Two recent studies offer novel insights into Parkinson’s disease pathology and early prognosis. One cohort study published in npj Parkinson’s Disease reveals significant alterations in cutaneous nerve fibers in patients with Parkinson’s and atypical parkinsonism, emphasizing peripheral nervous system involvement beyond established central nervous system features. Concurrently, research identifying perivascular space fluid diffusivity as a predictive biomarker for clinical decline in early Parkinson’s stages demonstrates a promising non-invasive tool for monitoring disease progression. These findings collectively expand the diagnostic framework and could influence future therapeutic strategies.