• Repeated falls
• Loss of coordination, unsteady gait (walking pattern)
• Stiffness and rigid movement in the neck, trunk, arms, legs
• Difficulty swallowing
• May have a tremor
• Pain or difficulty with bending the neck up or down
• Slow or stiff movements
• Vision difficulty
  • Unable to look up or down without bending the neck
• Changes in facial expression
  • "Masking," reduced expression
  • Deeply lined face
  • Jaw or face jerks or spasms
  • Eyes, pupils different size
  • Eye movements, uncontrollable
• Generalized slowness of all movement (bradykinesia) with strength relatively preserved
• Speech difficulties
  • Slow speech
  • Poor enunciation
  • Low voice volume
• Dementia, mild
  • Forgetfulness
  • Slowed thought processes
  • Apathy (indifference)
  • Difficulty manipulating knowledge
• Personality changes, vague and mild

A neurological examination may show Parkinsonian movements with typical stiffness and lack of coordination. Dementia is mild. Eye movements are limited, particularly vertical movements. However, vision, hearing, sensation, and voluntary control of movement remain intact.

Tests may be done to rule out other diseases. An MRI might show shrinking of the brainstem.