The onset is insidious and common presenting symptoms include tremor, stiffness, or clumsiness, usually involving one side. Other presentations include difficulty walking, fatigue, depression, dysarthria, or limb discomfort. The disease is generally asymmetrical at presentation.
The typical signs include a blank, mask-like facial expression, a reduction in the spontaneous blink rate, and a soft monotonous voice. The gait is characterized by difficulty initiating walking, walking with small slow shuffling steps or rapid small steps (festination). 'Freezing' occurs on turning or changing direction. Voluntary movements are slow (bradykinetic) and of reduced amplitude (hypokinetic). Due to the impaired postural reflexes, falls may become a fea
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