Brain and Cognition 58 (2005) 157–165 www.elsevier.com/locate/b&c 0278-2626/$ - see front matter  2004 Elsevier Inc. All rights reserved. doi:10.1016/j.bandc.2004.09.020 The relationships between television viewing in midlife and the development of Alzheimer’s disease in a case-control study Heather A. Lindstrom a,¤,1 , Thomas Fritsch a , Grace Petot b , Kathleen A. Smyth c , Chien H. Chen c , Sara M. Debanne c , Alan J. Lerner d , Robert P. Friedland e,¤ a University Memory and Aging Center, Case Western Reserve University, United States b Department of Nutrition, School of Medicine, Case Western Reserve University, United States c Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, United States d Department of Neurology, School of Medicine, Case Western Reserve University, United States e Laboratory of Neurogeriatrics, Department of Neurology, School of Medicine, Case Western Reserve University, 1101 Euclid Ave, Room TG2A, Cleveland, OH 44106-4962, United States Accepted 29 September 2004 Available online 22 December 2004 Abstract The relationship between leisure activities and development of cognitive impairment in aging has been the subject of recent research. We examined television viewing in association with risk of developing Alzheimer’s disease (AD) in a case-control study. Given recent focus on the importance of intellectually stimulating activities as preventive measures against cognitive decline, it is important to examine the eVects of less stimulating but common activities. Data are from 135 Alzheimer’s disease cases and 331 healthy controls. Demographic characteristics and life history questionnaire responses on the number of hours spent on 26 leisure activities during middle-adulthood (ages 40–59) were analyzed. Logistic regression was used to examine the eVects of middle-adult- hood leisure activities on case vs. control status. Results indicate that for each additional daily hour of middle-adulthood television viewing the associated risk of AD development, controlling for year of birth, gender, income, and education, increased 1.3 times. Par- ticipation in intellectually stimulating activities and social activities reduced the associated risk of developing AD. Findings are con- sistent with the view that participation in non-intellectually stimulating activities is associated with increased risk of developing AD, and suggest television viewing may be a marker of reduced participation in intellectually stimulating activities.  2004 Elsevier Inc. All rights reserved. Keywords: Leisure activity; Intellectual stimulation; Middle-adulthood; Case-control; Cognitive impairment 1. Introduction Interest in the association of leisure and social activi- ties 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 pro- tective against the development of Alzheimer’s disease (AD) (Bowirrat, Treves, Friedland, & Korczyn, 1998; Coyle, 2003; Crowe, Andel, Pederson, Johansson, & Gatz, 2003; Evans et al., 1997; Fillit et al., 2002; Fried- land, 1993; Friedland et al., 1997, 2001; Hultsch, Ham- mer, & Small, 1993; Hultsch, Hertzog, Small, & Dixson, 1999; Katzman, 1993; Scarmeas, Levy, Tang, Manly, & Stern, 2001; Schooler, 1984; Unverzagt, Hui, Farlow, Hall, & Hendrie, 1998; Verghese et al., 2003; Wilson et al., 2003; Zhang et al., 1993). Although the exact * Corresponding authors. Fax: +216 844 6466 (H.A. Lindstrom); +216 368 1989 (R.P. Friedland). E-mail addresses: hlindstrom@cdc.gov (H.A. Lindstrom), rpf2@po.cwru.edu (R.P. Friedland). 1 Present address: Division of Sexually Transmitted Disease Preven- tion, Centers of Disease Control and Prevention, 1600 Clifton Rd., Mailstop E-02, Atlanta, GA 30333, United States.