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Ability to ride a bike can aid differential diagnosis of Parkinson's disease in 
any setting
According to new study published in the Journal of Parkinson's Disease 
Amsterdam, NL, 7 October 2011 – In a new study published today in the Journal 
of Parkinson's Disease, Japanese researchers report that the ability to ride a 
bike can differentiate between atypical parkinsonism and Parkinson's disease, 
regardless of the environment or situations for bicycling. 
Atypical parkinsonisms are disorders that look similar to Parkinson's disease, 
but respond differently to treatments. The "bicycle sign" can help clinicians 
differentiate between the two. Patients with atypical parkinsonism lose their 
ability to cycle during the early phase of the illness, while patients with 
Parkinson's disease continue to ride well. Actual environments or situations 
for biking differ from one country to another, raising the question of whether 
the "bicycle sign" could be universally applicable. Hideto Miwa and Tomoyoshi 
Kondo, of the Department of Neurology at Wakayama Medical University, in 
Wakayama, Japan, set out to determine if the "bicycle sign" would be reliable 
in Japan, where the roads are hilly, narrow, and crowded with automobiles. 
The study found that 88.9% of Japanese patients with atypical parkinsonism had 
ceased bicycling during the few years around the onset of their illness, as 
compared with only 9.8% of the patients with Parkinson's disease. In fact, the 
prevalence of the "bicycle sign" may be much higher in Japan than in The 
Netherlands (51.5%), which is known as one of the world's most bicycle-
friendly countries. This may be because the tough bicycle environment in Japan 
makes it more difficult for atypical parkinsonism patients to bike. 
"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. When we see 
patients with parkinsonism without a definitive diagnosis, it is a simple thing 
to ask the question, 'Can you still ride a bicycle?'" commented Dr. Miwa.
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The article is "Bicycle Sign for Differential Diagnosis of Parkinsonism: Is It 
of Use in a Hilly Country Like Japan?" by Hideto Miwa and Tomoyoshi Kondo, 
Journal of Parkinson's Disease. 1(2). DOI 10.3233/JPD-2011-11039. Published by 
IOS Press. 

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