The slow, pill-rolling tremor is classically seen in which disease?

• A. Alzheimer's Disease
• B. Huntington Disease
• C. Amyotrophic Lateral Sclerosis
• D. Parkinson's Disease

Answer: (D)

The main feature being tested is a resting tremor that is characteristic of Parkinson's disease. The slow, pill-rolling tremor occurs when the limb is at rest and typically lessens with purposeful movement. It gets its name from the thumb and forefinger appearing to roll a tiny object. This tremor reflects the loss of dopaminergic neurons in the substantia nigra and the resulting imbalance in basal ganglia circuits that control movement, which also underlie other parkinsonian signs like bradykinesia and rigidity. The other diseases listed do not typically present with this resting, pill-rolling tremor: Alzheimer's disease centers on cognitive decline; Huntington disease features chorea; ALS presents with motor weakness and muscle wasting.