Sources, in the order they appear:
1. Smell loss as an early prodromal sign: established in the PPMI prodromal cohort (hyposmia), Siderowf et al, Lancet Neurology 2023.
pubmed.ncbi.nlm.nih.gov/3705…
2. Acting out dreams (REM sleep behaviour disorder): 6.3% convert per year, 73.5% by 12 years, n=1,280, 24 centres. Postuma et al, Brain 2019.
pubmed.ncbi.nlm.nih.gov/3078…
3. Smartwatch (wrist accelerometry) flagged Parkinson's up to 7 years before diagnosis and outperformed genetics, blood and lifestyle models. Schalkamp et al, Nature Medicine 2023.
pubmed.ncbi.nlm.nih.gov/3740…
Caveat worth saying plainly: the lead time is real, but the absolute accuracy at a population level is still low. It's a screening signal, not a diagnosis.
4. Retinal scan (OCT): GCIPL and INL thinning showed up on average about 7 years before a Parkinson's diagnosis. Wagner et al, Neurology 2023.
pubmed.ncbi.nlm.nih.gov/3760…
5. Skin biopsy (Syn-One test): cutaneous phosphorylated alpha-synuclein detected in 92.7% of Parkinson's patients (89 of 96), with 3.3% of controls positive, n=428 enrolled across 30 sites. Gibbons et al, JAMA 2024.
pubmed.ncbi.nlm.nih.gov/3850… Commercially available in the US via CND Life Sciences.
6. Spinal-fluid seed amplification assay (SAA): about 99% sensitivity in classic sporadic Parkinson's, and it turns positive in prodromal people (RBD, hyposmia) who have no motor symptoms yet. Siderowf et al, Lancet Neurology 2023, PPMI / Michael J. Fox Foundation.
pubmed.ncbi.nlm.nih.gov/3705…
The 2024 shift: a biological staging system (NSD-ISS) now defines Parkinson's by the alpha-synuclein protein detected in vivo, not by symptoms. Simuni, Hoglinger et al, Lancet Neurology 2024.
pubmed.ncbi.nlm.nih.gov/3826…
The smell story: Joy Milne, the Scottish nurse who could smell Parkinson's, led to the sebum-odour work in Barran's lab at the University of Manchester.
Honest caveats: most of these detect risk, not certainty. The skin and spinal-fluid tests are the most clinically established; the smartwatch and retinal signals are population-level research findings, not personal verdicts.