A 56-year-old man had progressive right-sided weakness, lack of dexterity, slowness, and micrographia. He also noted a muffled character in his voice and frequently was asked to repeat statements. On occasions, he also had difficulty swallowing medications but not food. He also noted urinary urgency, a weak urinary stream, and mild nocturia. He had no cognitive problems.

Our patient presented with a 3- to 4-year history of slowly progressive functional impairment of the right arm and leg. Initially, he had difficulties using the gas and brake pedals while driving. Subsequently, he had difficulty brushing his teeth, combing his hair, and buttoning clothes. While walking, he noted he would drag his right foot and hold his right arm in an elevated position.

Neurological examination demonstrated bradykinesia with facial hypomimia, decreased eyelid blink frequency, and hypophonia with a soft mumbling and monotonous speech. There was an overall paucity of spontaneous movements and decreased amplitude of movements. Handwriting was small (micrographia) and effortful. No tremor was present at rest or with the arms outstretched. There was asymmetric oscillating cogwheel rigidity (right > left) detected by passive movements of the limbs. Gait showed short stride and reduced arm swing (right > left). He had no difficulty with initiating walking. There was mild postural instability.

PD is a progressive neurodegenerative disorder characterized by a number of motor and nonmotor features. The cardinal features of PD are as follows: