Parkinson’s disease starts insidiously and progresses slowly. The first symptom is usually a tremor or clumsiness of movement in one limb, which in turn involves the opposite limb. The main clinical manifestations are resting tremor, bradykinesia, muscle tone and postural gait disturbances. In recent years, it has been increasingly noted that non-motor symptoms such as depression, constipation and sleep disorders are also common complaints in patients with Parkinson’s disease, and their impact on patients’ quality of life is even greater than that of motor symptoms. Stationary tremor (statictremor) About 70% of patients with tremor as the first symptom, mostly starting from the distal end of one side of the upper limb, appearing or obvious at rest, reduced or stopped during casual movement, aggravated by nervousness, disappeared after sleep. Resting tremor of the hands is aggravated when walking. Typically, it is a “pill-rubbing” tremor with a frequency of 4-6 Hz. Some patients may have postural tremor. Typical complaints of patients are: “One of my hands shakes a lot, the more I keep it still, the more it shakes, but it stops shaking when I’m working or holding things. It also shakes when I meet people or get excited, but not when I fall asleep.” When the examiner moves the patient’s limbs, neck or trunk, he or she may notice a significant resistance, which is uniform in all directions, similar to the sensation of bending a soft lead pipe, so it is called “lead-piperigidity” (lead-piperigidity). When the patient is combined with limb tremor, there may be intermittent pauses in the uniform resistance, such as turning a gear, so it is called “cogwheel rigidity” (cogwheelrigidity). A typical patient complaint is “my limbs are stiff and rigid.” In the early stages of the disease, sometimes the muscle stiffness is not easy to detect, then the patient can actively move one limb, passive activity of the affected limb muscle tension will increase. Bradykinesia Bradykinesia refers to slowed movements, difficulty in initiating movements, and loss of active movement. The patient’s range of motion is reduced, especially with repetitive movements. Depending on the area of involvement bradykinesia can manifest itself in a number of ways. Reduced facial expression and a decrease in the number of transient glances is called maskedface. Speech may be monotonous, low-pitched, and poorly articulated. Writing may become slower and smaller, called micrographia. Washing, dressing and other fine motor movements may become clumsy and inflexible. Walking becomes slower and more sedentary, and the range of arm swings decreases or even disappears. Gait distances become smaller. Salivation occurs due to inability to swallow actively to the extent that saliva cannot be swallowed. Difficulty in turning over at night may occur. In the early stage of the disease, patients often mistake bradykinesia for weakness and often misdiagnose it as cerebrovascular disease or cervical spondylosis due to soreness and weakness of one side of the limb. Therefore, patients should be alerted to the possibility of Parkinson’s disease when they experience slow onset of weakness in one limb, accompanied by increased muscle tone. Typical complaints of early-stage patients are: “I recently found that my right hand (or left hand) is not as sharp as before, my writing is not as beautiful as before, and I feel that my right hand is not as flexible as the other hand when I beat eggs. When walking I feel that my right (or left) leg is heavy and seems to drag a bit.” Postural Gait Disorder Loss of postural reflexes often occurs in the middle to late stages of the disease, and patients are less likely to be able to maintain balance, and may fall on slightly uneven surfaces. Typical patient complaints are “I’m afraid to walk by myself, the slightest touch or a small stone in the road can trip me up, I’ve fallen several times lately, so I’m now very careful when I walk.” Postural reflexes can be detected by the back-pull test. The examiner stands behind the patient and instructs him or her to pull on both shoulders when ready. A normal person can return to normal uprightness within one step back. Patients with absent postural reflexes often need to take more than three steps backward or require assistance to stand upright. patients with PD often walk faster and faster and cannot easily reach their feet, which is known as festinatinggait. A typical complaint is: “I often walk faster and faster and can’t stop.” Patients with advanced Parkinson’s disease may experience freezing, which is a sudden, short-lived inability to take a step while walking, in which the feet seem to stick to the ground, and there is a pause of a few seconds before the person can continue to walk or start again. Freezing commonly occurs when starting to walk (difficulty starting), when turning around, when approaching a goal, or when there is concern about not being able to cross a known obstacle, such as going through a revolving door. Typical patient complaints are: “I often have to pause for a few seconds when I get up to walk, and sometimes I can’t walk at all, especially when I turn a corner or see something in front of me. Non-motor symptoms In addition to motor symptoms such as tremor and slowness of movement, Parkinson’s patients may also experience non-motor symptoms such as depressed mood, anxiety, sleep disorders, and cognitive impairment. Fatigue is also a common non-motor symptom of Parkinson’s disease. Typical complaints of patients are: “I feel physically tired and weak; I have poor sleep and often can’t sleep; my bowel movements are laborious, once every few days; my mood is bad and I’m always unhappy; my memory is poor and my brain is slow to respond.