It can feel like Parkinson’s disease is everywhere — a parent, a friend, a colleague — and with that familiarity often comes fear. But the story we’ve been told about Parkinson’s is changing fast. Dr. Brent Anderson is joined by Dr. Andrew Lerman, a double board-certified neurologist and epileptologist and the founder and medical director of Grove Neurology in Miami, Florida, who has led more than 35 clinical trials investigating new treatments for Parkinson’s, Alzheimer’s, and other neurodegenerative disorders.
Dr. Lerman — a passionate advocate for movement, including Pilates, as medicine for the brain — explains why early diagnosis is reshaping the outlook for patients, what the first signs actually look like, and how exercise may be one of the most powerful interventions available. Together, he and Dr. Brent explore how to counsel patients with hope rather than fear, why community and family support change outcomes, and the emerging research suggesting that staying active can tap into the brain’s own dopamine reserves — without the disease having the final word.
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00:00 Guest Introduction
Dr. Brent introduces Dr. Andrew Lerman — a double board-certified neurologist and epileptologist, founder of Grove Neurology in Miami, and principal investigator on more than 35 clinical trials in Parkinson’s, Alzheimer’s, and other neurodegenerative disorders.
00:57 Episode Overview
A preview of the conversation ahead: what modern science says about Parkinson’s progression, the power of early diagnosis, and why movement may be one of the most potent interventions available.
03:23 The Information Age: More Knowledge, More Fear
Dr. Lerman opens on why so many people — including younger patients — now arrive worried after researching symptoms online, and how better information brings both anxiety and an encouraging shift toward earlier diagnosis and prevention.
05:24 Early Signs and How Patients First Present
The symptoms that most often bring people in — tremor, slowed movement, changes in speech, and a shuffling gait — and the fear that frequently accompanies that first appointment.
06:12 How Parkinson’s Is Diagnosed Today
Why the physical exam remains the gold standard, and how tools like DAT scans, MRI, skin biopsies, and spinal fluid analysis now add objective support to the diagnosis.
07:55 Why Progression Varies — Genetics vs. Lifestyle
A look at why no two patients follow the same path, and Dr. Lerman’s view that environment, fitness, and overall health often matter more than genetics in how the disease unfolds.
10:22 The Case for Exercise: Evidence and the Triad
The growing research behind high-intensity, cardiovascular, and resistance exercise — including studies showing markedly lower Parkinson’s risk — and the aerobic, strength, and balance “triad” Dr. Lerman recommends.
13:28 The Coral Gables Program and a Changed Outlook
Dr. Brent recalls a ten-year community Pilates program for people with Parkinson’s whose participants needed little change in medication — an experience that reshaped his outlook on a disease once dismissed with “diagnose and adios.”
15:30 Motor and Non-Motor Signs and Symptoms
A practical tour of what to watch for — tremor, shrinking handwriting, a quieter voice, and slowed movement — alongside the often-overlooked non-motor symptoms like anxiety, mood changes, and loss of expression.
19:56 Rigidity vs. Spasticity
Dr. Lerman clears up a common point of confusion, explaining how the stiffness of Parkinson’s differs from the spasticity seen after spinal cord or brain injury.
21:16 Community Exercise and the Research Behind It
How group exercise programs that once seemed ahead of their time are now backed by randomized trials — including the Park-in-Shape and SPARX studies — showing real effects on progression and medication needs.
23:25 Preventing Falls and the Social Determinants of Health
Since most people don’t die from Parkinson’s itself, the focus turns to preventing falls — and to the reality that access, education, and resources can shape how quickly the disease progresses.
24:32 The Peggy Roller Falls-Prevention Pilates Study
Dr. Brent describes a Pilates study of people with serious fall histories in which every participant moved out of the high-risk category after twelve weeks.
25:49 Why You Shouldn’t Face Parkinson’s Alone
The case for socialization and support — drawn from Dr. Brent’s own research on chronic back pain — and a clear message: find a community group, and if one doesn’t exist, build it.
27:23 Treatment Advances and the Community Approach
Dr. Lerman frames today’s advances as starting with family and community, pointing to programs like Rock Steady Boxing, Pilates, and dance — and an Argentine tango study showing fewer falls.
31:29 How Medications Work — and Surgical Options
A clear explanation of dopamine-based therapy and why doses escalate over time, plus surgical options like deep brain stimulation and newly FDA-approved focused ultrasound for tremor.
34:11 Disease-Modifying Therapies and GLP Agonists
The shift from treating symptoms to modifying the disease itself — including early trial signals from GLP-1 agonists and the intriguing link between Parkinson’s, Alzheimer’s, and metabolic health.
35:38 Using Medication Wisely
Why the goal is “as much as necessary, as little as possible” — using lifestyle to extend the years before symptoms demand higher doses, much like managing the body’s other regulatory systems.
37:31 Teaching, Programs, and an Open Invitation
Dr. Brent shares his faculty work at Miami’s University of St. Augustine and the Rock Steady and fall-prevention programs there, with an invitation for Dr. Lerman to return for future topics.
38:58 When Should You See a Neurologist?
Dr. Lerman’s guidance for patients and families on seeking care early, and why he treats lifestyle and Pilates as central recommendations — not afterthoughts.
40:30 Debunking the “Stopwatch” Myth and What Drives Progression
Why the long-held fear that starting medication “starts the clock” has been disproven, and Dr. Lerman’s view that neurodegeneration is likely a neuroinflammatory, metabolic process the field is only beginning to target.
43:35 Muscle Mass, Inflammation, and Brain Health
How muscle mass predicts longevity, why building the brain-muscle connection matters, and the role of inflammation, diet, and integrative care in protecting against decline.
48:23 Pilates’ Formula and the Case for Play
Joseph Pilates’ century-old formula for health — movement, nutrition, sleep, mental hygiene, and fresh air — and why unstructured play and outdoor time may be powerful antidotes to a rising tide of anxiety.
50:43 The Dopamine Connection and Staying Motivated
The science of how exercise taps into the brain’s own dopamine and anti-inflammatory reserves — and why, once you’re “on the hamster wheel” of movement, motivation tends to build on itself.
55:05 Closing: Hope, Home Practice, and Living Well
A hopeful close on doing the work at home, the message that people can live well for decades with Parkinson’s, and a reminder that movement and activity are among the most powerful tools we have.
MD
Double Board-Certified Neurologist & Epileptologist Founder and Medical Director, Grove Neurology Principal Investigator, Visionary Investigative Network
Dr. Andrew Lerman is a double board-certified neurologist and epileptologist dedicated to providing expert, compassionate care for patients with complex neurological conditions at Grove Neurology in Miami, Florida. With a deep commitment to both clinical excellence and cutting-edge research, Dr. Lerman built a practice that integrates advanced diagnostics, innovative therapies, and lifestyle modifications, creating a comprehensive, multidisciplinary approach to patient care.
The son of a physician, Dr. Lerman grew up watching his father care for their community — a formative experience that inspired his own path in medicine. After completing his first internship year, he discovered a profound fascination with neurology. The complexity of neurological disorders, the continual pursuit of new knowledge, and the opportunity to help patients facing life-changing conditions solidified his commitment to the field. Dr. Lerman completed his neurology residency at the University of Miami/Jackson Memorial Hospital, followed by a fellowship in Epilepsy and Clinical Neurophysiology at New York University’s Langone Medical Center. He holds a Bachelor of Science in Physiology from McGill University and earned his Doctor of Medicine from St. Matthew’s University.
In his clinical practice, Dr. Lerman treats a wide spectrum of neurological disorders including epilepsy, Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, CIDP, myasthenia gravis,
migraines, movement disorders, neuromuscular diseases, and cognitive decline. He performs advanced diagnostic and therapeutic procedures such as EEG, EMG/Nerve Conduction Studies,
Botox therapy, Deep Brain Stimulation (DBS), High-Intensity Focused Ultrasound (HIFU) for essential tremor, and monoclonal antibody therapies for Alzheimer’s disease. As a Principal Investigator, Dr. Lerman has led more than 35 clinical trials investigating emerging therapeutics in epilepsy, Alzheimer’s disease, Parkinson’s disease, and other neurodegenerative and autoimmune neurological disorders. His goal is to give patients direct access to the most advanced and promising treatments available — offering tomorrow’s breakthroughs today. Beyond medical treatments, Dr. Lerman is a strong believer in lifestyle modification including fitness and nutrition as essential components of neurological health. He encourages a holistic approach that empowers patients to take an active role in their healing journey — combining evidence-based medicine with meaningful lifestyle interventions to improve long-term outcomes .
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