Parkinson’s disease (PD), also known as “tremor palsy”, is an irreversible progressive degenerative disease of the central nervous system that occurs mostly in middle-aged and elderly people. When these nigrostriatal neurons degenerate and die to more than 80%, the synthesis of dopamine, an important chemical transmitter in the brain, is severely reduced and cannot maintain the normal function of the nervous system, and the ability to inhibit acetylcholine, another neurochemical transmitter, is reduced. The imbalance between the two chemicals results in a series of symptoms such as tremor, muscle rigidity, motor slowing and postural instability. Currently, Parkinson’s disease is the third most serious threat to the health of the elderly after stroke and Alzheimer’s disease. However, there is a serious lack of awareness of the disease, and patients are not able to seek early medical care, and there are prominent cases of underdiagnosis and misdiagnosis, resulting in more than 50% of Parkinson’s disease patients not receiving timely and effective treatment, making the disease worse and seriously affecting the outcome. In this paper, we firstly review the drug treatment of Parkinson’s disease, and then propose the early treatment strategy for Parkinson’s disease based on this review. 1, Parkinson’s disease drug treatment overview For the treatment of Parkinson’s disease, there are mainly drugs, surgery, genes, brain cell transplantation and other methods, of which drug therapy is currently the most mature and most used treatment means. The first generation is anticholinergic drugs and amantadine, which are effective for tremor by inhibiting the effect of acetylcholine and correspondingly increasing the effect of dopamine and correcting the dopamine imbalance; however, they are used with caution in patients older than 70 years old and may induce Alzheimer’s disease; the second generation is levodopa, which achieves therapeutic effect by replenishing dopamine in the brain and is effective for However, some complications can occur with long-term use, which some scholars call “long-term medication syndrome”; the third generation are agonists and enhancers of dopamine receptors, and almost all agonists are clinically applied to D2 or D2/D3 receptors; the fourth generation are monoamine oxidase B (MAO-B The fourth generation is monoamine oxidase B (MAO-B) inhibitors and catecholamine oxidation methyltransferase (COMT) inhibitors, the most successful MAO-B selective inhibitor is Silegiline, choose Antan and other drugs combined for early Parkinson’s disease effect is good. In recent years, the rapid development of neuroscience, PD etiology and pathogenesis in molecular biology, molecular pathology, molecular genetics and other significant achievements, some promising new treatment methods such as adenosine A2A receptor antagonists, and various new agents are also emerging. 2, Parkinson’s disease early treatment strategy Parkinson’s disease is a chronic progressive disease that will accompany patients throughout their lives. Once a patient is diagnosed, if no measures are taken to cause fear in patients, it will increase the psychological burden of patients. In addition, early treatment can affect the patient’s medication side effects later in life. Therefore, choosing the appropriate treatment plan is crucial for the treatment of patients with early Parkinson’s disease. (1) Non-pharmacological treatment If the disease does not affect the patient psychologically or physically in the early stage of the disease, the patient should be encouraged to persist in work, participate in social activities and medical physical therapy, and medication can be suspended for non-pharmacological treatment. Non-pharmacological treatment is the basis of all-round treatment for PD patients, including education for patients and their families, establishment of helping institutions, adjustment of patients’ emotions, training of nursing staff, functional exercise, reasonable nutrition, family help and giving patients more care. (2) Drug therapy Principle: The purpose of PD treatment is to delay the progression of the disease, control the symptoms of the disease, and improve the patient’s quality of life. Pharmacological treatment of Parkinson’s disease generally follows the following principles: (1) It is generally considered that the goal of treatment for young, early-stage patients is to maintain or restore the ability to work. (2) Some studies have shown that the health status of untreated Parkinson’s disease patients is significantly impaired 18 months after the initial visit. Therefore, even in early patients without functional impairment or minor impairment, if treatment is determined to be protective, whether medication or surgery, it should be given as soon as possible as a priority [3]. (3) Pharmacological treatment of PD is symptomatic and most of them have some side effects at the beginning of their application, the most common being symptoms of the digestive tract, such as nausea and vomiting. Therefore, the application of each anti-PD drug should be titrated, i.e., start with a small dose, slowly increase the dose, and maintain the treatment with the dose when the best efficacy is achieved within the tolerable dose of side effects. (4) Individualized selection of anti-Parkinsonian drugs according to the condition, such as the choice of Antan anticholinergic drugs for resting tremor. (5) Anti-Parkinson’s disease drugs should not be excessive, nor should they be stopped suddenly. Early neuroprotective therapy: Neuroprotective therapy can be defined as an intervention that delays or stops neuronal degeneration, and this intervention is aimed at preventing and controlling nigrostriatal cell death. In patients with newly diagnosed early PD, if the symptoms are mild and do not affect function, they can start without medication and strengthen functional exercises. When possible, some neuroprotective agents are taken. The antioxidant coenzyme Q10 is a definite neuroprotective agent, and studies have shown that using 320 mg-1200 mg daily may delay progression of the disease. The DATATOP study found that type B monoamine oxidase inhibitors (MAO-BI) may improve symptoms of PD, delay the use of levodopa, and have potential neuroprotective benefits.Rasagiline is a new selective irreversible MAO-B inhibitor that has shown efficacy in improving symptoms in both early and late stage PD patients.The TEMPO trial showed that Rasagiline has a neuroprotective effect. Therefore, MAO-BI can be used in patients with early diagnosed Parkinson’s disease. selleckiline may also have a protective effect. Symptomatic treatment: To date, the most effective drug therapy remains levodopa replacement therapy, using the principles of Parkinson’s treatment established and recommended by the American Academy of Neurology in 2002, which is considered the “gold standard” of PD drug therapy. Since the introduction of levodopa into PD treatment in the late 1960s, the quality of life of patients with Parkinson’s disease has improved significantly, extending their life expectancy and reducing mortality. However, during the course of levodopa use, levodopa was found to be ineffective for certain Parkinson’s disease symptoms and there were theoretical toxic effects of accelerated neurodegeneration. Diminished efficacy was observed after 2-5 years of long-term drug use as well as distant side effects such as motor fluctuations, including end-of-dose phenomenon, switching phenomenon and freezing phenomenon; heterokinesia including biphasic heterokinesia and dystonia. In any case, the mortality and disability rates of Parkinson’s disease patients while taking levodopa have been greatly reduced compared to the prelevodopa era. The point is that, to date, levodopa remains the most effective drug for Parkinson’s disease, despite the limitations of distant complications. How to take levodopa, obtain relatively sustained dopaminergic stimulation, and reduce the incidence of drug-induced dyskinesia is the question that currently needs to be addressed. Dopamine receptor agonists are currently recognized as effective drugs for the treatment of PD. There are two major classes of ergot derivatives and non-ergot synthetic dopamine receptor agonists. Due to the side effects of the former, such as fibrosis of the heart valves caused by concanavalin, ergot analogs are no longer recommended at present. Although DA receptor agonists are less efficacious than levodopa, they have clinical advantages due to their ability to delay the application and possible neuroprotective effects of levodopa, alleviate the motor complications of dopa drugs, and may have neuroprotective effects, and are now mostly preferred as first-line drugs for the treatment of early patients younger than 65 years of age, especially for younger patients with onset before 40 years of age . Agonists are currently recommended as the first choice when symptomatic treatment is needed in patients with Parkinson’s disease. Many studies have demonstrated that early use of dopamine agonists can stop or delay the fluctuations in motor symptoms associated with dopa medication and are therefore widely used in the early stages of PD. Ergot dopamine agonists such as pergolide and bromocriptine are now not used as first-line agents due to their side effects of cardiac valve fibrosis. Non-ergot dopamine agonists such as pramipexole and piribedil have been used as the best choice for the treatment of early PD. The debate on which drug is more efficacious, dopamine or dopamine agonist, has focused in recent years on the so-called neurotoxicity of levodopa and the neurocytoprotective effects of dopamine agonists, but no definitive conclusion has been reached so far. Since most of these views originate from the results of in vitro experiments, they do not provide significant guidance for clinical treatment. The view that levodopa has toxic effects has been largely discarded. As for DA receptor agonists and levodopa preparations, which one to use first should be considered in a comprehensive manner according to the patient’s condition. For patients with relatively young age and mild disease, DA agonists can be considered, and conversely, levodopa preparations can be considered. If the drug alone is not effective, a combination of drugs can be considered, and the dose of a particular drug should not be increased. Anticholinergic agents, amantadine, and sregiline: these drugs have low clinical efficacy and are therefore non-first-line drugs, especially in some elderly people who have the side effect of reducing cognitive performance. Anticholinergic agents are generally used in the early treatment of PD, especially when tremor is the main symptom. There is evidence that anticholinergic agents are superior to levodopa for the treatment of tremor. Because they are well tolerated by patients, some physicians choose them first to delay the application of other dopaminergic drugs. (3) Drug selection Drug selection is critical to the treatment of patients with early Parkinson’s disease. If the disease does not affect the patient psychologically or physically in the early stages, the patient should be encouraged to persist in work, participate in social activities and medical physical therapy, and medication may be withheld. However, if the patient believes that the disease has affected him, medication should be started. Age is the primary factor that should be considered. Patients who are pre-elderly (65 years of age) and do not have diminished intelligence may have the following options: ① dopa agonists; ② selagiline + vitamin E; ③ amantadine and/or anticholinergics, with anticholinergics chosen in those with significant tremor and when other antiparkinsonian drugs are not effective; ④ compound dopa + catechol oxygen methyltransferase inhibitor (COMTI); ⑤ compound dopa: generally when the first 3 treatment options when the first 3 treatment options are not effective. However, certain patients, with cognitive decompensation or the need to obtain significant improvement in motor symptoms due to special work requirements, may be preferred. As for dope-receptor agonists and levodopa preparations, which one is used first is considered in the context of the patient’s condition. For patients who are relatively young and have a mild condition, dope-receptor agonists can be considered, and conversely, levodopa preparations can be considered. If the drug alone is not effective, a combination of drugs can be considered, and the dose of a particular drug should not be increased. Elderly (R65 years) patients, or those with diminished intelligence: compound dopa, with the addition of a dopa agonist, B-type monoamine oxidase inhibitor (MAO-BI) or COMTI if necessary, and benzhexol as much as possible, especially in elderly male patients, unless there is severe tremor significantly affecting the patient’s ability to perform daily life. In conclusion, there is no absolute fixed pattern for the treatment of Parkinson’s disease, because the clinical symptoms can vary between patients, some with a predominantly tremor type, while others can have a predominantly less mobile tonic type; the sensitivity of different patients to anti-Parkinson’s disease drug therapy also varies, and the same patient has different needs for drug therapy in different stages of the disease. In conclusion, the most important treatment principle for Parkinson’s disease is to follow individualized treatment. Based on a scientifically sound regimen, it should not only be effective in improving symptoms, but also in slowing the progression of the disease. The chosen treatment plan must meet the specific requirements of the patient. Therefore, pharmacological treatment emphasizes individualized treatment and combination of drugs to improve the survival rate and quality of life of patients.