A multimodal MRI framework employing machine learning for detecting beginning cognitive impairment in Parkinson’s disease

Cognitive deficits affect up to half of the patients with Parkinson's disease (PD) within a decade of diagnosis, placing an increasing burden on patients, families and caregivers. Therefore, the development of strategies for their early detection is critical to enable timely intervention and management. This study aimed to classify cognitive performance in patients with PD using a binary support vector machine (SVM) model that integrates structural (high-resolution anatomical) and functional connectivity (FC; resting state) MRI data with clinical characteristics. We hypothesized that PD patients with beginning cognitive deficits can be detected through MRI in combination with machine learning. Data from 38 PD patients underwent extensive preprocessing, including large-scale FC and voxel-based analysis. Relevant features were selected using a bootstrapping approach and subsequently trained in an SVM model, with robustness ensured by 10-fold cross-validation. Although clinical parameters were considered during feature selection, the final best-performing model exclusively comprised imaging features-including gray matter volume (e.g., anterior cingulate gyrus, precuneus) and inter-network functional connectivity within the frontoparietal, default mode, and visual networks. This combined model achieved an accuracy of 94.7% and a ROC-AUC of 0.98. However, a model integrating clinical and only functional MRI data reached similar results with an accuracy of 94.7% and a ROC-AUC of 0.90. In conclusion, our findings demonstrate that applying machine learning to multimodal MRI data-integrating structural, functional, and clinical metrics-could advance the early detection of cognitive impairment in PD and could therefore be used to support timely diagnosis.