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Triad - Tremor (pill roll at rest), Rigidity (lead pipe), Slowness (bradykinesia - open and close fist or thumb to each finger tip and then faster) - usually asymmetrical
Inc Sx with reinforcement - clench fist (inc muscle tension), 
So Sx - fall over (postural instability), weak voice, chew, swallow, bowel and bladder function (remember to ask)

Dec Dopamine from Substantia Nigra - progressive neurodegenerative condition
Can be - idiopathic, vascular (ischaemia), drugs (esp antipsychotics), repetitive brain trauma (Boxers)

2M cf F 
average age 65yrs

Bradykinesia - mvt poverty (hypokinesia), short shuffling steps with dec arm swinging, difficulty initating mvt
Tremor - esp at rest (3-5Hz), worse when stressed / tired, typically pill rolling
Rigidity - lead pipe, cogweel (from tremor superimposed)

Mx
Need to map out problem - worse at what time of day, what is causing problem etc etc (on/off cycles - on when Sx go and off times when Sx are worse - may cycle 3-4x/day)
Use MDT - gait, ADLs, social activities, dietician, SALT (swallow ability)
Drugs - start low and inc slowly, adjust as to response, think of different routes
Dopa (esp if older at onset)
Enhancers (esp if younger at onset) - MAOI, "pexol" (beware impulsive behaviour)
aim for therapeutic window (effective but few SE) - may get narrower as time goes on
Toxic effects - dystonia, vomiting

Suggest 2ndary care for initial diagnosis (may be an evolving process over 6/12) and to connect into community support system.
Maintain by GP until reach complex stage when back to secondary

For patients the Sx of depression, constipation and pain may be worse than the classic triad

Drug-Induced PD
motor Sx have rapid onset and bilateral
rigidity and rest tremor are uncommon