History of tremor | 1.3 to 17 | 0.24 to 0.60 | Observed as patient rests hands in his or her lap; often described as pill-rolling in quality; must be distinguished from postural tremor (as limb is held against gravity) or kinetic tremor (occurs with movements) |
Distal resting tremor as a sign | 1.3 to 1.5 | 0.47 to 0.61 |
History of bradykinesia and rigidity | 4.5 | 0.12 | Difficulty with rapidly and sequentially tapping the fingers of one hand and then the other on a table top; difficulty tapping the heel rapidly; difficulty twiddling or circling the hands rapidly around each other in front of the body; reduced arm swing on affected side during ambulation |
Difficulty turning over in bed | 13 | 0.56 |
Difficulty opening jars | 6.1 | 0.26 |
Difficulty rising from a chair | 1.9 to 5.2 | 0.39 to 0.58 |
Rigidity as a sign | 0.53 to 2.8 | 0.38 to 1.6 | The physician feels resistance as he or she places a finger within the patient’s antecubital fossa and repeatedly flexes and extends the patient’s arm at the elbow; resistance can be cogwheel rigidity (catching and releasing) or lead-pipe rigidity (continuously rigid); rigidity must be distinguished from spasticity, which has only increased flexor tone; rigidity also can be tested at wrist supination or pronation |
Poor heel-to-toe gait | 2.9 | 0.32 | Small, shuffling steps may be observed, with difficulty initiating ambulation; patients may have a festinating gait (involuntary acceleration of gait); heel-to-toe ambulation is impaired; arms often are stationary; posture often is stooped; patients may have difficulty turning and have poor balance |
History of shuffling gait | 3.3 to 15 | 0.32 to 0.50 |
Loss of balance | 1.6 to 6.6 | 0.29 to 0.35 |
History of micrographia | 2.8 to 5.9 | 0.30 to 0.44 | Handwriting is small and often indecipherable |