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Introduction   In Parkinson's disease the dopamine producing neurons in substantia nigra are lost Parts of substantia nigra Caudate nucleus Putamen Globus Pallidus Subthalamic nucleus Substantia nigra Signs and symptoms 1. Bradykinesia - Slowing of movements 2. Rigidity  Cog wheel rigidity Lead pipe rigidity 3. Mask facies - Expressionless face 4.  Tremors Resting tremor  Pill rolling tremor - Index finger and thumb are affected  5. Gait - Shuffling gait 6. Autonomic disturbance  Hypersalivation, constipation, incontinence 7. Cognitive impairment Treatment Medications improve symptoms but don't slow progression Goal is to increase dopamine availability inside CNS Medications used are Carbidopa - Levodopa - Levodopa is combined with carbidopa to help Levodopa reach the brain Pramipexole Selegiline Amantadine Tolcapone/Entacapone