Suppose $\deg P=d$ and $P$ has $d_0$ distinct roots $x_1,\ldots,x_{d_0}$ with respective multiplicity $n_i\geq 2$. Let $\Sigma = \sum_{i=1}^{d_0} n_i$ and let $x_1',\ldots,x_{d-\Sigma}'$ denote the simple roots of $P$, so that
$$P(X)=\prod_{i=1}^{d_0}(X-x_i)^{n_i}\prod_{i=1}^{d-\Sigma}(X-x_i')$$
Then $P(X)+P'(X)= \prod_{i=1}^{d_0}(X-x_i)^{n_i-1}Q(X)$ for some polynomial $Q$ with $\deg Q = d-(\Sigma -d_0)=d+d_0-\Sigma$.
Since $(e^xP(x))'=e^x(P(x)+P'(x))$, Rolle's theorem applied at the $d_0+d-\Sigma$ distinct roots of $P$ yields $d_0+d-\Sigma-1$ new distinct roots of $P+P'$ (they are roots of $Q$). But since $\deg Q =d+d_0-\Sigma$, this implies that $Q$ only has real roots (one of them can be repeated once).
So $P+P'$ only has real roots. Besides, it has exactly $2d_0+d-\Sigma-1$ or $2d_0+d-\Sigma$ distinct roots (while $P$ had $d_0+d-\Sigma$ distinct roots).