Pill rolling is a sign associated with which neurodegenerative disease?

• A. Alzheimer's disease
• B. Huntington's disease
• C. Parkinson's disease
• D. Multiple sclerosis

Answer: (C)

Pill rolling is a resting tremor most characteristic of Parkinson's disease. It arises from loss of dopamine-producing neurons in the substantia nigra, which disrupts the nigrostriatal pathway and alters basal ganglia circuits that regulate movement. The result is a rhythmic, small tremor of the thumb and fingers that typically appears when the limb is at rest and often eases with voluntary movement or sleep. This sign usually comes with other motor features of Parkinson's, like slowness (bradykinesia) and stiffness (rigidity). Other neurodegenerative conditions present differently—Alzheimer's focuses on cognitive decline, Huntington's disease on choreiform movements, and multiple sclerosis on demyelination-related symptoms—so the resting pill-rolling tremor helps point to Parkinson's disease.