Personalized DAT Selection in Advanced Parkinson’s Disease: A Milestone-Guided, Phenotype-Aligned Framework

Oral medication frequently fails in advanced Parkinson's disease (PD), necessitating a prompt switch to device-aided therapies (DAT) such as DBS, LCIG, or CSAI. Current DAT initiation techniques, however, continue to be non-individualized, reactive, and delayed. We offer a useful, phenotype-aligned, milestone-driven model to help choose therapies based on the unique paths of each patient. We created a decision framework and scoring checklist based on patient subtypes and clinical milestones by incorporating ideas from important literature. Three primary PD phenotypes: tremor-dominant, PIGD, and cognitive decline - are correlated with five milestone-based clinical indicators. Our structured model allows for more accurate and timely DAT initiation by striking a balance between treatment efficacy, invasiveness, and contraindications. A decision tree and scoring matrix provide a visual summary of the framework, maximizing its practicality. This framework supports multidisciplinary collaboration and shared decision-making, enhancing patient outcomes by providing structured yet flexible approach to advanced PD management.