Physical signs

• Power, reflexes and sensation are usually normal.

• The earliest abnormal physical signs to appear are loss of dexterity of rapid alternating movements and absence of arm swing, in addition to increased tone with distraction.

• Frontal lobe signs such as grasp and glabellar taps (only allow 3 blinks) are more common with parkinsonism.

Note: There is no laboratory test for Parkinson's—it is a clinical diagnosis. Hypothyroidism and depression, which also cause slowness of movement, may cause confusion with diagnosis. The Steele-Richardson syndrome (parkinsonism, mild dementia and vertical gaze dysfunction) is worth considering.

failure to swing amn

Fig. 29.2 Basic clinical features of Parkinson's disease

V J y staring expression slow, monotonous speech failure to swing amn

¡^J^s pill-raliing S^^? tremor at rest slow and scuffling gall short steps

Fig. 29.2 Basic clinical features of Parkinson's disease

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