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Clinical features

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

There are many manifestations of Parkinson's disease. The classical diagnostic symptoms are (1):

  • slowness and poverty of movement
  • stiffness
  • shaking

The physical signs of Parkinson's disease include (1):

  • slowness of movement (bradykinesia)
    • loss of facial expression and arm swing (1)
    • difficulties with fine movements e.g. - buttoning, use of utensils (2)

  • poverty of movement (hypokinesia)

  • rigidity
    • classic "lead pipe" or "cog wheel" rigidity (3)
    • there may be associated pain e.g. - painful shoulder is one the commonest initial symptom seen in PD (2)

  • rest tremor
    • is the most common and easily identifiable symptom of the disease
    • described as typical "pill-rolling" involving the thumb and the index finger (3)
    • may involve the lips, chin, jaw and legs (2)
    • fatigue or emotional stress may aggravate the tremor (3)

The many manifestations of Parkinson's disease are:

  • shuffling gait
  • expressionless, unblinking face
  • slurred monotonous speech
  • small handwriting
  • increased salivation and dribbling
  • loss of facial expression and arm swing
  • difficulty with fine movements

The signs are usually unilateral at diagnosis and may become bilateral as the disease progresses.

Later in the disease additional signs may be present.These include:

  • postural instability
  • cognitive impairment
    • a degree of cognitive impairment is present in up to 70% of patients
    • dementia occurs in 40% of patients with Parkinson's disease
  • orthostatic hypotension



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