A. Aspiration can occur in later stages of Parkinson disease due to impaired swallowing and muscle coordination, but it is not an initial symptom. B. Dementia may develop as the disease progresses, but it is not typically seen in the early stages. C. Akinesia, or the absence or loss of voluntary movement, may appear later but is not usually the first sign. D. Pill-rolling movements of the hand (a type of resting tremor) are often one of the earliest signs of Parkinson disease and commonly prompt individuals to seek medical evaluation.