Congratulations Dr. Michael Okun on your viewpoint article “Tapping the Brakes on New Parkinson Disease Biological Staging,” which appears in the July 8, 2024 issue of JAMA Neurology.
Parkinson disease (PD) is a heterogeneous disorder, and there remains a gap in our understanding of its pathogenic mechanisms. Two 2024 publications1,2 have boldly proposed new biological definitions for PD. Though these biological definitions are exciting, there are crucial reasons to tap the brakes on an immediate implementation of a biologically based definition for PD. An increasing number of clinicians have embraced the concept of Parkinson diseases, plural, to acknowledge the marked clinical and pathological heterogeneity. Thus, biological definitions and classification schemes should ideally evolve organically alongside advances in science and technologies.