The first A 2A adenosine receptor antagonist, istradefylline, was approved in 2013 in Japan for the treatment of Parkinson's disease (PD). This will allow long-term studies to elucidate the neuroprotective potential of A 2A antagonists in patients. New A 2A antagonists are in clinical evaluation for PD. Additional promising indications for A 2A antagonists are being explored, including Alzheimer's disease (AD) and other neurodegenerative diseases, depression, and attention deficit hyperactivity disease (ADHD). A 2A antagonists may be useful for the treatment of several rare neurodegenerative diseases, and their clinical evaluation for those diseases is warranted. Dual-and multi-target drugs combining A 2A antagonism with A 1 antagonism, MAO-B inhibition, dopamine receptor activation and/or NMDA receptor blockade may be advantageous for the treatment of PD and perhaps also for other brain diseases. X-ray structure of the human A 2A adenosine receptor in complex with several antagonists and agonists provide a basis for understanding drug-receptor interactions and support the development of new drugs.