Initial symptoms may be mild and nonspecific (such as mild tremor, slight feeling that one leg/foot is stiff or dragging).

• Muscle rigidity:
  • Stiffness
  • Difficulty bending arms or legs
• Posture may be unstable, stooped, or slumped over
• Movement difficulties:
  • Loss of balance
  • Gait (walking pattern) changes
  • Shuffling
  • Slow movements
  • Difficulty beginning to walk, difficulty initiating any voluntary movement
  • Small steps followed by the need to run to maintain balance
  • Freezing of movement when the movement is stopped, unable to resume movement
• Muscle aches and pains (myalgia)
• Muscle cramps and dystonia
• Shaking, tremors (varying degrees, may not be present):
  • May occur at rest or at any time
  • May become severe enough to interfere with activities
  • May be worse when tired, excited, or stressed
  • Finger-thumb rubbing (pill rolling tremor) may be present
• Changes in facial expression:
  • Reduced ability to show facial expressions, "mask" appearance
  • Staring
  • Eye movement abnormality (difficulty moving eyes up and down)
  • May be unable to close mouth
• Voice or speech changes:
  • Slow speaking
  • Low pitched voice
  • Monotone
  • Difficulty speaking
• Difficulty chewing or swallowing
• Loss of fine motor skills:
  • Difficulty writing, may be small and illegible
  • Difficulty eating
  • Difficulty with any activity that requires small movements
  • Frequent falls
• Mild decline in intellectual function (may occur)

• Depression
• Confusion
• Dementia

The health care provider may be able to diagnose secondary parkinsonism based on the patient's history, symptoms, and physical examination. However, the symptoms may be difficult to assess, particularly in the elderly.

For example, the tremor may not appear when the person is sitting quietly with the arms in the lap. The posture changes may be similar to those caused by osteoporosis or other changes associated with aging. The lack of facial expression may be a sign of depression.

Examination may show increased muscle tone, tremors of the Parkinson's type, and difficulty initiating or completing voluntary movements. Reflexes are usually normal.

Tests are not usually specific for secondary parkinsonism but may be used to confirm or rule out other disorders that may cause similar symptoms.