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 'Bicycle Sign' May Distinguish PD From Atypical Parkinsonism 
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Joined: Fri Aug 11, 2006 1:46 pm
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Post 'Bicycle Sign' May Distinguish PD From Atypical Parkinsonism
This is a news article based upon some new research published in the latest issue of The Lancet. "New research suggests the preserved ability to ride a bicycle after onset of symptoms may accurately differentiate between Parkinson's disease (PD) and atypical parkinsonism," such as PSP, CBD, MSA, LBD, and vascular parkinsonism.

"Making the differential diagnosis ... is important clinically for counseling patients and accurate inclusion of suitable patients into trials but remains challenging," the researchers note. "Here, we suggest that the answer to 1 simple question — 'Can you still ride a bicycle?" — offers good diagnostic value for separating Parkinson's disease from atypical parkinsonism."

The short, two-page article in The Lancet is available at present at no charge online. See:
http://www.thelancet.com/journals/lance ... 40-6736(11)60018-4/fulltext

The table is worth a quick look.

Here's a link to the news article in Medscape and the full text.

Robin



http://www.medscape.com/viewarticle/735425

'Bicycle Sign' May Distinguish Parkinson's From Atypical Parkinsonism
Susan Jeffrey
From Medscape Medical News > Neurology

January 7, 2011 — New research suggests the preserved ability to ride a bicycle after onset of symptoms may accurately differentiate between Parkinson's disease (PD) and atypical parkinsonism.

The investigators, with senior study author Bastiaan R. Bloem, MD, PhD, medical director of the Parkinson Center Nijmegen at Radboud University Nijmegen Medical Center, the Netherlands, had previously reported a case study of a patient with advanced PD who showed an astonishing residual ability to ride a bicycle.

Now they have found in a new series of patients that preserved cycling ability is limited to patients with PD but is lost after disease onset among those with atypical parkinsonism.

"Simply asking about cycling abilities could be added to the list of red flags that can assist clinicians in their early differential diagnosis of parkinsonism," the study authors conclude.

They report their findings as correspondence in the January 8 issue of The Lancet.

Freezing of Gait

In April 2010, Dr. Bloem and colleague Anke Snijder, MD, reported the case of a 58-year-old man with advanced PD and severe freezing of gait who could nonetheless ride his bicycle for up to 15 miles per day. After meeting this patient, Professor Bloem reported having found an additional 20 PD patients in his outpatient clinic, where he specializes in gait and balance disorders, all of whom could still ride a bicycle (N Engl J Med. 2010;362:13).

"In hindsight, it's not a unique observation, and we've just missed out, maybe because we failed to ask about it or patients fail to volunteer this, but it's certainly not a unique observation," he told Medscape Medical News at that time.

Making the differential diagnosis between PD and atypical parkinsonism disorders, such as progressive supranuclear palsy, multiple system atrophy, or Lewy body dementia, is important clinically for counseling patients and accurate inclusion of suitable patients into trials but remains challenging, they note.

"Here, we suggest that the answer to 1 simple question — 'Can you still ride a bicycle?" — offers good diagnostic value for separating Parkinson's disease from atypical parkinsonism," they write.

To look at this prospectively, investigators performed an observational study of 156 consecutive patients who presented with parkinsonism but did not yet have a definitive diagnosis. All had a structured interview, comprehensive neurological assessment, and cerebral magnetic resonance imaging (MRI) at baseline. Standard questions in the interview asked "whether, when, and why" cycling had become impossible for them.

The gold standard for diagnosis was at 3 years of follow-up, based on clinical examination, response to treatment, and MRI.

Of these patients, 111 had ridden a bicycle before first manifestation of their disease; 45 developed PD and 64 some form of atypical parkinsonism, mostly multiple system atrophy (n = 35, 31.5%) or vascular parkinsonism (n = 17, 15.3%).

At the time of inclusion in the study, occurring at a median disease duration of about 30 months, 34 of 64 patients ultimately diagnosed as having atypical parkinsonism had stopped cycling compared with only 2 of the 45 PD patients, yielding a sensitivity of 52%, and a specificity of 96% (area under the curve, 0.74; 95% confidence interval, 0.64 – 0.83).

The loss of cycling ability was seen with all atypical parkinsonism conditions, they note, and regression analysis showed no significant effect of age, parkinsonism, or ataxia on this ability, "suggesting this was an independent marker of atypical parkinsonism," they write.

Cycling requires a highly coordinated interplay among balance, coordination, and rhythmic pedaling of the legs, Dr. Bloem and colleagues point out. "This skilled task is probably sensitive to subtle problems with balance or coordination, caused by the more extensive extranigral pathology in atypical parkinsonism," they speculate.

"We suggest that loss of the ability to cycle after disease onset might serve as a new red flag, signaling the presence of atypical parkinsonism," the study authors conclude. "The diagnostic value of the 'bicycle sign' was good: its presence was highly specific for the diagnosis of atypical parkinsonism."

The study was supported by a research grant from the Internationaal Parkinson Fonds. The study authors have disclosed no relevant financial relationships.

Lancet. 2011;377:125-126.


Fri Jan 07, 2011 2:18 pm
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Joined: Wed Dec 30, 2009 1:46 pm
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Post Re: 'Bicycle Sign' May Distinguish PD From Atypical Parkinso
I guess in the UK more older people ride bicycles than do here.

_________________
Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Fri Jan 07, 2011 5:06 pm
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Post Re: 'Bicycle Sign' May Distinguish PD From Atypical Parkinso
Fascinating. Just trying to remember the last time my dad ever tried to ride a bicycle - maybe 1955! Pat makes a good point - there are tons of people around here who bicycle, but I don't usually see many people over maybe 70ish on bikes. It would be interesting to study people in The Netherlands, England, Ireland, and many Asian countires, etc. where biking is much more common than the US among people over 70 or 80. Would love to see more on this topic. Thanks for posting. Lynn

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Lynn, daughter of 89 year old dad dx with possiblity of LBD, CBD, PSP, FTD, ALS, Vascular Dementia, AD, etc., died Nov. 30, 2010 after living in ALF for 18 months.


Fri Jan 07, 2011 5:17 pm
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Joined: Wed Oct 28, 2009 11:53 am
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Post Re: 'Bicycle Sign' May Distinguish PD From Atypical Parkinso
Dale rode his exercise bike up to Thanksgiving when he said the bike was broken. I didn't bother to check on it because his condition was going down hill so fast. Now, I'm curious.

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Leone Carroll (75); wife of Dale (75) who passed away March 23, 2011


Fri Jan 07, 2011 7:13 pm
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Post Re: 'Bicycle Sign' May Distinguish PD From Atypical Parkinso
I wonder if, with PD, the momentum of the lower pedal facilitates the forward motion of the upper leg and it just carries through? But not with Lewy?

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Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Fri Jan 07, 2011 7:32 pm
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Post Re: 'Bicycle Sign' May Distinguish PD From Atypical Parkinso
Florida is loaded with older bicycle riders ! Mostly I would think because the weather is warmer many more months !

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Irene Selak


Fri Jan 07, 2011 7:48 pm
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Post Re: 'Bicycle Sign' May Distinguish PD From Atypical Parkinso
I assume this is a balance problem. Those with the atypicals have compromised balance but those with PD have preserved balance until very late in the disease.


Fri Jan 07, 2011 9:35 pm
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