MAY/JUNE 2006 BY WALLACE MATTHEWS How ‘~e Sopranos’ Realistically Portrays Alzheimer’s Disease As Uncle Junior on TV's biggest hit, '~e Sopranos,' Dominic Chianese portrays Alzheimer's disease from memory and the heart. And just like that, Dominic Chianese, playing the old mob boss Corrado (Uncle Junior) Soprano on the blockbuster HBO series "The Sopranos," fired the most famous television shot since someone capped J.R. Ewing on "Dallas" a quarter- century ago. But Chianese did much more than that. In one 40-second scene, he conveyed all the horrific, tragic and, yes, even comic moments that occur over the course of the long, slow progression of Alzheimer's. More importantly, he's exposing millions to a realistic portrayal of a disease many never see until it hits them where they live. In addition to creating an unforgettable character, he's been serving as both trailblazer and conduit: the most public face of a disease that will only become more common as life spans increase. "I'm just an actor doing a job," says Chianese, in real life a vibrant and healthy 71- year-old with a wife, six grown children, a dozen grandchildren and a full plate of professional commitments. "I just play what's on the page." Dominic Chianese is also playing what's in his heart and in his memory. His knowledge of dementia and his empathy for Alzheimer's patients come firsthand. For more than 20 years, he has volunteered as a recreational worker at St. Cabrini Nursing Home in Dobbs Ferry, N.Y., singing and playing guitar for its 300 residents, more than half of whom have Alzheimer's. And for two agonizing years, he watched his mother descend into dementia until her death six years ago at age 93. "She was sliding away, her memory was going," he says, recalling how heartbroken he felt when she couldn't even recognize him. "It was a horrible thing." His personal experience informs his performance as Junior Soprano, who began showing signs of dementia several seasons ago. Uncle Junior's increasing fear and forgetfulness boiled over in this season's premiere episode when he was summoned to dinner by Tony, his successor as boss of the Soprano crime family. Mistaking Tony for a long-dead mobster he believes had robbed him of $40,000, Junior reacted from instinct. Unlike the "Who Shot J.R.?" phenomenon that captivated a guessing nation in 1980, "Who Shot Tony Soprano?" isn't a mystery at all. We know it was Uncle Junior. But does Uncle Junior know? Long before he'd pull the trigger, Uncle Junior's worsening dementia was becoming a source of concern for his family. "How's he doing, Tony?" "He's Knucklehead Smith, that's how he's doing. He don't even remember if he ate or not." Dominic Chianese's big break came in The Godfather, Part II, playing the henchman Johnny Ola. Yet despite a successful career that featured supporting roles in Dog Day Afternoon and many other movies, something was missing. So, at age 50, Chianese decided to return to his true passion: singing and playing guitar. And he found the easiest way to do that was performing free for senior citizens. While playing a Jersey mob guy on TV, Chianese in real life prefers his New York City roof with a view. "I come from a generation of people who didn't watch TV for recreation; they had music in their homes, the piano, the guitar, the mandolin," he says. "I knew that for the people in the senior centers, it was their form of recreation too. I knew nothing about neurology. I was just an entertainer." He was also an observer. And soon he came to realize that old songs—many in Italian, all sung with enthusiasm—could move patients who might otherwise be difficult to reach. "I noticed that people with Alzheimer's wouldn't remember what day it was or what they had for breakfast, but they would remember song lyrics," he says. "Many of these people didn't know where they were, but they would come up with these lyrics, perfect lyrics, to the songs of years ago. It's amazing." Chianese uses his music to reach people with Alzheimer's. Years later, Chianese would incorporate those observations into his character on "The Sopranos." Uncle Junior floats in and out of periods of lucidity—sometimes reverting to the vicious mob boss he'd once been, sometimes retreating into the shell of a confused old man, other times dissolving into tears for no apparent reason. "When I'm singing the songs with the Alzheimer's patients I work with at the nursing home, they're looking right at you, they're really in the moment; and then when the song is finished, they're gone," Chianese says. "And Uncle Junior is like that. He comes in and out. One moment he's lucid, and another moment he isn't. In a way, it's kind of a childlike quality. You get a child to look at something, then you take the toy away and all of a sudden they're lost." In the judge's chambers, a discussion is taking place that will determine Junior Soprano's fate. Citing "evidence of dementia" found by a neuropsychologist, the judge recommends further evaluation behind bars. Junior's lawyer argues for hospitalization. The D.A. wants Junior tried for shooting Tony. Through it all, Junior stares intently at the small object in his hands—turning it, shaking it, scrutinizing it. It's as if he's never before seen a box of Tic Tacs. A first, Uncle Junior's symptoms were subtle, barely noticeable. A momentary loss of concentration during a conference with his lawyers. The occasional bizarre outburst at the dinner table. And then, an entire episode in which Junior, clad in bathrobe and pajamas, wandered out of his suburban New Jersey house to return on foot to his old Newark neighborhood in search of his long-dead brother. Still, even after he exhibited this classic Alzheimer's symptom of wandering, it had never been quite clear if Junior was really afflicted with dementia or merely "playing crazy" to avoid prosecution. He seemed to be channeling the real-life mob boss Vincent (Chin) Gigante, who took to wandering the streets of Greenwich Village in a bathrobe while facing federal racketeering charges. "Does he really have it or not?" Chianese says. "I think he does. I have to play it as if he does. My character had to shoot Tony not knowing what the hell he was doing: he thought Tony was somebody else, he doesn't even remember shooting him. That's why the writing is so great on this show. It's incredible the depth and levels of things they explore every week." Dementia has been a recurring theme on "The Sopranos," most recently when Tony, in his gunshot-inflicted coma, hallucinates that he's been diagnosed with early- onset Alzheimer's. But while James Gandolfini, playing Tony Soprano, merely had to act the part of a person receiving a frightening diagnosis, Chianese has to inhabit the persona of an elderly man in the grip of a dreaded disease. "So what I did with Alzheimer's is, I realized if the memory is gone, I would concentrate on something other than memory," Chianese says. "And that gives the impression you're in your own world. You're concentrating on that, and you're not aware of what's going on at all." Somehow, he manages to evoke deep sympathy for a character who's been merciless and conniving for much of the seven-year run of "The Sopranos" but now just seems helpless and lost. His portrayal of Uncle Junior has earned Chianese two Emmy nominations. But how do real experts in the field of geriatric medicine critique it? "His portrayal is pretty well on," says Gerard Montuori, M.D., medical director of St. Cabrini Nursing Home. "They usually don't shoot anybody—but I guess Uncle Junior is used to guns and that's the way a gun was used all his life, so you can see it. The rest of the behavior—the forgetfulness, the paranoia, the mood stuff—are pretty much typical." Of all the warning signs that foreshadowed the shooting, the most poignant came when Tony sought Junior's counsel only to finally accept that his uncle was no longer capable of providing it. At one point, wondering why Junior was being so nasty, Tony asked, "Don't you love me?" Tears streamed down Junior's face, but he didn't respond. As TV's hottest show, "The Sopranos" has thrust Dominic Chianese and Alzheimer's into the public consciousness in a way no educational program could. Improbably, a character actor playing a mobster has become what he good-naturedly refers to as "the poster boy for the disease." Even more than acting, Chianese loves entertaining nursing home residents with his prized flamenco guitar. "It's important, I think, to use the character to increase awareness," he says. "I'm not really a symbol, just somebody to use as an opening to raise money to fight the disease, to do the research, and I have a powerful platform to do it from." Entertaining the gang at last season's premiere That's why the Alzheimer's Association chose to honor him this spring at its Forget- Me-Not Gala not far from his Manhattan apartment. "Alzheimer's is still a very low- profile disease, and there's still a stigma attached to it," says Lou-Ellen Barkan, president of the association's New York City chapter, noting that Chianese's presence ensures a sellout for its annual black-tie affair.