It is worsened by stress, and generally decreases or disappears with action. One may note a 'pill-rolling' tremor of the opposed thumb and fingers. The rigidity of Parkinson's produces a resistance to passive movement which is equal in all muscle groups and does not alter throughout the range of the passive movement. Down-gaze is spared. Drooling of saliva is common, due to failure to swallow and dysphagia may occur.
Constipation is almost invariable.
Cognitive problems and dementia may occur later in the disease. Video clips illustrating some of these features in a 55 year old man with Parkinson's disease. Clearly, the successful treatment of Parkinson's disease involves much more than just the use of drugs. It is vital that management is considered as part of a multidisciplinary approach with the involvement of nursing, occupational and physiotherapy, speech therapy, dieticians etc. Indeed, with recent advances in neurosurgery, on occasion, a number of surgical procedures need to be considered as one of the treatment options.