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Ability to Ride a Bike Can Aid Differential Diagnosis of Parkinson’s Disease in Any Setting

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.

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.


Full text of the article is available to credentialed journalists. Contact Daphne Watrin, IOS Press, Tel: +31 20 688 3355, Journalists wishing to interview the authors should contact Hideto Miwa, MD, at


Launched in June 2011 the Journal of Parkinson’s Disease is dedicated to providing an open forum for original research in basic science, translational research and clinical medicine that will expedite our fundamental understanding and improve treatment of Parkinson’s disease. The journal is international and multidisciplinary and aims to promote progress in the epidemiology, etiology, genetics, molecular correlates, pathogenesis, pharmacology, psychology, diagnosis and treatment of Parkinson’s disease. It publishes research reports, reviews, short communications, and letters-to-the-editor and offers very rapid publication and an affordable open access option.


Commencing its publishing activities in 1987, IOS Press ( serves the information needs of scientific and medical communities worldwide. IOS Press now (co-)publishes over 100 international journals and about 130 book titles each year on subjects ranging from computer sciences and mathematics to medicine and the natural sciences.

IOS Press continues its rapid growth, embracing new technologies for the timely dissemination of information. All journals are available electronically and an e-book platform was launched in 2005.

Headquartered in Amsterdam with satellite offices in the USA, Germany, India and China, IOS Press has established several strategic co-publishing initiatives. Notable acquisitions included Delft University Press in 2005 and Millpress Science Publishers in 2008.

Daphne Watrin
IOS Press
Tel: +31 20 688 3355
Fax: +31 20 687 0019