Towards a Better Definition of Patient-Centered Therapeutic Strategy of Parkinson’s Disease: An Opinion Paper

Recent Parkinson's disease (PD) treatment guidelines remain predominantly drug- and stage-centric and only inconsistently articulate a patient-centered medication strategy. We aimed to identify this gap and propose pragmatic, consensus-based principles for fully individualized, preference-sensitive pharmacological care across the patient journey. Seventeen movement disorder experts from eight European countries convened (March 2026) and generated key clinical questions spanning early to advanced PD. Panelists completed an anonymized questionnaire; semantic AI supported identification of areas of consensus and dissensus, followed by a single-round Delphi-style discussion to refine agreed statements. The panel reached consensus on eight statements across five focus areas: (i) incorporating patient characteristics and contextual factors underrepresented in guidelines (comorbidities, co-medications, behavioral/cognitive risk, non-motor symptom burden, and-when appropriate-genetics); (ii) treating therapy initiation as a longitudinal process with shared decision-making, education, and non-pharmacological foundations; (iii) legitimizing watchful waiting or dose reduction in selected scenarios; (iv) using both motor and non-motor symptoms and lifestyle goals as primary drivers of oral therapy selection; and (v) transparently managing evidence gaps while providing good-practice guidance on reassessment. Examples on how these recommendations can be used to plan a therapy strategy are presented for different patients' personae. In conclusion, a patient-centered medication strategy in PD should be explicit, structured, and revisited over time, aligning therapeutic choices with symptoms, risks, context, and individual goals and preferences. A wide range of treatments must always be available throughout the patient's care pathway to allow for greater individualization of care, particularly regarding treatment sequencing, drug combinations, and dosage thresholds. This requires new forms of validation beyond traditional standardized clinical trials.