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Ten steps to identify atypical parkinsonism
  1. W F Abdo1,
  2. G F Borm2,
  3. M Munneke1,
  4. M M Verbeek3,
  5. R A J Esselink1,
  6. B R Bloem1
  1. 1Department of Neurology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  2. 2Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre
  3. 3Laboratory of Paediatrics and Neurology, Radboud University Nijmegen Medical Centre
  1. Correspondence to:
 B R Bloem
 Parkinson Centre Nijmegen, Institute of Neurology, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands; b.bloem{at}


Background: Balance impairment is a frequently encountered problem in patients with Parkinson’s disease. A profound balance disorder, however, is an atypical feature.

Methods: Tandem gait performance (10 consecutive tandem steps) was judged in 36 consecutive patients with Parkinson’s disease and 49 consecutive patients with atypical parkinsonism.

Results: Only 9 (18%) patients with atypical parkinsonism had a fully normal tandem gait (not a single side step) as opposed to 33 (92%) patients with Parkinson’s disease. Analysis for the subgroup of patients with a disease duration of <3 years yielded the same diagnostic accuracy.

Conclusions: Tandem gait performance has a good diagnostic ability to differentiate patients with atypical parkinsonism from those with Parkinson’s disease, and might be used as an additional “red flag” to assist existing clinical tests in identifying atypical parkinsonism.

  • MRI, magnetic resonance imaging
  • PIGD, postural instability and gait disability
  • PSP, progressive supranuclear palsy
  • SPECT, single photon emission computed tomography

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  • Published Online First 1 August 2006

  • See Editorial Commentary, p 1299

  • Funding: WFA was supported by a research grant from the Stichting Internationaal Parkinson Fonds. This non-corporate funding organisation had no role in study design or conduct of the study, data collection, data analysis and interpretation, and manuscript preparation.

  • Competing interests: None.

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