When it comes to the diagnosis of Parkinson’s Disease and signs that are normal for this condition or atypical, asking whether or not a person can ride a bicycle could help determine the severity of Parkinson’s properly.

Patients with Parkinson’s disease have few balance problems moving sideways, their gait is typically narrow-based and can show a remarkable ability to ride a bicycle. Cycling requires a highly coordinated interplay between balance, coordination, and rhythmic pedalling of the legs. This skilled task is probably sensitive to subtle problems with balance or coordination, caused by the more extensive extranigral pathology in atypical parkinsonism.

As outlined by Drs. Marjolein B. Aerts, Wilson F. Abdo, and Prof. Bastiaan R. Bloem, Department of Neurology, Parkinson Centre Nijmegen, Netherlands, an assessment was done of 111 Parkinson’s patients, 45 with Parkinson’s disease and 66 with atypical Parkinsonism.

Aside from administering a brain MRI scan, nuclear brain imaging, electromyography, and a spinal tap, they also asked the patients if they were still able to ride a bicycle.

The authors say:

“We suggest that the answer to one simple question ‘Can you still ride a bicycle?’ offers good diagnostic value for separating Parkinson’s disease from atypical parkinsonism.”

Of the patients with Parkinson’s disease, only two (4%) were unable to ride a bike, while 34 (52%) with atypical parkinsonism could not cycle. The most interesting part was that this simple question had better diagnostic value than the array of invasive ancillary tests.

Asking about cycling could thus save considerable expenses, and reduce the burden for patients. According to the National Parkinson’s Foundation, each patient spends an average of $2,500 a year for medications. Estimates of costs of medical care, disability payments and lost income exceed $5.6 million annually. This does not include the effect on caregivers and family.

The exact cause of Parkinson’s is not known. Degeneration of certain brain cells causes a reduction in Dopamine an essential chemical of the brain. Exactly what causes the degeneration of those brain cells is not known although much research is being done. Diagnosis of Parkinson’s is made by a specialist and is based on the symptoms presented and ruling out other possible causes.

In conculsion the doctors state:

“Cycling requires a highly coordinated interplay between balance, coordination, and rhythmic pedalling of the legs. This skilled task is probably sensitive to subtle problems with balance or coordination, caused by the more extensive extranigral pathology in 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 ‘bicycle sign’ for atypical parkinsonism”
MB Aerts, WF Abdo, BR Bloem
The Lancet, Volume 377, Issue 9760, Pages 125 – 126, 8 January 2011
doi:10.1016/S0140-6736(11)60018-4

Written by Sy Kraft, B.A.