Comedy and Courage: Comedian Richard Lewis on Living with Parkinson’s Disease

Episode Transcript

Dr. Daniel Correa:
From the American Academy of Neurology, I'm Dr. Daniel Correa. This is The Brain & Life podcast. Saludos, I'm glad you're back with us on the Brain & Life Podcast. Some of our longtime listeners know that I grew up in the eighties, but for the rest of you, one of the aspects of my childhood in the eighties particularly was laughing along with lots of different TV shows. And that includes our guest today and actor who I laughed along with for many years and has started with Richard Lewis's role as Prince John in the movie Robin Hood: Men in Tights.
And then many of his later characters on other TV shows. Today this episode continues our content about Parkinson's disease. Please make sure to go back and enjoy our episodes with American Ninja Warrior, Jimmy Choi and NBA veteran Brian Grant, who both experienced a young onset of their Parkinson's disease symptoms. While most people first developed their symptoms after age 60, about five to 10% could experience the onset of symptoms before the age of 50 like Brian and Jimmy.
But Richard had his onset of symptoms around the age of 72, which is more typical. Recently, he has started sharing about his symptoms, diagnosis and how he's learning to live with hope and gratitude. Make sure also to subscribe and follow the podcast so that you don't miss some of our upcoming great content. We will be having David Arons, the chief executive officer of the National Brain Tumor Society on. And stay tuned to that episode to learn more about the National Brain Tumor Society, the updates on what we know about brain tumors and the latest direction of research.
We also have an interview coming up with the bestselling author Dan Buettner, who talks about Blue Zones and also the new Netflix docuseries Live to 100: Secrets of the Blue Zones. I'm guessing that many of you have already had conversations with friends about these episodes. We also have exciting news. Our team is growing and next week we'll be introducing a new team member to you in our Brain & Life community. I hope you enjoy this episode. Today our guest is actor, writer, standup comedian with over 50 years on stage that many of you know from Curb Your Enthusiasm and a long line of movies and TV shows.
We can't even list them here. Most recently he's opened up about his own diagnosis of Parkinson's and we're glad to have him here on the podcast to share his own story and so we can talk about this condition. Thank you so much for joining us, Richard.

Richard Lewis:
It's my pleasure, doctor, and for anybody who's listening, I'm doing this not only to learn for myself but to let people know that we can fight this and there's a lot of things being done now that are moving along in research. And quite frankly at my age now, and I'm a recovering alcoholic for almost 30 years, that disease, I'm taking a day at a time and I'm taking Parkinson's a day at a time. That's why I'm wanting to meet you and hear what you have to say.
I saw a news show yesterday and Michael J. Fox was on and he said with gratitude, optimism is sustainable. And I just wanted that to be on the tape because it's a very important statement that he made and I'm going to try to live by it the rest of my days.

Dr. Daniel Correa:
I want to go back to even to the beginning and learn more about you. What made you go into standup and acting? What drew you to that career path?

Richard Lewis:
Well, quite frankly, I came from a family that was all into their own heads and I felt I was tethered to nothing like a painting. So when I graduated college, I went to Ohio State University and I got a degree in marketing. I thought I'd be a copywriter and I was for a while, but my father died soon after I graduated. I was 21, I was broke. I was born in New York, but I was living in different apartments in New Jersey. And when my father passed away, I decided that since I'd always been funny and that humor was the most important part of my family. In real life, it wasn't a great upbringing.
But when we would watch TV back in the fifties and early sixties of great TV shows, Jackie Gleason and Phil and Milton Berle and all of these shows when I was a little boy. My family would sit on one big bed and we would watch these shows and we would laugh out loud and it was a great moment for me because I heard all the tension in the family. I wrote a book about recovery for The Other Great Depression. And I remember one essay I had was when there was so much yelling and arguing going around in the house, I would be in my bed and I pulled the covers over me.
And I had this image when I was a little kid that I had a candle in my belly and I said that no matter what goes on in this family, they'll never blow that candle out. And that candle for me was hope, and I'm trying to latch onto that same candle now with Parkinson's. I felt that since comedy was such an important part of my childhood, connecting with life and feeling good, and I had more dopamine then than I have now, unfortunately, darn it. But I started writing jokes for all the comics, but they weren't very famous.
And they would hand back all the good jokes and all the good jokes was about me and I said, "Wait a minute, there's something going on here." And then I realized that unless I went on stage and found my authentic self as a humorous and a standup comedian, that my life would be basically a waste of time. So I was propelled on stage soon after my father died and I never looked back. I mean, I knew that I had found home. And one thing led to another and Johnny Carson, David Letterman, shows, concerts, Carnegie Hall, little clubs, big clubs, opera houses, you name it. 50 years on the road.
It's been a blessing in my life. I had two people that were very important to me in my career. There were so many, but Jamie Lee Curtis had a show back in the late eighties called Anything but Love. It really put me on the map. And then of course in 2000, Larry David, my best friend, we were born in Brooklyn in the same hospital three days apart. He became a legendary writer, the Norman leader of my generation. And when he did Curb Your Enthusiasm, he came over to my house, doctor, and he said, "I'm doing this show and I'm playing myself and I'd like you to play yourself."
I mean you don't turn down Larry David, but I said, "I don't want to just do one episode, I want to have an arc. I want to be in three or four the first season." And he agreed to do that, and the rest is history. We just finished the 23rd year, the 12th season, so into my early seventies, I'm on a cult show. I had a very blessed life on standup.

Dr. Daniel Correa:
Over your career at times, many of your characters or even some of your jokes, they focus on a little bit of a neurotic character and often talking about health even in those instances. What was it that changed for you offstage that made you realize something was wrong with your movements or your coordination?

Richard Lewis:
Well, let me just to go back to one step. I was always neurotic and always a hypochondriac and some of the titles of my tours and my HBO specials I had, "I'm in pain, I'm exhausted, I'm doomed." I always felt that something was going to happen to me, but I had a pretty lucky life for 72 years. But what happened was it wasn't initially the Parkinson's and no one's ever sure when it's finally there. About a year before I had some really bad luck for three and a half plus years.
My back is really bad. I have scoliosis and stenosis and I had this horrible bout of horrible pain for months and I finally had an operation for the sciatica nerve. So I did that and it did fairly well. But after I got my operation, I started working out with my trainer and I was in my swimming pool and I came out and I slipped. And I smashed my rotator cuff and I had to be rushed through surgery, but they couldn't fix the rotator and that was the second operation in eight months.
So I had to go back in five months later and get a reverse shoulder replacement. So that's three surgeries in under two and a half years. I was finally getting it together, doctor. And my wife was out with our little dog, Lila, and I was just going into the backyard and just going to walk around the pool for about 25 minutes or so. And I slipped on a rag on my steps and I fractured my hip. I was in a state of shock. My wife, luckily she was here in town, but I think it was as close to having a nervous breakdown as I ever had.
I was shrieking for help and I couldn't believe after these three operations that I knew that I would have to go all over again. My wife came home, she was terrified, but she got the ambulance and I went to a nearby hospital, but I had to start rehab again for the fourth time. So I would say midway through these four operations, and I think it's important to mention these other operations because my state of mind wasn't good to begin with.
I think that when I started freezing, when I got to doorways and I started shuffling. I went to a neurologist and in his office he had me do some tests and I walked down his hallway. I was there with my wife and I fell in his hallway, so that's all he needed to know and he got me to get a brain scan and then it was legitimate. I had Parkinson's disease. Once I learned I had Parkinson's and I was shuffling, and even this morning when I got out of bed.
I mean I take dopamine four times a day, but I have to really plan it out and I know it brings anxiety and depression, so I've read. I want to go out and do things more. Here's a simple example, with my wife. My friends would say, let's meet at this restaurant. In the past, I said, sure, but now I say, do I really want to go to a restaurant? I went to a restaurant a month ago with Larry David. I went and we had a great time.
I was with him and one of his daughters who I love and my wife Joyce, and we were just laughing for an hour, hour and a half. It was a packed restaurant and people recognized us. It looked like we were doing a scene from Curb. We're laughing and taunting and teasing each other. So then I had to get up and go to the bathroom not thinking about anything except what fun I'm having. And as I walk out of the bathroom, it was a very narrow doorway and I couldn't walk.
I froze and everyone is looking at me. I somehow got a message to my wife to help me. Poor Larry and his daughter, I learned a lot from that night. I learned that I have to own this disease. It doesn't define me, it's just part of me now. It's easy to say after the fact but I was embarrassed that night because it was the first time with a big scene like that. I'm sitting with Larry David, but I guess what I wanted to just share with people is that in terms of going out and being sociable, you got to just do it depending on how bad your situation is.
If I just stay in these symptoms for a while, I could go out. I mean it takes me longer to shower now, I have bars everywhere. It takes me longer to get dressed. I mean life has become more difficult, but it could be much worse than it is. We all know that. I like to try to remember that.

Dr. Daniel Correa:
I'm thinking back to what it must be to work on a set for one of your tours and all of the time it takes not only work or shopping jokes, but then getting out on different stages and just trying things out and it takes a lot of steps. And some of that you probably in a very different way had times in the past where you were either bombed on stage or felt just totally frozen and had no idea where you were going.
I think you were just saying, the only way you can figure out how you are going to live with Parkinson's and your own symptoms in your own life is you have to take those small steps together with those partners and those people in your life that care for you. Because that's the only way you'll figure out how to manage when you freeze in public.

Richard Lewis:
The analogy you were making after 50 plus years on stage, I knew what to do going on stage. I never did the same act ever. Every night I would go on, I would look at thousands of premises a day or two before a concert, so I just was free-associating most of the time and thinking of new things that made me feel alive on stage and a better artist. But in terms of the steps for Parkinson's, pardon the pun, I feel that you have to live within your problems. I can walk. I'm not in a wheelchair and I don't need a cane yet, so that's the good news.
Like this morning when you get up, that's after a lot of hours without dopamine. There are many times when I freeze, get out of bed. And my doctor told me one thing that I've been trying to incorporate in my life, to realize that when it happens that you shouldn't be shocked by it and surprised and like, "Oh my God, what is this?" I know it's going to happen and it's going to progress most probably. And I also stand still the best I can because if I try to walk and I'm not ready to walk, I start tiptoeing and it's wreaking havoc on my knees.
I try to stop and take deep breaths and take a deep breath in, and take my step when I exhale. It's really a baffling disease because when you consider that my legs have the strength to walk, but I'm not allowing myself to, it's just mind-boggling. I'm sure everybody that first comes in touch with this disease, unfortunately, they have the same feeling like, why is my brain trying to screw me over like this? Be silly about it, but that's how I feel.
I mean, I get angry. I get very sad sometimes when I'm alone. We don't have any kids, but even our little rescue dog who I adore. My wife is out, she'll come to the bedroom and she'll want me to leave the room. So she will stand in front of me and walk ahead of me and I go, "Lila, don't stop." But when she stops, I can freeze. Here I am trying to convince our little dog, a little eight pound dog to keep going. Your father needs to walk. Don't stop him.
I retired from standup before all this happened. I retired at the top of my game and it was a great tour and after 51 years, enough. So now I even do a podcast now approximately once a week with friends of mine in and out of the business. I did Peter Frampton today and he's suffering from another disease that's similar of some sorts, but it's muscle weakness. He does a lot of charity stuff and I plan to do that as well.

Dr. Daniel Correa:
You talked earlier about how you've had both anxiety and depression that has changed or increased after your diagnosis maybe related to feeling so limited and your mobility and being able to socialize. What did you learn in the past from how you've dealt with anxiety and depression in your history or in recovery from your alcoholism that you're trying to put in place in managing your condition and those mental health symptoms now?

Richard Lewis:
I'm not perfect at this. I don't think anyone is. I certainly try to reach out and not isolate. I would have a tendency to isolate. By definition, touring as a standup comic, I didn't travel with people. I was my own guy and I'm used to isolating and preparing. I need it as an artist on stage, as a comedian. But with my alcoholism, I clearly met tons of people that were addicts who wanted to help me. I was in psychotherapy and psychoanalysis. My last therapist who I just actually Zoomed with, I hadn't gone for about eight or nine years.
I felt the need to reach out to my last therapist. I had gone to her for 20 plus years. She's a brilliant, magnificent woman, but I was having suicidal ideation and my wife insisted, and she knows this psychotherapist, to call her and just to talk about it. And that's something that's very important to do when you're really depressed or you go that dark. I knew that I wasn't going to do anything. I wasn't going to take my life.
I feel it's such a miracle that I had this life, that I had my career, that I met my wife, a woman that I had to be with. But when you wake up in the morning or you're walking and you can't walk and you have pains and it takes you a long time to put your sock on and this goes on endlessly, this stuff is happening all the time. I needed to reach out to my psychotherapist and I felt better as soon as I told her that I had Parkinson's.
As soon as I told somebody I was an alcoholic, it was a boulder off my shoulder. The same thing with the Parkinson's. I'm not going to let this disease stop me because my brain might be suffering from a lack of dopamine, but so far from what I'm told, I still have my same sense of humor. I'm not slowing down when I'm talking to people allegedly. So I'm going to live my life around this disease the best I can.

Dr. Daniel Correa:
Each person has unique symptoms and unique manifestations of Parkinson's and many conditions. As you said, you didn't really describe having the tremor or the things that people think about at the beginning. You had some falls and then you started having a change in how you were walking, and that's really where things moved forward. I'm sure there were times when you didn't look forward and see that it was going to be those great 50 years.
There was probably times when there was a lot of uncertainty in both success and finances. Is there something you think you learned about how you approached those choices and the things at that time that you could apply now to you're looking forward to years where you feel uncertain about living with Parkinson's?

Richard Lewis:
I'm in my last act in my life and I'm not doing what I love more than anything, and that was making people laugh on stage and feeling authentic as a humorous and also being validated for my feelings. As you mentioned before, I did talk about my feelings and about my health issues and my fears and all that, but it's come home to roost, unfortunately, the big Parkinson's. And I'm going to try to take it a day at a time like I did with alcoholism, and take it a show at a time like I did with standup.
And to work on material always every night when I did it, but I have to work on a way of accepting this disease and trying not to beat myself up for it. That's for sure. Not to feel sorry for myself, not to whine all the time and be considerate for my wife who really is a caregiver. I can't avoid saying that, I have trouble with this because I wish it wasn't the case. This is the time when I'm thinking I wish I had a big family. I had some caregivers a year and a half ago for about two months.
They're like angels, and these are people that you should really treat like gold, all caregivers, but I don't know, doctor. Everyone has a different scenario and right now everything is coming to one intersection. My age, my career basically is over so to speak, and I'm trying to make use of my time alive and not fall. How's that? That's the big deal.

Dr. Daniel Correa:
As you've engaged with some others in the community living with Parkinson's, are there things that you've learned that have helped you in managing your symptoms or helped you and your partner in thinking about your long-term plans?

Richard Lewis:
You got to do things that are within your range of a Parkinson's patient. My wife loves the ocean, so we can go and take the dog to a hotel up the coast and she can be near the ocean and I can lie and sit in a chair and the dog can run around. I try to have some kind of spirituality. I meditate off and on. I don't do it as often as I should, but it helps me a lot.
I don't have a problem sleeping at all. I'm just grateful for what I have now and not what I don't have, and that's how I live every day with this disease.

Dr. Daniel Correa:
That's its own focus, both the gratitude and finding purpose. These are all things that are essential for everyone's brain health, and as you said, for your own management of things. It's to think about the things that you can do to get out on adventures together with your partner.

Richard Lewis:
You have to try to live a life for you, for your loved ones, for your partner. And if you live alone, reach out to people. Don't isolate. If you want to go somewhere, there'll be plenty of friends who will say, I'll pick you up. I'll come get you. I'll help you out of the car. Help is there for people if they reach out and don't be embarrassed for doing it. That's an important lesson I learned.

Dr. Daniel Correa:
Richard, thank you so much for opening up, for sharing your own perspective. Your voice and your laughter, all of these years and now about your journey and your experience with Parkinson's. I hope to listen to your podcast and to hear more of your voice in this community.

Richard Lewis:
It was my pleasure, doc.

Dr. Daniel Correa:
The American Brain Foundation is the American Academy's philanthropic partner. To learn more about how you can help make a difference, please visit americanbrainfoundation.org. The American Brain Foundation believes that when we can cure one disease, we will cure many. Now, Richard just shared his own experience receiving his Parkinson's diagnosis and a lot of the challenges he's dealt with as he's adapted to this new life and his diagnosis.
And a lot of the non-motor or the non-movement symptoms of Parkinson's disease as he has been joining this community, and I'm glad here to be joined today by Dr. Joseph Friedman. He's a researcher and a clinician who works with the community living with Parkinson's at Brown University. Thank you so much, Joe, for joining us today.

Dr. Joseph Friedman:
I really appreciate the invitation, so thank you very much.

Dr. Daniel Correa:
And I was really looking forward to speaking with you because you have had an interest and a focus at looking at some of the non-movement related symptoms of Parkinson's and how we can help and support both the community living with this condition along with the doctors who are helping take care of them.

Dr. Joseph Friedman:
Yes, well, I started a long, long time ago, and back when I started Parkinson's was obviously considered a movement disorder and there wasn't really any emphasis placed on behavioral problems that occur in Parkinson's. I'm not sure whether it was that they weren't recognized or they just didn't think they were important.
So that when I was in training, the only issue related to emotions or behavior was whether Parkinson's disease depression, which was recognized back then was part of the disease or was simply a reactive process that anybody might have if they had a progressive possibly disabling disorder that couldn't be cured. And I got interested in it really purely by happenstance.

Dr. Daniel Correa:
I wanted to just remind our listeners, so this is a continuing series of discussions that we've had on Parkinson's disease. For some more background about what is Parkinson's and some of its symptoms, particularly those related to movement. I would ask you guys to go back and check out our interviews with Jimmy Choi and our medical expert and our interview with NBA veteran Brian Grant and that medical expert interview.
Today with Joe, we're going to talk more about these non-movement related symptoms. So Joe, when you are approaching this discussion, when you're going beyond management of the tremor and the movement related symptoms for someone with a new diagnosis of Parkinson's, how do you explore the discussion about what else might be going on or impacted by their diagnosis?

Dr. Joseph Friedman:
Approaching patients at different stages of their disease is of course very, very different. So that when you're first diagnosing a patient, it's unlikely that they have any major behavioral problems. Though having said that, there are problems that frequently occur in Parkinson's and may actually precede the development of the motor symptoms. So people with Parkinson's may have started to feel fatigued, for example, they may have unexplained fatigue.
They go to their primary care doctor, they don't find anything wrong with them, or they may start becoming anxious or even depressed before they know that there's anything wrong with their movements. And so in talking to people with who I diagnosed with Parkinson's disease, questions about those issues often come up, although there's so much to talk about at a first visit that they may not because people have to deal with the impact, the gravity of being diagnosed with something like that.
And then of course there's always the very interesting problem of REM sleep behavior disorder. In which people, particularly men much more than women, will act out their dreams when they're having dreams of very vigorous physical activity, usually violent dreams. They're being chased by something or they're in a fight and they end up punching their bed partner or kicking the wall or jumping out of bed.
So I always ask about REM sleep behavior disorder because that can be a danger to the patient or to their bed partner. And will often ask about these other problems, but they are certainly very common early in the disorder and usually I will ask about those as we have further visits.

Dr. Daniel Correa:
That poses an interesting or a challenging question that I think many of us have been trying to understand a little bit more over the years, and I'd like to have you let our listeners know what we really know about that. So in terms of these conditions that are more common or can commonly occur before the movement symptoms present, so that being the anxiety related mood disorder symptoms or the REM sleep behavior disorder, the movement during a nightmare.
Is it that they just happen more often in the community who ends up getting a Parkinson's diagnosis? Is it a predictor of a greater likelihood? Where are we with that understanding?

Dr. Joseph Friedman:
Well, all of those things are predictors, but there are a lot of other things that are predictors and these sorts of things occur just in normal life with the exception of REM sleep behavior disorder. So the number of people who are anxious in the world is very large and only a very small fraction of them have Parkinson's disease. And the same thing for depression and the same thing for fatigue.
So those are common in the general population and because somebody with those problems are at greater risk of developing Parkinson's disease, you can say the same thing about people who are constipated. I mean constipation is much more common in Parkinson's in the general population. But it's so common in the general population that simply because an older person gets constipated, they shouldn't be running to the neurologist to see if they have Parkinson's disease.
It would be unlikely. So your question is a very important one because these things have to be taken in context. Now, REM sleep behavior disorder is different because when men in particular have REM sleep behavior disorder, their chances for developing Parkinson's disease is so high that REM sleep behavior disorder is really a premonitory or herald symptom of the disease.
But the difficulty there is that they might not develop the disease for 10 years or even longer than that. So learning about the connection is sort of a mixed blessing. There's a good side and a bad side. You have an idea about your future, but then again, you may not want to have an idea about your future.

Dr. Daniel Correa:
So that kind of covers some of the early symptoms that may even exist before diagnosis. And now after someone has a new diagnosis, are there initial non-motor symptoms or even mood and behavioral symptoms that really should be closely followed in the first few years and as they start treatment?

Dr. Joseph Friedman:
Every patient is unique and it really is true. And although constipation might be say a mild problem for some people, for some others, constipation is their worst problem with Parkinson's disease. So everybody is different, so you can't give a generalization about that. Another thing that I like to point out is that some of the problems that people with Parkinson's may run into, the non-motor problems we may not have treatment for, but simply recognizing that it's part of the disease can be very important.
So for example, fatigue. Fatigue is a problem that again, I stumbled on. These problems I largely stumbled on because a patient perhaps made an impression on me. So fatigue is one of those where a patient of mine who was about my age then, this is a long time ago, was working full time. He had physical labor as part of his job and he said, "I can cope with the tremors. It's not a big deal. I can move around fine, I can do my job.
But at the end of the day, I just can't move and I just lie on the sofa. I don't fall asleep, I just can't do anything. I'm too tired." He looked like a normal person. He didn't have major problems from the Parkinson's disease. And I started asking my Parkinson's patients about it and discovered that 50% of Parkinson's patients thought that fatigue was one of their three worst symptoms. That's a big number.
And one third actually rated fatigue as their single worst problem. And we still don't have known treatment for fatigue, but simply recognizing it was extremely important because people often thought of themselves and their families too is there was something sort of morally weak about them. They weren't trying. They weren't doing things as much as they used to. And simply if they had what they used to call the power of positive thinking, they could get over it.
And learning that fatigue is as intrinsic to Parkinson's disease as tremor has a large impact in understanding what is going on. We may not understand why people get fatigued, but the fact that fatigue is part of it sort of relieves people from the moral burden of being inadequate or at least helps them feel that way. But as a disease goes on, of course, more and more problems develop.
Ones that attract a lot of attention are of the hallucinations, which is an area I've been really focused on for a very long time. And the hallucinations are more bothersome to people who are worried about developing them than often when they actually occur. Hallucination is a very interesting phenomenon because for some people, they're actually a little bit entertaining.
Most people don't want to have them, of course, because they don't like to be unsure about things they experience being real or not real. Sort of like what I was saying about fatigue in explaining the fact that the hallucinations are due to the medications and the medication effect on the disease makes people feel reassured and patients won't mention hallucinations to anybody, they hide them. So it's important to ask about that sort of thing.
And related to that, but luckily, much, much less common is a problem we call delusions. Delusions are false, irrational beliefs. So people with Parkinson's who are treated, it doesn't occur in people who are untreated or almost never, will sometimes develop delusions. And the delusions, unlike the hallucinations, are really very bothersome. Hallucinations often are mostly without any kind of emotional content.
So people will see children playing in their living room. They may see somebody sitting on a chair in their room watching TV with them. They may see people walking in their yard who aren't really there. And although they may be upset that there's somebody walking in their yard, doesn't belong there. It's not something where they get really excited, they're not worried about it. But the delusions tend to be of a paranoid nature.
And the single most common we found in our population was really what we call jealous delusions. Thinking that the husband or the wife was having affairs with other people. And that can be really devastating because it's devastating to the patient to think that their spouse is doing this. And it's devastating to the spouse who's often putting in tremendous amount of effort in caring for their loved one.
And so they won't talk about it because they're embarrassed. They're embarrassed that this is happening even though it's not happening. And so it becomes very important for the doctor often to ask about it because otherwise it may go unaddressed. And these days we can treat that with some fair success. So it's important to recognize,

Dr. Daniel Correa:
Very good to hear and an important opening for conversation both within families and with people and their doctors. Are there some other symptoms that you have found are commonly unspoken either by the family or by the person living with the condition?

Dr. Joseph Friedman:
I think really fatigue and these psychotic symptoms are the most common. Another symptom actually that's fairly common unfortunately, is something people don't really talk about because they don't really recognize, which is a problem of apathy. So apathy means not caring, not having an emotional spectrum. People don't get happy like they used to get happy. They don't get sad like they used to get sad.
They tend just not to care a whole lot. And when that's mild or moderate even, people will often think that the patient is depressed. So the family views the patient as depressed because they don't want to go out and do anything. They don't want to socialize. They don't want to interact much with other people. They don't want to pursue their old hobbies.
And it's really largely because they don't care. It doesn't give them pleasure to do these things. Sort of in the extreme case, you have a patient who may sit and watch television all day and not particularly care what's on the TV. They may not even care if the TV is on. And the only pleasure they get in life is when their grandchildren visit and that lasts about five minutes and then they don't care anymore, or they're overwhelmed by the amount of activity.
But with apathy, people often don't recognize that it's really happening. They just see the energy, the light that comes from this individual being slowly diminished more and more. And we don't have treatment for that unfortunately. But again, it's important to recognize that this can be part of the illness. It can be very difficult to distinguish from depression, but we do have treatments for depression.
So it's often worth trying to treat, hoping that depression is a large component of it. But when it really is apathy, like fatigue, it's important to recognize that it's intrinsic to the disorder and not some kind of moral weakness of the patient.

Dr. Daniel Correa:
Important for the individual and their family to understand somehow it's not tied to something they're doing or not doing. And in our previous episodes, we spoke with Jimmy Choi who's talked about using exercise to help manage some of his symptoms. And Brian Grant, his own experience as a former NBA player has incorporated exercise in the management of his symptoms.
How have you been encouraging your Parkinson's patients in that community in incorporating movement and activity to help support their condition?

Dr. Joseph Friedman:
I'm a very strong believer in physical activity and in exercise. And one of the things I tell my patients is that there were studies that were done that were published within the past year, both related to dementia in general, not having specifically to do with Parkinson's disease. But that people who walked more than 8,000 steps a day, in one study, significant amount of exercise in the other study with large populations.
That patients who exercised more were less likely to develop memory and cognitive problems. And so all of us are at risk for developing memory and cognitive problems whether we have Parkinson's disease or not. So this is a recommendation for all people, but since Parkinson's patients are at greater risk for developing these problems and because they already all have motor dysfunction, exercise is even more important for them.
Because on the one hand, they really want to protect their memory and their ability to think. But on the other hand, you're always better physically if you're in your best shape. Your risk of falling diminishes. We know that exercise is good for helping both improve and reduce the likelihood of depression, for example. So I think both for a cognitive point of view, from an emotional point of view and from a physical point of view, exercise is crucial.
And what I tell my patients about exercise is that medications help you today. How are you going to walk five years, 10 years, or 15 years from now? Depends on how much exercise you do now. So exercise is an investment in your future. Medication just helps you today. And people will talk about, well, I have to take my medicine at exactly five minutes after 12 or 10 minutes after whatever.
That may be important for them but what's more important is that they put in their 30 to 60 minutes of exercise every day. That's going to help them more 10 years down the road than being on time and taking their medicine on schedule today.
And one other thing, when we'd be talking about non-motor, today we've talked only really about behavioral sorts of problems, but there are of course a large number of non-motor symptoms that have nothing to do with behavior like bladder control and bowel control and blood pressure control and sweating and pain, of course, which is a big issue in Parkinson's disease. So there are a number of things as well, and I don't want to overlook them as important factors in quality of life.

Dr. Daniel Correa:
Is there a resource that you would suggest or a place that people go to online that would help them go through and maybe have a checklist or consider symptoms as to whether or not they have them to bring them up with their doctor?

Dr. Joseph Friedman:
That's a very good point. The one I'm going to give you is a book that I wrote. It's only online. It's not printed and it's free. There's no charge. You don't have to sign up for anything. It's totally digital and it has, I think 20 or 30 video examples of problems, and it's just called Free Guide to Parkinson's Disease.

Dr. Daniel Correa:
And for our listeners, we'll include a link to Dr. Friedman's free online resource on his understanding of Parkinson's so that you can look through these examples and these possible symptoms in our show notes. Thank you so much, and we truly appreciate you taking the time with us today.

Dr. Joseph Friedman:
Well, thank you for the invitation. I like doing this very much. Thank you.

Dr. Daniel Correa:
Thank you again for joining us today on the Brain & Life podcast. Follow and subscribe to this podcast so you don't miss our weekly episodes. You can also sign up to receive the Brain and Life magazine for free at brainandlife.org and even get the Espanol version. For each episode, you can find out how to connect with our team and our guests along with great resources in our show notes.
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