INTRODUCTION: Impaired copy of intersecting pentagons from the Mini-Mental State Examination (MMSE), has been used to assess dementia in Parkinson's disease (PD). We used a digitizing tablet during the pentagon copying test (PCT) as a potential tool for evaluating early cognitive deficits in PD without major cognitive impairment. We also aimed to uncover the neural correlates of the identified parameters using whole-brain magnetic resonance imaging (MRI). METHODS: We enrolled 27 patients with PD without major cognitive impairment and 25 age-matched healthy controls (HC). We focused on drawing parameters using a digitizing tablet. Parameters with between-group differences were correlated with cognitive outcomes and were used as covariates in the whole-brain voxel-wise analysis using voxel-based morphometry; familywise error (FWE) threshold p < 0.001. RESULTS: PD patients differed from HC in attention domain z-scores (p < 0.0001). In terms of tablet parameters, the groups differed in Shannon entropy (horizontal in-air, p = 0.003), which quantifies the movements between two strokes. In PD, a correlation was found between the median of Shannon entropy (horizontal in-air) and attention z-scores (R = -0.55, p = 0.006). The VBM revealed an association between our drawing parameter of interest and gray matter (GM) volume variability in the right superior parietal lobe (SPL). CONCLUSION: Using a digitizing tablet during the PCT, we identified a novel entropy-based parameter that differed between the nondemented PD and HC groups. This in-air parameter correlated with the level of attention and was linked to GM volume variability of the region engaged in spatial attention.

Applied Neuroscience Research Group Central European Institute of Technology CEITEC Masaryk University Kamenice 753 5 625 00 Brno Czech Republic

Applied Neuroscience Research Group Central European Institute of Technology CEITEC Masaryk University Kamenice 753 5 625 00 Brno Czech Republic; 1st Department of Neurology Faculty of Medicine St Anne's University Hospital Masaryk University Pekarska 664 53 656 91 Brno Czech Republic

Applied Neuroscience Research Group Central European Institute of Technology CEITEC Masaryk University Kamenice 753 5 625 00 Brno Czech Republic; Faculty of Medicine Masaryk University Kamenice 753 5 625 00 Brno Czech Republic; Surgeon General Office of the Slovak Armed Forces Ul generala Milosa Vesela 21 03401 Ruzomberok Slovak Republic

Department of Telecommunications Brno University of Technology Technicka 12 616 00 Brno Czech Republic

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