”Hand tremor” is not necessarily Parkinson’s disease. Last month, a 45-year-old female patient came to our hospital. She told me that her hands would shake involuntarily whenever she ate, was tense or excited, and that the shaking would disappear when her hands were at rest. 2 years ago, she went to a hospital where the doctor diagnosed her with Parkinson’s disease and told her to take “Medopa”. She insisted on taking the drug for more than 2 months, but stopped taking it on her own because the effect was not obvious. In the past year, she felt that her hands were shaking more and more, and she had difficulty even picking up food with chopsticks, so she had to see a doctor again. After careful examination, I found that she belonged to a typical postural tremor – the tremor was obvious when the hands were in a certain position or doing certain movements (e.g., holding the hands flat, eating with chopsticks), and disappeared when the hands were at rest. She had neither symptoms of slow movements, limb stiffness, nor tendency to fall, and her neurological examination did not reveal any signs of increased muscle tone or limb stiffness, so I told her that she had benign idiopathic tremor and not Parkinson’s disease. Analysis: If the hands only shake when holding something (e.g., food with chopsticks or drinking from a cup) and the shaking decreases or disappears when at rest, idiopathic tremor should be considered first, not Parkinson’s disease. Idiopathic tremor has a long history, ranging from several years to decades, and there are often similar cases among relatives of patients. Most of them have a good prognosis and do not have symptoms such as slow movement or limb stiffness, and some patients do not even need to take medication. Data show that the disease has 2 peak incidence – adolescents and about 50 years old, “hand tremor” will generally decline in frequency and increase the amplitude of shaking with age. Of course, there are some patients for many years as a day, the symptoms will not worsen. Reminder: In addition to the most common Parkinson’s disease and idiopathic tremor, certain special circumstances can also cause “hand tremor”, such as quarrels, anger and other emotional stress caused by psychogenic tremor, tension, anxiety, fatigue, hunger-induced physiological tremor, as well as cerebellar lesions, hyperthyroidism, alcohol withdrawal, the side effects of certain drugs. Parkinson’s disease does not always have “hand tremor” In March this year, a patient was referred from the osteoporosis clinic, a female, 65 years old. The patient said she had back pain and was prone to falls, and had been seen in orthopedics and then in osteoporosis. After taking medication for a period of time, the back pain was relieved, but she still fell easily and walked much slower than before. After careful history taking, I found that the patient had a long history of constipation. In the past 2 years, she had not only fallen many times, but also moved more and more slowly, often walking forward and feeling like she could not brake. I also noticed that the patient had little facial expression, walked slowly, and had increased muscle tone in both upper limbs. Despite the absence of “hand tremors,” I considered that she had Parkinson’s disease. Analysis: “Hand tremor” is not a necessary condition for the diagnosis of Parkinson’s disease, and about 30% of people with Parkinson’s disease do not have hand tremor. However, Parkinson’s disease patients will invariably have a slow movement performance, if accompanied by limb stiffness, increased muscle tone, postural imbalance and other problems, especially if the disease is unilateral and has a better effect on dopa preparations, the diagnosis can be confirmed. Reminder: Middle-aged and elderly people who have uncontrollable shaking of one side of the arms and legs (“pill-rolling” movement), and the shaking is obvious when the limb is at rest and decreases when it is active, should be highly alert to the possibility of Parkinson’s disease. The likelihood of Parkinson’s disease is higher when there is also slow movement, difficulty with fine motor movements of the arms and legs, or even unstable walking and falling. Some elderly people who do not have “hand tremors” but have significantly slower movements when buttoning buttons, putting on socks, tying shoes, brushing teeth, or have problems with writing too small or too large, or falling easily, or have symptoms such as smell disorder, sleep disorder, depression, or constipation, should also be aware of the early signs of Parkinson’s disease. Although Parkinson’s disease is not fatal, once it develops to an advanced stage, the clinical manifestations are extremely complex and the treatment is tricky. The elderly should go to the hospital as soon as they find themselves with the “telltale signs” of Parkinson’s disease.