December Newsletter
In This Issue
TV Will Make You Stupid
Can Coffee Make You Live Longer?
Take a Chill Pill
A New Model of Medical Care
Dr. Niedfeldt
Old-fashioned medicine with 21st Century convenience and technology
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I hope this newsletter finds you and your family well. I hope everyone has a wonderful holiday season. It's always nice to take a few minutes to reflect as the year comes to a close on our blessings, put negativity behind us, and start the new year with a clean slate. Happy New Year to all of you and all the best for 2016!


The first article this month looks at the dangers of our televisions. No they aren't going to blow up or have some poltergeist-type situation. But, they may speed cognitive decline. With all the reality-type programming out there, is anyone surprised?


Many of us start our days with a cup (or three) of coffee, remembering that the Grande is equal to 2 cups of coffee. I find that many people seem embarrassed about how much coffee they drink. The second study shows us that perhaps we can drink away (since decaf also gives benefits) because it looks like coffee may make us live longer, and we'll be awake for it...


Stress is a major part of our lives. While some of it is "first world problems" like waiting in line at Starbucks, it seems that how we perceive and deal with our stress may have an effect on our later development of Alzheimer's. 


Click on the links the the left to check out our web site...

TV Will Make You Stupid
watching TV
Inverse relationship between activity and cognitive decline
Ok, I admit I used a dramatic headline to get you here. This study, from JAMA Psychiatry, followed people for 25 years and found that high TV viewing and low physical activity led to worse cognitive performance in middle age. 
Summary of findings:
  • Importance:  Sedentary behaviors and physical inactivity are not only increasing worldwide but also are critical risk factors for adverse health outcomes. Yet, few studies have examined the effects of sedentary behavior on cognition or the long-term role of either behavior in early to middle adulthood.    
  • Objective: To investigate the association between 25-year patterns of television viewing and physical activity and midlife cognition. 
  • Design, Setting, and Participants: Prospective study of 3247 adults (black and white races; aged 18-30 years) enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) Study (March 25, 1985, to August 31, 2011). Data analysis was performed June 1, 2014, through April 15, 2015.
  • Main Outcomes and Measures: We assessed television viewing and physical activity at repeated visits (≥3 assessments) over 25 years using a validated questionnaire. A 25-year pattern of high television viewing was defined as watching TV above the upper baseline quartile (>3 hours/d) for more than two-thirds of the visits, and a 25-year pattern of low physical activity was defined as activity levels below the lower, sex-specific baseline quartile for more than two-thirds of the of the visits. We evaluated cognitive function at year 25 using the Digit Symbol Substitution Test (DSST), Stroop test, and Rey Auditory Verbal Learning Test. 
  • Results: At baseline, the mean (SD) age of the 3247 study participants was 25.1 (3.6) years, 1836 (56.5%) were female, 1771 (54.5%) were white, and 3015 (92.9%) had completed at least high school. Compared with participants with low television viewing, those with high television viewing during 25 years (353 of 3247 [10.9%]) were more likely to have poor cognitive performance (<1 SD below the race-specific mean) on the DSST and Stroop test, with findings reported as adjusted odds ratio (95% CI): DSST, 1.64 (1.21-2.23) and Stroop test, 1.56 (1.13-2.14), but not the Rey Auditory Verbal Learning Test, adjusted for age, race, sex, educational level, smoking, alcohol use, body mass index, and hypertension. Low physical activity during 25 years in 528 of 3247 participants (16.3%) was significantly associated with poor performance on the DSST, 1.47 (1.14-1.90). Compared with participants with low television viewing and high physical activity, the odds of poor performance were almost 2 times higher for adults with both high television viewing and low physical activity in 107 of 3247 (3.3%) (DSST, 1.95 [1.19-3.22], and Stroop test, 2.20 [1.36-3.56]).
  • Conclusions and Relevance: High television viewing and low physical activity in early adulthood were associated with worse midlife executive function and processing speed. This is one of the first studies to demonstrate that these risk behaviors may be critical targets for prevention of cognitive aging even before middle age.

This study followed 3247 young adults (average age 25) over 25 years and assessed television viewing and physical activity over the time period. The subjects who watched more TV (> 3 hours/day) had lower cognitive performance when tested. Those who had low physical activity were also lower on some of the cognitive testing. When compared to low TV watchers who are physically active, the high TV watchers with low physical activity were almost two times more likely to score poorly on testing. Many people underestimate their actual TV watching and the average American watches 2.8 hours of TV daily. This study didn't examine the effects of other screens or video games on cognition, but these tend to be sedentary activities. People who watched more than 3 hours of reality TV daily were 5 times more likely to score lower - OK, I made that one up (but I bet it would be true). Hmm, maybe my headline isn't so far off. 

Can Coffee Make You Live Longer? 
Consuming 1-5 cups daily associated with decreased risk of mortality

Good news for those of you who like to enjoy a cup (or three) of coffee during the day. This study from Circulation, found a 6-15% decrease in mortality in coffee drinkers, depending on how much coffee they drink. The lowest rate of mortality was actually in those drinking 3-5 cups daily, but any coffee consumption showed improvement. 

Summary of findings      
  • Background:  The association between consumption of caffeinated and decaffeinated coffee and risk of mortality remains inconclusive.
  • Methods and Results: We examined the associations of consumption of total, caffeinated, and decaffeinated coffee with risk of subsequent total and cause-specific mortality among 74,890 women in the Nurses' Health Study (NHS), 93,054 women in the NHS 2, and 40,557 men in the Health Professionals Follow-up Study. Coffee consumption was assessed at baseline using a semi-quantitative food frequency questionnaire. During 4,690,072 person-years of follow-up, 19,524 women and 12,432 men died. Consumption of total, caffeinated, and decaffeinated coffee were non-linearly associated with mortality. Compared to non-drinkers, coffee consumption one to five cups/d was associated with lower risk of mortality, while coffee consumption more than five cups/d was not associated with risk of mortality. However, when restricting to never smokers, compared to non-drinkers, the HRs of mortality were 0.94 (0.89 to 0.99) for ≤ 1 cup/d, 0.92 (0.87 to 0.97) for 1.1-3 cups/d, 0.85 (0.79 to 0.92) for 3.1-5 cups/d, and 0.88 (0.78 to 0.99) for > 5 cups/d (p for non-linearity = 0.32; p for trend < 0.001). Significant inverse associations were observed for caffeinated (p for trend < 0.001) and decaffeinated coffee (p for trend = 0.022). Significant inverse associations were observed between coffee consumption and deaths due to cardiovascular disease, neurological diseases, and suicide. No significant association between coffee consumption and total cancer mortality was found.
  • Conclusions: Higher consumption of total coffee, caffeinated coffee, and decaffeinated coffee was associated with lower risk of total mortality.
I always ask people about caffeine consumption when they come in for a physical. Most assume that I am going to chide them about the amount of coffee they drink. When I was in residency, we were taught to get people off coffee if they had high blood pressure or other conditions. It's interesting that there are now studies out showing that caffeine doesn't affect blood pressure (if it is daily intake). At this point, it looks like coffee is actually good for you. This large study from Harvard using data from the Nurses Health Study and Health Professionals Follow-up Study found that drinking coffee (caffeinated or decaffeinated) is associated with lower rate of death. We don't really know why this is the case. It is thought that coffee may improve insulin sensitivity and reduce inflammation. Coffee has also been linked to lower symptoms of depression. At any rate, don't hesitate to have that cup of coffee in the morning. Just leave out the cigarettes and take it easy on the scones. 

Take a Chill Pill...
Being 'stressed out' may increase risk of cognitive decline work stress
This study, from the journal Alzheimer Disease & Associated Disorders, found that perceived stress may be a risk factor for cognitive impairment and Alzheimer's disease. Older adults who perceived themselves to be under the most stress had a 30% greater risk of early cognitive impairment. 

Summary of findings:   
  • Stress is a potentially remediable risk factor for amnestic mild cognitive impairment (aMCI). Our objective is to determine whether perceived stress predicts incident aMCI and to determine if the influence of stress on aMCI is independent of known aMCI risk factors, particularly demographic variables, depression, and apolipoprotein genotype. The Einstein Aging Study is a longitudinal community-based study of older adults. The Perceived Stress Scale (PSS) was administered annually in the Einstein Aging Study to participants (N=507; 71 developed incident aMCI; mean follow-up time=3.6 y, SD=2.0) who were aged 70 years and older, free of aMCI and dementia at baseline PSS administration, and had at least 1 subsequent annual follow-up. Cox hazard models were used to examine time to aMCI onset adjusting for covariates. High levels of perceived stress are associated with a 30% greater risk of incident aMCI (per 5-point increase in PSS: hazard ratio=1.30; 95% confidence interval, 1.08-1.58) independent of covariates. The consistency of results after covariate adjustment and the lack of evidence for reverse causation in longitudinal analyses suggest that these findings are robust. Understanding of the effect of perceived stress on cognition may lead to intervention strategies that prevent the onset of aMCI and Alzheimer dementia.
Perception of stress appears to be a significant risk factor for Alzheimer's disease and overall cognitive decline. This study found that the daily hassles we experience and how we cope with them may be a significant risk factor and this is independent of depression. Learning coping mechanisms such as medication, breathing techniques or other cognitive-behavioral therapies may help to stave off this cognitive decline. It appears that it isn't necessarily the stressful situations, more how we cope with them. Just don't watch TV to cope...I think I'd better get to work on my meditation techniques. 
Thank you for taking the time to read through this newsletter. I hope you have found this information useful as we work together to optimize your health. 


Spending too much time in front of the television may be problematic at two levels. First, we are generally totally sedentary when doing it and there may be some issues with just watching it for over 3 hours daily. For the new year, perhaps this would be a good place to start a healthy behavior.


Don't feel guilty about that cup of coffee, it may be making you live longer. If the caffeine gives you problems, don't worry, decaf works as well!


We are really a chronically stressed out society. It is important that we learn techniques to handle stress. For some, it may be exercise or yoga. Others may tend toward meditation and breathing techniques. Whatever you choose, practice the technique and use it often. It may help you keep your mind - literally! 


As always, if you have questions about anything in this newsletter or have topics you would like me to address, please feel free to contact me by email, phone, or just stop by! 

To Your Good Health,
Mark Niedfeldt, M.D.