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Dr. Marwan Sabbagh – The Cutting-Edge Research on Alzheimer’s

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Dr. Marwan Sabbagh

Dr. Marwan Sabbagh is a board-certified Geriatric Neurologist at the Cleveland Clinic Lou Ruvo Center for Brain Health, specializing in Alzheimer’s disease and other forms of dementia. He has dedicated himself to finding a cure for Alzheimer’s and similar neurodegenerative diseases. His expertise has earned him the position as the Camille and Larry Ruvo Endowed Chair for Brain Health.

Dr. Sabbagh authored the book, The Alzheimer’s Answer: Reduce Your Risk and Keep Your Brain Healthy, which translates his research into practical advice to help cognitive function for his readers. In addition, he has written and co-written over 300 scientific articles on research surrounding Alzheimer’s.

Here’s a glimpse of what you’ll learn: 

  • Dr. Marwan Sabbagh describes how he became an expert on Alzheimer’s disease
  • What should you do if you suspect a loved one has dementia?
  • Dr. Sabbagh talks about research on blood tests for identifying dementia
  • The intersection between hearing loss and Alzheimer’s
  • Different ways to keep your brain healthy
  • What is the field of Alzheimer’s going to look like in 10 years?

In this episode…

There are many diseases that were once written off as incurable, but can now be managed through innovations in science and medicine. Take diabetes as an example, which once had a high mortality rate. Now, most people with diabetes are able to live normal lives. However, when it comes to Alzheimer’s, the best-case scenario is slowing down the process for someone — or is it? 

Recently, there has been research that suggests a better solution is on the way. Whether it’s through early tests or advanced treatment, these neurodegenerative diseases might soon be manageable. Want to know more?

Dr. Mark Syms hosts Dr. Marwan Sabbagh, a board-certified Geriatric Neurologist at the Cleveland Clinic Lou Ruvo Center for Brain Health, to learn about the new research on Alzheimer’s and other neurodegenerative diseases. They talk about the recent developments with blood tests and medicine from leaders in the field. They also go over ways to reduce your risk of diagnosis and advice for family members with early symptoms. Find out more on this episode of the ListenUp! podcast.

Resources mentioned in this episode

Sponsor for this episode…

This episode is brought to you by the Arizona Hearing Center.

The Arizona Hearing Center is a cutting-edge hearing care facility providing comprehensive, family-focused care. Approximately 36 million Americans suffer from some sort of hearing loss, more than half of whom are younger than the age of 65. That’s why the team at the Arizona Hearing Center is focused on providing the highest-quality care using innovative technologies and inclusive treatment plans. 

As the Founder of the Arizona Hearing Center, Dr. Mark Syms is passionate about helping patients effectively treat their hearing loss so that they can stay connected with their family and friends and remain independent. He knows first-hand how hearing loss can impact social connection and effective communication. By relying on three core values—empathy, education, and excellence—Dr. Syms and his team of hearing loss experts are transforming the lives of patients. 

So what are you waiting for? Stop missing out on the conversation and start improving your quality of life today!  

To learn more about the Arizona Hearing Center, visit https://www.azhear.com/ or call us at 602-307-9919. We don’t sell hearing aids—we treat your hearing loss.

Episode Transcript

Intro  0:04  

Welcome to the ListenUp! podcast where we explore hearing loss communication connections and health.

Dr. Mark Syms  0:15  

Dr. Mark Syms here I’m the host of the ListenUp! podcast where I feature leaders in health care. Today we are going to feature Dr. Marwan Sabbagh. He is a excellent neurotic neurologist. This episode is brought to you by Arizona Hearing Center where we only treat ears, I’m the E of ENT. I am passionate about hearing loss because I lost my brother twice. I listen first to hearing loss from radiation to his brain tumor, and then again to the brain tumor itself. I’ve performed over 10,000 surgeries. I’ve taken care of 1000s of patients with hearing loss and we’re dedicated to treating hearing loss better. I’ve written a book called Listen Up: A Physician’s Guide to Treating Your Hearing Loss. If you want to learn more about that go to www.listenuphearing.com. If you want to learn more about my clinical practice, go to www.azhear.com. Today I have Dr. Marwan Sabbagh. He is a Board Certified neurologist and is a leading expert in Alzheimer’s and dementia. He attended Berkeley undergraduate University of Arizona for medical school. He did his residency at Baylor and did a fellowship at University of California San Diego. He is at the Cleveland Clinic, Camille and Larry Ruvo brain chip brain sorry, center for brain health in Las Vegas. He’s going to be relocating to the Barrow Neurological Institute shortly. He’s authored multiple books, and has has several 100 peer reviewed journals. He is a rock star in dementia, and Alzheimer’s, and we’re here to talk to him. I’m very happy to have him today. So welcome. 

Dr. Marwan Sabbagh  1:42  

Thank you for including me.

Dr. Mark Syms  1:44  

Oh, my pleasure. Can you tell us what’s your journey to being an expert and having a passion about Alzheimer’s?

Dr. Marwan Sabbagh  1:51  

So that’s a question I get asked from time to time and people. I’m not racing against the clock, my parents are still alive. And there’s still a hole, at least cognitively. It was the fear of getting old. But when I was in college, I had this deep seated fear of getting all and I said that Alzheimer disease is the embodiment of everything sad and destructive about getting old. And I decided very early on 18 years old, that I would dedicate the entirety of my life and career to managing and taking care of people with Alzheimer’s. And that’s how I got into it.

Dr. Mark Syms  2:27  

Yeah, I guess, you know, when we look at people hearing loss, that deep seated drive is independence, right? The desire to, you know, one of the reasons people treat hearing losses is frankly, they’re afraid that their kids are going to say, Hey, Mom, Dad, you’re losing a step. You know, you’re not as sharp as you want, you’re not gonna be able to take care of yourself. So it’s interesting. It’s kind of the same driver. Are you deeply independent? I mean, is that part of who you are as a person? 

Dr. Marwan Sabbagh  2:51  

Yeah. I, I want to live the the totality of my life in its fullest extent. And I don’t want any of it to be compromised from physical or cognitive disability.

Dr. Mark Syms  3:04  

And that’s great. I mean, I think it’s awesome. We all, as we know it, seemingly in both of our lives. I think we’re about contemporaries, right, you know, 40 40, 50 becomes a new 40, 60 becomes a new 50, it seems to be keeping on at least from what I what I hear, and I want to hear keeps on moving up, right. So So let’s say somebody has a family member who they suspect has a cognitive issue or dementia, what should they do? What are the steps? Or what should they look for? What would you give their advice? 

Dr. Marwan Sabbagh  3:34  

The first thing I would say is, don’t wait. If you’re saying, you know, dad or mom is repeated, that are getting lost in their neighborhood, don’t attribute it to forget, you know, just they’re depressed, they’re sad, if there’s an issue and you’re noticing it that change for them, go get a checkup. And I will say to you that I know a lot of doctors though, primary care, they take mom and dad to the primary care like a, it’s just the depressed he said it. And they don’t the doctors themselves don’t take it seriously. So that’s number one. Number two is understand that the changes in the brain that lead to Alzheimer dementia can start 20 years before the first day of forgive them. So by the time they walked into my clinic, the dimensions, the end of the disease, not the beginning of it. So it’s kind of like, you know, metastatic cancer really effectively by the time they come in the door, that door is spread. So I think again, don’t wait, because if there’s a problem, we should take it, tackle it head on early on, get it thoroughly evaluated.

Dr. Mark Syms  4:35  

So you’re saying the dementia is the product of the process that’s been going on for 20 years? Is that right? 

Dr. Marwan Sabbagh  4:40  

That’s exactly right. 

Dr. Mark Syms  4:41  

And so that process is detectable How?

Dr. Marwan Sabbagh  4:44  

So this is a critically important question at this moment. Dr. Syms because the fact is that, you know, until now, we have relied too heavily on clinical screening measures. There’s clinical screening evaluations, but we’re now seeing a transformational moment in the field. That’s not science. Research is transformational in that we are now starting to detect, biologically the changes of Alzheimer’s. So we had PET scans which are not covered by Medicare, we had spinal fluid analysis, which is covered by Medicare. But now we’re looking at the reality of blood tests, which are actually starting to wind their way into the clinic, although not routine, or they’re not common in there are widespread, but the idea of a blood test and like a hemoglobin a one C, or a PSA for a man that’s coming now, not 10 years from now, not 20 years from now that’s coming now, those kinds of tests are becoming rapidly available. So we’re in a transformational moment. Imagine you go to the primary care physician is like, you know, my memory, you have your annual Medicare screening tests, my memory is either not as good as it was, or the doctor decides to do a brain memory test and it’s not good. Instead of just deciding what to do next, they just get a blood test. If you have Alzheimer changes. And if it’s abnormal, then you would refer on if it’s normal, then you don’t refer all these the kinds of transformational moments that are occurring, and you will see become routine in the next few years.

Dr. Mark Syms  6:08  

You know, I’m being serious, it’s a bit of a joke, but that’s a lot easier than a colonoscopy.

Dr. Marwan Sabbagh  6:13  

Oh, yeah. People joke to me, I really, you know, like I said, we’re probably contemporaries, you and I, you know, they used to say, Why do you go neurology is diagnose and Adios. We don’t do that anymore. We’re actually looking at Alzheimer’s, I should say, all neurology is a therapeutic field. And Alzheimer’s will join the pack here very well. 

Dr. Mark Syms  6:34  

Certainly, if you can get people further upstream, meaning before the end and organ manifestation of it, you’ll be able to try therapies that would then prevent progression. Like you’re saying, with metastatic cancer, it’s kind of the game’s kind of over if somebody’s got it all out their body things. But stopping it before it goes, there is really what the goal is.

Dr. Marwan Sabbagh  6:54  

And eventually so I see if we get to it, the Alzheimer’s is going through this transformational process, but we are in we could see within a few years detecting it before you have simply Okay. And then and then either vaccinating in a way, or doing something to prevent you from ever getting to dementia, that that’s not that far off. Maybe people think that science fiction, but that in my world that these people were having those discussions and doing those studies now.

Dr. Mark Syms  7:22  

That’s great. So So are you doing those types of blood tests in your clinic experimentally?

Dr. Marwan Sabbagh  7:27  

Yes. So interestingly enough, quest diagnostics habit ran, rolled out a test, it was no, not that good in terms of sensitivity and specificity. But there’s a company out of St. Louis called PTN, which now has a brand new blood test called the precipitate blood test. And yes, we are starting to roll that out here. And I expect that will be widely available in the country by six months from now. There are two cut technologies right on the heels nipping at the heels of this company. One is called the Quanterix Simoa platform. And then the other one’s called the MagQu IMR platform. So you know, this first one is not going to be the only one. Imagine like everything else, there’ll be several products on the market within a few years.

Dr. Mark Syms  8:15  

Competition is good, right? Because this area will get great innovation and rapid marketplace will make them innovate with pricing pressures to which will be great, too. 

Dr. Marwan Sabbagh  8:25  

And costs will come down too.

Dr. Mark Syms  8:27  

Great. That’s awesome. That’s really interesting to have. I had no idea. So I wonder if I will. We’ll talk offline whether or not I do okay. I’ll leave it at that. So you know, as you know, my passion is hearing loss, what what role do you see hearing loss and dementia? there? We were talking in the pre interview about sensory issues, right? These people.

Dr. Marwan Sabbagh  8:48  

Interestingly enough, the intersection it was only kind of looked at recently, you know, we’ve seen all the same population that gets Alzheimer’s and other dementia in the same population that has a sensory deprivation through hearing loss, but we never kind of insect intersect the two until quite recently, we just said, you have them and you have involved but but now we’re seeing Of course, that hearing loss and as a sensory deficit, can make the cognitive deficit worse, or appear worse. So they may in fact, there’s a few study just came out recently saying that they tested people with the hearing loss. They did the cognitive neuroscience better system. They did the same test, after they corrected the hearing. And lo and behold, 25% improvement on cognitive testing, and people like oh my gosh, maybe we should be correcting for their hearing before we give them the test. And that is, I mean, that sounds obvious to you because this is your job. But to us dementia people like oh, that’s it, that’s a revelation, which is that the light bulb went off.

Dr. Mark Syms  9:53  

Yeah, well, it’s more painful than that. I mean, I’ll just 30 of the statistics so only 20% of people with hearing loss treat. Oh my goodness, but only, only a third of them have been treated appropriately, which means only 8% of people are treated. And that’s why I decided to pursue I mean, this has become kind of my passion. I mean, I can surgery, but this is really where I think there needs to be more physician leadership. So, uh, yeah, I don’t know if you but you know, there was the big. So in our field, what really got lit up was the Lancet study group paper in 2018, where they basically showed it, hearing loss is by far the most modifiable factor to to improve your, your cognitive ability. Yeah, absolutely. So I was just blown away. I mean, it was like, I don’t know fivefold greater than like cholesterol, exercise, diabetes, control, no smoking. I mean, it’s the only thing that’s better is like, I think childhood education is a better thing to prepare cognitive stuff that obviously, for most of us is beyond us at this point. Do you see any role of screening people for hearing loss? I mean, you kind of touched on it.

Dr. Marwan Sabbagh  11:05  

You know, I think that it has not made its way into clinical practice routinely, but it would make a lot of sense. And particularly, you know, we talk about the Medicare annual visit, right, you know, we in the Alzheimer space, kind of are taken aback that, you know, you’re getting osteoporosis screening and depression screening and cholesterol screening and colon cancer screening, what’s not doing cognitive screening. And so we in the Alzheimer field think that should be corrected. But, you know, I think you have a better shot of getting your hearing address, but maybe you should do both routinely, right, cognitive and hearing. But it hasn’t, hasn’t made its way into practice.

Dr. Mark Syms  11:52  

Yeah, that the hearing space has had challenges. You know, we don’t have really good data to demonstrate, you know, that, that the screening is worth it. And then the other issue is hearing aids are not covered by Medicare. And so I think there’s, you’re maybe opening some of this up in terms of who can and can’t do it. But I agree 1,000%, I mean, and so for me, the thing that’s amazing is, one patients don’t perceive their own hearing loss because they compensate with speech reading and contextual. And I, you know, I know that a lot of physicians don’t realize people have hearing loss is a community, I say to patients, just because you communicate effectively does not mean you hear well, it just means you compensate for your hearing loss. Or as unfortunately, it’s kind of like, in your space, you don’t know what you don’t hear, which is kind of like you don’t know what you don’t remember. Right? I mean, you know, the so and so outside of that, what other things would you advise people to do to keep their brain health and keep, you know, what are the other things? So obviously, this emerging blood test will be huge for people. But you know, what others are, you know, when you were sparked at 18, and you wanted things to be high quality, like exercise, I assume, but what other things would you tell people? 

Dr. Marwan Sabbagh  13:03  

So you talk about the Lancet commission, there’s-

Dr. Mark Syms  13:07  

Other things like when somebody comes in and says to you, I want my brain to be better. I mean, your sudoku, or is it what is-

Dr. Marwan Sabbagh  13:15  

So it’s all of it. So, if you follow the National Academy of Sciences, medicine, engineering, there are three official recommendations, blood pressure management, okay. stimulation, and physical exercise, those now have sufficient evidence to say they’re enough to that you should recommend them to protect the brain and cognitive health. But you know, the Lancet commission now recommends a lot of things, you talk about sensory deprivation. So we think that we know there’s plenty of evidence about those three things that I’ve recommended. The data on, diets is kind of soft, trending, but soft. Heart disease,

Dr. Mark Syms  13:53  

If you the though, if you keep your heart healthy, right?

Dr. Marwan Sabbagh  13:58  

The data on supplements is soft, but there are things you can do physical exercise is as good as prescription medications, hard stuff, okay. cog stim, you know, brain games. We understand that socialization, we understand it, managing mood, we understand that taking care of things like sleep apnea, we understand that certain diets are probably protective. So it’s not just, oh my god, I’m forgetful. I’m going to go to Costco and buy the whole roll of supplements. And that’s good enough, right? 55 and I know that cognitive health starts today. And I exercise every day and I eat right every day and I try to get good eight hours of sleep. And you know, I believe I drink the kool aid that I’m telling people I actually do it myself. You’re walking the walk, you’re running my family, I still do it because I believe in cognitive health.

Dr. Mark Syms  14:49  

Yeah, I think the cognitive I mean, you know, if your say your three recommendations, right, low blood pressure physical is the cognitive one that, you know, for a lot of people they’re kind of trying to figure out what Is that right? Because, you know, I had a relative who thought that she got a lot of exercise because she’d go out and hang the laundry and the laundry line every day. I was like, well, that’s not actually exercise such as doing your activities of daily living. That’s not the good part, right? So what what type of things would people do, you know. 

Dr. Marwan Sabbagh  15:17  

For physical exercise, we would basically follow the American Heart Association guidelines. So 30 minutes of moderate to least vigorously exercise five days a week, or 150 total minutes a week would be good. So when I tell people to build that in their life, you know, changes heart is. And I’m saying, you know, taking your dog on a walk, and sniffing every bush does not count as exercise, you know, you need to, if you’re going to walk, walk, right. And I usually try to be prescriptive about it. And you know, when people have been set in jail, so you don’t like every other doctor, you got to start exercising, guess what they do? They’re like, yeah, yeah, yeah, I’ve heard that before. And they don’t do it. So I say start with 10 minutes a day, every day, like it’s medicine, right? 10 minutes a day, and add one minute, a week to this week, 10 minutes a day next to 11 minutes the next day, and walk with purpose, robust, physical, you know, and keep going, you know, in, in six weeks, you’re at whatever, that’s 42 minutes, there are some that are actually say, 16 minutes, and then you can get the and then your body’s used to adapt to get there after a while.

Dr. Mark Syms  16:30  

Now, that’s great stuff. I mean, I guess, you know, the other problem is, I’m not sure surfing Facebook, or looking at Instagram is cognitive stimulation,

Dr. Marwan Sabbagh  16:39  

it still has to be something interactive. And that stimulates the brain. So there, you know, there’s become a cottage industry, in the brain games and brain stem. I think the best one and I have no ownership, just just tell you that I have disclosed these things. BrainHQ I think probably has the best one is that remember Lumosity was the one that caught everybody’s imagination. But you know, Lumosity is one of dozens and the brain games in general, are the things that I would say, I my dad is 88. And he’s trying to learn a new language. And I’m like, Good for him. That’s great. Yeah, you know, stuff like that. So try to do something that your brain wouldn’t normally do. And just numbing yourself with Facebook or Instagram is not the there’s not necessarily.

Dr. Mark Syms  17:31  

What about conversation is that?

Dr. Marwan Sabbagh  17:34  

As long as you recalling them and staying with them? Yeah, sure, I think you need to do something that would be beyond the norm. Like, for example, I, I, I I have no patience for Sudoku. But I try to read four books at a time. Because I get bored reading them. And I try to remember four books at a time. So that’s what I’m doing. 

Dr. Mark Syms  17:57  

That’s a lot. Yeah, I mean, Well, it depends if they’re, especially if they’re all like, same genres, that’d be very hard. But if they’re very different, though, that’s good. Because I have a really hard time, all of a sudden, I don’t think I could do for murder mysteries or something like that would be a little hard. So that’s good. So you know, you touched on a little bit like where do you see the field going, like 10 years from now, you know, you see therapeutics for these markers, or what do you see?

Dr. Marwan Sabbagh  18:27  

So I think we’re gonna undergo a three generations of change in the nekteck. One is we’re in the moment in time that I’ve been talking about for years, where we’re going to transform Alzheimer’s disease from a terminal disease, you and I know it to a chronic disease. This is the diabetes and HIV of our time. I graduated from medical school 30 years ago, and I remember very distinctively in medical school. You know, if you had diabetes, you were going to get amputated blind, and on dialysis, that was like, done. Now you get diabetes, then you live a normal life. And that’s-

Dr. Mark Syms  19:03  

And it gets regulated. And yeah.

Dr. Marwan Sabbagh  19:04  

And that’s become normal. I believe Alzheimer’s will be in that transform is the beginning of the transformative moment, for all the firestorm of controversy around this new monoclonal antibody. And understand I’ve been in the middle of that conversation. So that today, by the way, yeah. I want to say that this audience, this is not one drug there for drugs right behind it that are pretty much doing the same thing. And doing a B maybe potentially even better. So stay tuned, we’re gonna have five or six new drugs on the market in a matter of two or three years. It’s a very exciting time to be in the outback.

Dr. Mark Syms  19:44  

Because that number is there. Are there like brain coaches? Are there people who are doing this type thing where they’re coaching on all all phones? 

Dr. Marwan Sabbagh  19:51  

Oh, yeah, bar but centers of excellence that I’ve been part of him we’ll have we have more of an Arizona are doing these very So, you know, a good news for you for this audience is Arizona is one of the hotbeds of Alzheimer’s studies, research and treatment.

Dr. Mark Syms  20:09  

So how does that work? You get assigned somebody is it, you’ll be assigned to a job? Yeah, that’s great. 

Dr. Marwan Sabbagh  20:16  

The second thing is, is that we’re going to be able to biologically determine people at risk. And third thing we’re going to be able to do is, is maybe prevent Alzheimer’s outright, you’ll never get it. I think that’s maybe a little bit down the road, but not impossible. 

Dr. Mark Syms  20:33  

Do you see it as a, I mean, then you would have to find a few pathways of etiology. Right?

Dr. Marwan Sabbagh  20:40  

Yeah. And those are, biologically we’re understanding, you know, people don’t understand we know a lot more about the disease, most people think, and way more than Dr. Google tells you, is going on, you know, everybody gets their information on Google. There’s a lot of things going on in this week. It’s funny, you and I should have this conversation because our major global trade trade, meaning the Alzheimer’s Association, international conference is going on as we speak, in Denver this year.

Dr. Mark Syms  21:04  

Is it virtual? 

Dr. Marwan Sabbagh  21:06  

It’s hybrid. So 90% of the attendees are attending virtually in 10% are there in person and I will in fact, normally I’d be there but COVID kind of had a say in what I did.

Dr. Mark Syms  21:21  

Yeah, I mean, our academy meetings in Los Angeles, I’m not sure anybody, not because they don’t want to go but I’m just gonna. Okay. Well, this has been great. I really appreciate. He’s an expert on Alzheimer’s in neurology. It’s been great to have him here today. Thank you so much for coming on the show. 

Dr. Marwan Sabbagh  21:39  

Thank you for including me. 

Dr. Mark Syms  21:40  

Thanks. Appreciate it.

Outro  21:46

Thanks for tuning in to the ListenUp! podcast. We’ll see you again next time and be sure to click subscribe to get updates on future episodes.

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