Snapshot A 65-year-old man present with a tremor in his right hand. His tremor is most apparent at rest and improves with movement. His movements are noticeably slower and he has difficulty initiating movement. On physical exam, the patient appears apathetic and has rigidity with passive arm movement. Gait testing is notable for shuffling with a stooped posture. Introduction Definition login to view 5 more bullets Parkinson-plus syndromes login to view 14 more bullets Associated conditions login to view 4 more bullets Pathogenesis Loss of dopaminergic neurons in the substantia nigra leads to dopamine depletion in the striatum login to view 1 more bullet Impaired degradation of α-synuclein can lead to degradation of dopaminergic striatal neurons Presentation Symptoms/physical exam login to view 11 more bullets Studies Clinical diagnosis Differential Huntington disease login to view 2 more bullets Essential tremor login to view 2 more bullets Drug-induced Parkinsonism Treatment Medical login to view 5 more bullets Operative login to view 3 more bullets Complications Dementia Sleep disorders Falls