Clinical features

Parkinsonism usually occurs in subjects over 40 years of age.

The symptoms and signs associated with parkinsonism include (1):

• hypokinesia ( poverty of movement)
• bradykinesia (slowness of movement)
  
• rigidity
• rest tremor

The clinical features of parkinsonism are often initially unilateral. They may present as :

• coarse tremor present at rest
• pill-rolling movements
• cogwheel rigidity
• slowness of movement
• speech is typically monotonous, soft, faint, and lacking intonation
• expressionless face; dribbling
• small writing is characteristic - micrographia
• shuffling parkinsonian gait - festination
• oculogyric crises - forced upward deviation of the eyes - may occur in post-encephalitic or drug-induced parkinsonism

Reference:

• (1) Parkinson’s Disease.National clinical guideline for diagnosis and management in primary and secondary care. NICE full guideline.2006