Parkinson's disease is a movement disorder caused by degeneration of neurons in the brain that produce dopamine, leading to an imbalance between dopamine and acetylcholine neurotransmitters. Its main features include bradykinesia, tremors, rigidity, and postural instability. In addition to motor symptoms, it can also cause neuropsychiatric symptoms like depression, anxiety, sleep disturbances, and cognitive impairment. There are also Parkinson-plus syndromes that share similar features but also have additional signs, such as multiple system atrophy which can cause autonomic dysfunction and cerebellar signs in addition to parkinsonism.

1. PARKINSONS DISEASE
DEFINITION- Movement disorder of unknown etiology due to degeneration of neurons in the nigrostriatal
dopaminergic system causing animbalance between dopamine and acetylcholine neurotransmitters.
FEATURES
GENERAL GAIT HYPOKINESIA
 MASKED FACIES
 UNIVERSAL FLEXION
 SHUFFLING GAIT
 EN BLOC TURNING
 FREEZING GAIT
 REDUCED ARM SWING
 FESTINATION
 KINESIA PARADOX
 BRADYKINESIA
 MICROGRAPHIA
 HYPOTONIA
 SIALORRHEA
TREMORS RIGIDITY EYE SIGNS
 RESTING
 PILL ROLLING
 DRUM BEATING
 COGWHEEL
 PLASTIC/LEADPIPE
 FLEXED STOOPED
POSTURE
 DECREASED BLINK RATE
 HYPOMETRIC SACCADES
 REFLEX BLEPHAROSPASM
(MEYERSON’S SIGN)
 REVERSED ARGYL ROBERTSON
PUPIL
NON-MOTOR
FEATURES
NEUROPSYCHIATRIC
SYMPTOMS
 SLEEP DISTURBANCES
 SENSORY
ABNORMALITIES
 PAIN
 ANOSMIA
 AUTONOMIC
DISTURBANCES
 DEPRESSION
 ANXIETY
 COGNITIVE IMPAIRMENT
 PSYCHOTIC SYMPTOMS
 DEMENTIA
 IMPULSE CONTROL
DISORDES
PARKINSONS PLUS SYNDROMES
ALPHA SYNUCLEINOPATHIES
MULTIPLE SYSTEMS ATROPHY-
A. SHY DRAGER-
(EARLY) DYSAUTONOMIA
(LATE) PARKINSONISM
CEREBELLAR SIGNS
MND SIGNS WITH AMYOTROPHY
CORTICOSPINAL SIGNS
OCULAR PALSIES
DEMENTIA
B. OLIGOPONTOCEREBELLAR ATROPHY-
(EARLY) CEREBELLAR DYSFUNCTION
PARKINSONISM
(LATE) DYSAUTONOMIA
C. STRIATO NIGRAL DEGENERATION-
(EARLY) PARKINSONISM
(LATE) DYSAUTONOMIA WITH CEREBELLAR SIGNS
TAUPATHIES
A. PROGREESIVE SUPRANUCLEAR PALSY-
AKINETIC RIGID PARKINSONISM
PSEUDOBULBAR DYSARTHRIA
SUPRANUCLEAR EYE MOVEMENTS ABNORMALITIES
DIZZINESS- UNSTEADINESS- FALLS
B. CORTICOBASAL DEGENERATION-
ASYMMETRIC PROGRESSIVE APRAXIA
RIGIDITY AND DYSTONIA
MYOCLONIC JERKS
ALIEN LIMB PHENOMENON
FRONTO TEMPORAL DEMENTIA
ASYMMETIC CORTICAL SENSORY SIGNS
TOTAL INCAPACITY WITH PARAPLEGIA IN FLEXION