A 65 year old man presents with a one year history of a tremor and

progressive difficulty with initiating gait. The tremor started on the

right side and subsequently affected the left side as well. There is no
history of falls. On examination he has a resting tremor affecting the
right side more than the left.
a) What is the most likely diagnosis? Justify your answer based on
the information provided.
b) Discuss the secondary causes of Parkinson’s disease and how you
would differentiate these from IPD.
 c) Discuss an approach to the pharmacological management of
idiopathic Parkinson’s disease.
Four years later the patient reports increased forgetfulness, poor
sleep, memory disturbances and feeling depressed.

d) Discuss the possible causes for these symptoms.