Alberto Espay, MD, FAAN, University of Cincinnati, Cincinnati, OH, shares his thoughts on the accuracy of the brain-first versus body-first hypothesis of Parkinson’s disease pathology. The concept separates patients by the site of pathology initiation. Patients whose disease begins in the body are said to show symptoms in a different order to those where pathology starts in the brain. Prof. Espay highlights the limitations of this dichotomization, particularly noting the issues with assuming that pathology detection represents the start of the disease. This interview took place during the 2021 International Congress of Parkinson’s Disease and Movement Disorders.