Sign/symptomLR+LR-Description
History of tremor1.3 to 170.24 to 0.60Observed 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 sign1.3 to 1.50.47 to 0.61
History of bradykinesia and rigidity4.50.12Difficulty 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 bed130.56
Difficulty opening jars6.10.26
Difficulty rising from a chair1.9 to 5.20.39 to 0.58
Rigidity as a sign0.53 to 2.80.38 to 1.6The 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 gait2.90.32Small, 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 gait3.3 to 150.32 to 0.50
Loss of balance1.6 to 6.60.29 to 0.35
History of micrographia2.8 to 5.90.30 to 0.44Handwriting is small and often indecipherable