Bicycle Sign Aids Differential Diagnosis of Parkinsonism

In hilly countries like Japan, bicycle sign seen mostly in atypical parkinsonism, not Parkinson's

WEDNESDAY, Oct. 12 (HealthDay News) -- The bicycle sign may be useful in differentiating atypical parkinsonism (AP) from Parkinson's disease (PD) in a hilly country like Japan, with the majority of patients with AP ceasing to ride a bicycle around the time of disease onset, according to a study published online Oct. 4 in the Journal of Parkinson's Disease.

Hideto Miwa, M.D., and Tomoyoshi Kondo, M.D., from the Wakayama Medical University in Japan, investigated whether the bicycle sign was clinically useful in patients with parkinsonism living in hilly areas like Japan. Data on cycling habit from 86 patients with diagnosed PD and 26 with diagnosed AP were classified into six categories: 0 (never rode a bicycle); 1 (no habit of bicycling since adolescence); 2 (used to bicycle, but have long since stopped riding); 3 (stopped bicycling within a few years around disease onset: bicycle sign); 4 (ceased bicycling two years or more after disease onset); and 5 (ride a bicycle even now).

The investigators found that 13.2 and 11.5 percent of patients with PD and AP, respectively, were in category 0, and 38.6 and 30.8 percent of patients were in categories 1 or 2. The bicycle sign (category 3) was observed significantly more frequently in patients with AP than with PD (88.9 versus 9.8 percent). A total of 40.9 and 3.9 percent of patients with PD and AP, respectively, were in category 5.

"Although bicycling cultures may differ between countries, it is possible that the bicycle sign could contribute to earlier and better differential diagnosis of parkinsonism during the diagnostic interview," the authors write.

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