Those Sunday crossword puzzles may not prevent the ageing brain from slowing down – but they might protect it in a different way, a new study suggests.

Researchers looked at the “use it or lose it” theory on brain health. The concept holds that mentally engaging activities – from reading to crosswords to board games – may help the brain resist dementia later in life.

A lifetime of engagement

In this study, older adults who said they enjoyed those pastimes were no less likely to show signs of mental decline over time, versus other older folks.

But they did, on average, score higher on standard tests of mental sharpness. That means that while they did decline over time, they did so from a higher “starting point”, the researchers explained.

“The results indicate that a lifetime of engagement lifts you to a high point from which you decline, and that can be considered as passive cognitive reserve,” said lead researcher Roger Staff, of the University of Aberdeen in Scotland.

“Starting from a high point,” he said, “will mean that the threshold at which you are considered impaired will be farther into the future.”

“Cognitive reserve” can be seen as the brain’s ability to find alternative ways to get things done. In theory, a person with greater cognitive reserve may be able to withstand pathological changes in the brain for a longer time before showing signs of dementia.

“The idea is that yes, you’ll decline – but the higher the level you start from, the more years you’ll have with good functioning,” said Keith Fargo, director of scientific programmes and outreach for the Alzheimer’s Association.

Protecting mental function

Fargo, who was not involved in the study, saw the results in a positive light – agreeing that they support the cognitive reserve hypothesis.

However, he said, they do not actually prove that study participants’ penchant for puzzles directly boosted their brain power.

That takes “intervention trials”, Fargo said – where people would be randomly assigned to engage in certain mentally stimulating activities or not.

The Alzheimer’s Association is launching a trial, dubbed POINTER, that will test the effects of mental stimulation along with other lifestyle changes – including exercise, social engagement and better control of health conditions such as high blood pressure and diabetes.

It will look at whether those measures can protect mental function in older adults at increased risk of decline.

The latest study included nearly 500 older British adults who had all taken the same intelligence test when they were about 11 – back in the 1940s. Starting at the age of 64, they answered questions about whether they engaged in intellectually stimulating activities, such as solving puzzles, playing board games, reading or going to museums.

They also took standard tests of memory and thinking over the next 15 years – up to five times.

‘Have a hungry mind’

Overall, the study found, people who liked to challenge their minds were no less likely to show mental decline over time. But they did perform better on the memory and thinking tests – especially those who enjoyed problem-solving activities like puzzles.

That was true even when the researchers factored in childhood intelligence and education level.

The results were published in the BMJ journal.

Staff agreed that the findings do not prove a cause-and-effect link. But, he said, they do support the importance of feeding the mind – ideally starting early in life.

“Have a hungry mind,” Staff advised. “It’s like money in the cognitive bank.”

Use your mental skills in a fun way

But is it ever “too late” for older adults to take up chess or crosswords?

Fargo said there’s not enough evidence to answer that question. But, he stressed, research does suggest that adults can help protect their brain health through various lifestyle choices.

Those include exercising regularly, eating healthfully, not smoking, getting enough sleep – and, yes, staying mentally active.

And if you don’t like puzzles, find something else that uses your mental skills in a fun way.

“Most people do get some enjoyment from challenging themselves,” Fargo said.

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For doctors and nurses in hospitals, hand-washing between patients is a must. But what about their stethoscopes?

A new hospital study finds that stethoscopes are laden with a wide range of bacteria. Some, such as Staphylococcus aureus, can cause serious infections such as pneumonia.

Rigorous infection control procedures

The findings were published in the journal Infection Control & Hospital Epidemiology.

“This study underscores the importance of adhering to rigorous infection control procedures,” said study senior author Dr Ronald Collman, a professor of medicine at the University of Pennsylvania.

This means following decontamination recommendations set by the US Centers for Disease Control and Prevention between patients, or using single-patient-use stethoscopes kept in each patient’s room, Collman said in a journal news release.

For the study, researchers analysed 40 stethoscopes in a hospital intensive care unit: 20 traditional reusable stethoscopes carried by doctors, nurses and respiratory therapists, and 20 single-use disposable stethoscopes used in patient rooms.

Additional research needed

All 40 stethoscopes were significantly contaminated with a large number and extensive variety of bacteria, including some that can cause health care-associated infections, the study found.

All had an abundance of Staphylococcus bacteria, and more than half were contaminated with S. aureus, which causes the most dangerous staph infections. Other bacteria that can cause health care-associated infections, such as Pseudomonas and Acinetobacter, were found in small amounts.

However, it wasn’t known if any patients became ill because of contact with the stethoscopes.

Collman said the DNA test used to identify bacteria could not distinguish live from dead bacteria, so it is not clear if the stethoscopes would actually spread disease-causing agents. Additional research is needed to address that question, he said.

The researchers also assessed cleaning of stethoscopes with hydrogen peroxide wipes, alcohol swaps and bleach wipes. Each method reduced the amount of bacteria, but did not consistently lower contamination to the level of clean, new stethoscopes.

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Diabetes has been tied to a number of complications such as kidney disease, but new research has found that older people with type 2 diabetes can also have more difficulties with thinking and memory.

During a five-year study, participants with diabetes showed a decline in verbal memory and fluency. Using MRI scans, researchers saw that the participants’ brains were smaller at the start of the study – but the rates of decline in brain size did not differ over the years the patients were followed. The investigators didn’t find a connection between brain size and the thinking and memory troubles.

Brain function affected

“Although memory and executive function [thinking and planning skills] declined at a greater rate in people with type 2 diabetes, this was not explained by a decline in brain volume,” said study author Michele Callisaya, a research fellow at the University of Tasmania.

Callisaya said the researchers were surprised by this finding. They expected that decreased brain volume would have been more common in people who were having memory and thinking issues. But she added that it’s possible over a longer time, a relationship between these factors might become evident.

And, she added, “The overall message is that type 2 diabetes affects brain function.”

Past research has found that having diabetes might double a person’s risk of dementia, the researchers said. Although previous studies have shown the connection between the two conditions, none has proven a cause-and-effect relationship. That’s what prompted Callisaya and her colleagues to look at whether or not a loss of brain volume might be behind the connection.

They recruited more than 700 people between 55 and 90 years old for the study. At three different points during the five years, the participants underwent testing to measure their thinking, planning and memory skills. They also had an MRI scan each time.

Trouble in verbal fluency

About half of the participants had type 2 diabetes (348 people) and their average age was 68. The group without diabetes had an average age of 73.

The researchers found that people with diabetes had lower scores on verbal memory and verbal fluency tests.

Verbal memory is the ability to recall words, and verbal fluency is a measure of thinking and planning skills. People who have problems in these areas might forget people’s names or have trouble finding things more frequently, Callisaya said. People who have trouble in verbal fluency might have difficulties with planning, initiating and organising things, she added.

The MRI scans showed that people with diabetes had smaller brain volume at the start of the study than people without the blood sugar disorder. But Callisaya’s team saw no evidence that brain size was directly related to the declines in thinking and memory.

Dr Gisele Wolf-Klein, director of geriatric education at Northwell Health in Great Neck, New York, reviewed the findings and said, “While there is no doubt that diabetes is a risk factor for the development of cognitive changes, the relationship with brain atrophy remains uncertain.”

Good, regular exercise

Dr Joel Zonszein, director of the clinical diabetes centre at Montefiore Medical Center in New York City, agreed the study didn’t show any correlation between brain size, diabetes and thinking and memory troubles.

Zonszein said the differences in the two study groups may have played a significant role in the study’s findings. He said the people in the diabetes group were heavier, and had higher cholesterol and blood pressure than people in the other group.

“The take-home message to me is that good early control of all of these risk factors – blood sugar, cholesterol, weight and blood pressure – is important, along with getting good, regular exercise. People who have these risk factors have a higher risk for cognitive decline,” he said.

Wolf-Klein said that, while it hasn’t been proven that good blood sugar management can reduce the risk of brain health issues, “physical activity and a wholesome diet have been associated with a lesser risk of dementia in the general population, as well as a decreased incidence of diabetes.”

Callisaya agreed. “What’s good for the heart is also good for the brain,” she said. In addition to a healthy diet and regular activity, she also recommends to stay social and to keep challenging your brain.

The study was published in the journal Diabetologia.

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When Dr William White shines a bright light in his patient’s eye, he’s looking for more than just vision problems.

He’s searching for clues indicating the effects of high blood pressure, or hypertension, and what he finds could help prevent heart attacks, strokes and other serious health problems far beyond the eye.

‘The silent killer’

“We can see changes due to vascular conditions caused by diabetes or hypertension,” said White, an optometrist with Baylor Scott & White Health in Temple, Texas. “The blood vessels in the retina can become a little more stiff and hardened. They’ll push on each other and cross, like two hoses in a confined space.

“When it gets really bad, we’ll see some of the blood vessels start to leak; we’ll see some haemorrhaging. And that can cause a whole range of vision issues.”

Vision symptoms may not show up for years. But ultimately, high blood pressure can result in hypertensive retinopathy, blood vessel damage causing blurred vision or loss of sight; choroidopathy, a buildup of fluid under the retina that can distort or impair vision; or optic neuropathy, a blood flow blockage that can kill nerve cells and cause vision loss.

Similarly, high blood pressure may not reveal itself for decades before causing a heart attack or stroke, which earns its grim description as the “silent killer”.

That is why detecting high blood pressure early and treating it with diet, exercise and medication is crucial, and why White says eye doctors are on the front lines of the battle.

Eye doctors need to educate patients

“Sometimes people will say, ‘I’m just here to get my glasses. Why are you checking my blood pressure?'” he said. “We try to inform them about the unique opportunity we have to look at these blood vessels in the eye.”

A 2013 study reported in the journal Hypertension underscored the point. Researchers checked about 2 900 patients with high blood pressure for hypertensive retinopathy, then tracked them for an average of 13 years. They found that those with a mild form of the condition had a 35% greater risk of stroke. That increased risk leaped to 137% for those with moderate or severe hypertensive retinopathy.

Although more research is needed to confirm the findings regarding stroke risk, White has no doubt about the crucial role of eye doctors to educate patients about the need to control blood pressure.

“You’re not just a pair of eyeballs walking into an exam room,” he said. “We have to look at the entire person and the whole picture. These are things that can impact their lives significantly, and we have a responsibility for their overall health.”

‘I don’t like going to the doctor’

But doesn’t every medical checkup start with a blood pressure check? And doesn’t every pharmacy have a machine to measure it yourself?

White said many people would be surprised how many of his patients rarely see another doctor, or if they do, don’t always follow medical advice or don’t take their blood pressure medication.

“Some people don’t go for a routine checkup every year,” he said. “They tell me, ‘Look, I just don’t like going to the doctor.’ But their eyes are a problem, so they’ll come to us.”

Knowing the risks of high blood pressure, White said, keeps him vigilant.

“It’s so important because of the silent nature of this problem,” he said. “People can feel absolutely fine, but high blood pressure has a cumulative effect. If it’s uncontrolled over years, it’s going to cause damage later in life.”

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