping at 463 min per day and main job activities at 216 min.
While most studies of aging and television viewing focus on the current viewing habits of elders over the age of 65 (Hickman, 1997, Horgas et al., 1998), we are interested in middle-adulthood viewing as an indicator of potential disease development in later life.
The current analysis focuses on individuals born between 1915 and 1944 for whom retrospective reports on television viewing habits during ages 40–59 years were obtained. We hypothesize that higher levels of television viewing may be associated with an increased risk of AD development later in life.
Section snippets
Subjects
All subjects were participants in the AD Case-Control Study, Case Western Reserve University School of Medicine, University Hospitals of Cleveland, begun in 1991.
Cases (n = 135) were recruited from clinical settings and from the community and were all enrolled in the Research Registry of the University Memory and Aging Center, University Hospitals of Cleveland, Case Western Reserve University. Cases were evaluated by neuropsychological, laboratory and neurological examinations. Data for cases was
Socio-demographic characteristics
A comparison of cases and controls on basic socio-demographic characteristics is shown in Table 2. Cases and controls did not differ significantly with respect to median year of birth. However, the upper end of the distribution of birth years for controls extended eight years beyond that of cases. Cases had significantly lower levels of completed education compared to controls, and this relationship was true for both men and women. There was also a significant difference between cases and
Discussion
Our analyses focused on the premorbid, middle-adulthood (ages 40–59) leisure activities of subjects enrolled in a case-control study of AD. The analyses include retrospective reports of those subjects born between 1915 and 1944. We hypothesized that greater numbers of middle adulthood television viewing hours might be associated with an increased risk of subsequent AD development.
Our findings indicate that AD cases watched more hours of television during their middle-adulthood years than
Acknowledgments
Supported in part by the National Institute on Aging (Epidemiology, Demography and Biometry Program; PO 263-MO-818915), the Alzheimer Disease Research Center Program (P50 AG 08012), the Joseph and Florence Mandel Foundation, the Nickman family, the Institute for the Study of Aging, NY, and Philip Morris, USA. The contributions of M. McClendon are also gratefully acknowledged. The sponsors had no role in the design, conduct, interpretation or analysis of the study.
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Present address: Division of Sexually Transmitted Disease Prevention, Centers of Disease Control and Prevention, 1600 Clifton Rd., Mailstop E-02, Atlanta, GA 30333, United States.