Early Recognition of Parkinson’s Disease in Emergency Medicine: Commentary on an Unrealized Opportunity for Improved Care and Research in Movement Disorders

Despite Parkinson’s Disease (PD) typically being diagnosed after 80% of dopaminergic neurons are lost, evidence suggests that many patients exhibit early symptoms and frequently utilize emergency department (ED) services years before formal diagnosis. Here we examine the untapped potential of EDs in early PD recognition and intervention. Analysis of nearly 14,000 PD patients from two major healthcare systems revealed that 74% visited the ED or urgent care in the two years preceding diagnosis, yet of over 147,000 PD-related articles published since 1950, only 203 address PD in the ED setting, with just 22 authored by emergency medicine personnel. Early manifestations bringing patients to the ED include falls, syncope, autonomic dysfunction, and neuropsychiatric symptoms, often preceding classic motor symptoms by years or decades. We propose that EDs, serving as healthcare safety nets with over 131 million annual visits in the United States, are uniquely positioned to improve early detection of movement disorders through: (1) utilization of simple targeted screening protocols integrated with ED workflows, (2) creating clear pathways for fall patient evaluation that include direct referrals for mobility assessments, and (3) building research bridges between emergency medicine and movement disorder specialists. Earlier recognition could significantly impact patient outcomes through timely intervention and increased clinical trial participation, while advancing research in movement disorders.