Abstract: Parkinson disease (PD) is a neurodegenerative disorder classically characterized by dyskinesia. The pathogenesis of PD is complex, and current clinical management remains largely symptomatic, with no ability to halt disease progression. Therefore, developing novel therapeutic strategies that confer neuroprotection and promote neural repair is of considerable significance. Exosomes (Exos)—naturally secreted nanoscale vesicles—offer advantages including low immunogenicity, favorable biocompatibility, and the ability to cross the blood–brain barrier, positioning them as promising candidates for the treatment of central nervous system disorders. This review summarizes the primary cellular sources and biological characteristics of therapeutic Exos, with a focus on their mechanisms of PD treatment. To date, studies have demonstrated that Exos can exert neuroprotective effects by modulating intercellular communication and the immune microenvironment, as well as by promoting neural regeneration. However, challenges remain in terms of large-scale production and targeted in vivo delivery. Future efforts should focus on engineering Exos to optimize their targeting and drug-loading capacities, and on developing combination therapy regimens, thereby facilitating the clinical translation of Exo-based strategies toward personalized and non-invasive PD therapy.