Emerging Advances in Parkinson Disease Ahead of MDS 2026: Benjamin Walter, MD, MBA

The field of Parkinson disease (PD) continues to evolve as researchers work to better understand the biological mechanisms underlying the disease and identify approaches that can improve diagnosis and treatment. Advances in biomarkers, genetic testing, neuromodulation, and the identification of patients in early or prodromal stages have increasingly shaped the research landscape.

The 2026 International Congress of Parkinson’s Disease and Movement Disorders (MDS), held October 4-8 in Orlando, Florida, will feature discussions across these areas, including emerging strategies in adaptive deep brain stimulation (DBS), the growing role of biomarkers and genetics in clinical care, and efforts to identify patients with PD earlier in the disease course. Despite progress across these fields, the need for effective disease-modifying therapies remains a major priority.

Ahead of MDS 2026, Benjamin Walter, MD, MBA, section head of movement disorders and medical director of the Deep Brain Stimulation Program at Cleveland Clinic, spoke with NeurologyLive® about some of the developments shaping the PD landscape. In the discussion, Walter discusses advances in neuromodulation and biomarker testing, the evolving role of genetic information in personalized care, and the challenges of developing disease-modifying and neuroprotective therapies for PD.

NeurologyLive: Heading into MDS 2026, which emerging concepts, areas of research, or therapeutic advances are you most excited to see discussed at the meeting?

Walter, MD, MBA: I'm really looking forward to the movement disorders community coming together in Seoul. My particular interests focus on neuromodulation and novel health care delivery systems. With deep brain stimulation, I think there have been a lot of changes over the last couple of years, and I expect to see more.

There are some great presentations planned, particularly looking at adaptive DBS and some of the strategies around that. We're heavily involved in that space, so I'm excited to see that. Additionally, I think there's a focus on aging across the lifespan at this particular conference.

There has been an emerging, ongoing theme around predictive biomarkers, how we actually define PD pathologically, which I think is starting to change over time, and getting closer toward patient-specific or personalized medicine based on some of the different pathways through which people develop these syndromes.

Are there any specific advances in PD that appear particularly close to entering clinical practice, and what should clinicians be watching in that space over the next couple of years?

Certainly biomarkers have been evolving, and I do think we're starting to get more data on our patients. We've had some capabilities with scans for quite a while. Now, there's been an emergence of different types of alpha-synuclein pathology testing. The Syn-One Skin Biopsy has been around for a little bit, but getting these tests into practice where they're useful in an expert's hands has been lacking.

In some cases, people would use DAT scans in the past in lieu of referring to a movement disorder specialist, which isn't really a great way to use a test like that because your pretest probability goes down dramatically. Then, the accuracy of the test goes down as well. We typically use it when we have real questions to answer.

As these technologies evolve, though, we now have the opportunity to see patients with different characteristics, particularly thinking about how that interacts with genetic testing. Alpha-synuclein can be negative in the skin and CSF, and you can still have PD. When we're characterizing those patients, we often see that there are genetic etiologies.

Getting a better understanding of that interaction between biomarkers in our workup and genetics is evolving. Then, how do you treat these patients differently, or do you? Are there going to be therapies available for certain genotypes of PD? These are all things that I think will evolve more as we get more data, where the data in the past has been lacking.

I think that's an exciting emergence that is starting to actually change how we work up and treat patients. That's an exciting change for clinicians, even outside of the movement disorder space.

How has genetic testing in PD evolved in recent years, and where does the field stand in integrating this genetic information into clinical care?

Again, where it's been lacking is not necessarily the ability to get the testing. It was expensive and not covered by insurance, and so I think one of the really great catalysts for this has been the efforts by the Parkinson's Foundation through the PD GENEration study.¹

This particular study has funded phenotyping and testing, initially with the 7 most common genes for PD. Now, it's reporting out the 7 most common genes through whole-genome sequencing, so more genetic material is available for later processing as more genes get discovered.

This has been fantastic because it's really been a lack of actionable data, rather than a lack of the ability to obtain that data. As we accumulate more data, I think, for one, clinicians will have a better idea of how this presents in their clinic. But we're also starting to see people look at responses to different therapies, and particularly different therapies that may be targeting specific subpopulations of people with PD based on their genetic makeup, at least initially, and seeing those in clinical trials.

That's going to be exciting, particularly if any of these start to turn positive. We're going to have a huge transformation in genetic testing for people with PD, and that will really change things. I think if we do that, we're going to learn a lot more and be able to take better care of people as well, again driving forward personalized medicine.

MDS 2026 will feature discussion around early and prodromal PD. How has our understanding of this stage of the disease evolved, and what ongoing initiatives could help identify and treat patients earlier?

I think it's been a focus for quite some time now. Particularly as we've seen the failure of one after another disease-modifying, putatively disease-modifying study, detecting PD early is going to be key to getting something that works.

Knowing that it takes a significant amount of degeneration before you develop symptoms and receive a diagnosis of PD, we don't want to start preventing progression once the horse is already out of the barn. So, early detection is key. It has been for a while, and I think that will continue to be an important point.

Which emerging biological targets or pathways currently show the most potential, and where might neuroprotective strategies fit into the overall landscape?

The one that works is going to be the best one, and that's been the challenge. I think there are a lot of exciting theories, and we need to fund clinical trials to test these theories and find something that works well. It's not a matter of just finding the right agent to test; it has to be a good trial design and the right patient population, and you have to do it early enough that you have a chance of seeing the benefits.

So, it's really putting money where our mouths are and funding these studies, including getting government funding in particular for Parkinson research, which is really a pandemic now and affecting a greater and greater number of people across this country and others.

REFERENCES
1. Cook L, Verbrugge J, Schwantes-An TH, et al. Parkinson's disease variant detection and disclosure: PD GENEration, a North American study. Brain. 2024 Aug 1;147(8):2668-2679. doi: 10.1093/brain/awae142.