Early descriptions of subtypes of Parkinson’s disease (PD) are dominated by the approach of predetermined groups. Experts defined, from clinical observation, groups based on clinical or demographic features that appeared to divide PD into clinically distinct subsets. Common bases on which to define subtypes have been motor phenotype (tremor dominant vs akinetic-rigid or postural instability gait disorder types), age, nonmotor dominant symptoms, and genetic forms. Recently, data-driven approaches have been used to define PD subtypes, taking an unbiased statistical approach to the identification of PD subgroups. The vast majority of data-driven subtyping has been done based on clinical features. Biomarker-based subtyping is an emerging but still quite undeveloped field. Not all of the subtyping methods have established therapeutic implications. This may not be surprising given that they were born largely from clinical observations of phenotype and not in observations regarding treatment response or biological hypotheses. The next frontier for subtypes research as it applies to personalized medicine in PD is the development of genotype-specific therapies. Therapies for GBA-PD and LRRK2-PD are already under development. This review discusses each of the major subtyping systems/methods in terms of its applicability to therapy in PD, and the opportunities and challenges designing clinical trials to develop the evidence base for personalized medicine based on subtypes.

帕金森病 (PD) 亚型的早期描述主要采用预定组的方法。专家们根据临床观察，根据临床或人口统计特征定义了分组，这些特征似乎将帕金森病分为临床上不同的子集。定义亚型的共同基础是运动表型（震颤主导型与运动不能性僵硬或姿势不稳定步态障碍类型）、年龄、非运动主导症状和遗传形式。最近，数据驱动的方法已被用来定义帕金森病亚型，采用无偏见的统计方法来识别帕金森病亚组。绝大多数数据驱动的子分型都是根据临床特征完成的。基于生物标记的亚型分析是一个新兴但仍相当不发达的领域。并非所有的亚型分型方法都具有治疗意义。这可能并不奇怪，因为它们主要来自表型的临床观察，而不是关于治疗反应或生物学假设的观察。亚型研究应用于帕金森病个性化医疗的下一个前沿是基因型特异性疗法的开发。 GBA-PD 和 LRRK2-PD 的疗法已经在开发中。这篇综述讨论了每种主要的亚型分型系统/方法在帕金森病治疗中的适用性，以及设计临床试验以开发基于亚型的个性化医疗证据基础的机遇和挑战。