Finding a better way to spot memory loss, dementia

ATLANTA - It took Andy and Beth Bussey years to find The Emory Brain Health Center in Atlanta, and an answer to why the 67-year-old retired Columbus father of 4 was struggling to keep up with conversations, or switch gears.

"It was just kind of a real fog," Andy Bussey says."And he was a brilliant engineer, so you don't see this coming," says Beth Bussey.  "You think, 'He is just disorganized. Or, maybe he just has to slow down now to thinks something through.' and you write it off."

But by 2014, Andy Bussey knew something was wrong. So, he went to his doctor, who did a full workup, and sent him to a neurologist in Columbus.

"He talked to me,  and said, 'You just really need to relax, and that went on for three years,'" Bussey says.

By 2017, it was getting harder and harder to run his engineering firm.

"I got to where I really couldn't focus on it anymore," Bussey says. "Fortunately, my oldest son took reign of it."

When the Busseys finally came to Emory University, Andy Bussey was given a full physical and neuropsychological workup. It included a pen and paper test, known as the Montreal Cognitive Assessment, or MoCA. He was asked to performing a series of tasks to evaluate his verbal and visual recall.

"A lot of those, I couldn't get any of them," Bussey remembers. "So, that was kind of not good."

To catch memory loss early, Emory neuropsychologist Dr. Felcia Goldstein says physicians have been using a screening tool during their regular patient exams.

It's known as the Mini-Mental Score Exam, or M-M-S-E, and is designed detect signs of mild cognitive impairment, or MCI.

"And we know that (those) changes start 20 to 30 years even before the person starts to exhibit cognitive changes," Dr. Goldstein says.  "So, the goal is to catch people early."

Patients who take the MMSE are given a score between 1 and  30, with the higher the score the better the patient's cognitive function. But, Goldstein says, the test doesn't factor in the patient's age or level of education, which are both important in spotting abnormal memory loss.

"For example, someone with a 26 on the MMSE now might not even raise a flag," she says.  "They might say, 'Oh, that score is normal. They're doing well.'  But, let's say that person is highly-educated, and really, that 26, for them, is not a good score. They missed 4 points that they shouldn't have missed."

Now researchers are developing an experimental new tool that would factor in the patient's age and level of education, plotting out where the patient falls on a graph of his or her peers of the same age and education.

"They can now see, 'Where that dot is falling," Goldstein says.

The patient might fall into a certain band that indicates the patient's brain is not aging normally, and the drop in score is significant. Or, Dr. Goldstein says, the graph may show the patient is cognitively doing well, and there's nothing to worry about.

When the Busseys were told Andy Bussey is in the early stages of Alzheimer's disease, they felt heartbroken, but, unexpectedly, empowered.

"A diagnosis frees you up to do something," Beth Bussey says.  "By knowing that, we automatically started on medication. My husband was very fortunate to get into a clinical trial."

The Busseys are also participating in a cognitive rehab program at Emory, where they've learned to use notebooks to keep up with their schedules, goals, and information they might need to remember.

Among their goals, to learn how to become beekeepers on their farm, and go skiing again for the first time in decades. They've done both, focusing on making their memories right now.

"It's really worked out," Andy Bussey says.