The Rey–Osterrieth complex figure (ROCF) test is widely used to assess constructional praxis. Qualitative scoring methods, such as the Boston Qualitative Scoring System (BQSS), enable the detection of alterations in spatial organization, planning, and executive control during copying performance. While alterations in constructional abilities have been previously reported in Parkinson’s disease (PD), the possible presence of subtle qualitative modifications in PD patients without cognitive impairment (PD-CU) and their relationship with the cognitive functioning is still to be elucidated. This study evaluates differences in copying strategies and error patterns in PD patients with (PD-MCI) or without (PD-CU) mild cognitive impairment, assessing the link with the cognitive profile.

Seventy PD patients and 56 healthy controls (HC) were recruited. All participants underwent a neuropsychological assessment, including the ROCF. Their performance was assessed by standard quantitative scoring and qualitative rating scales (BQSS). Statistical analyses compared BQSS performance between groups and examined associations between qualitative visuo-constructional features and other cognitive domains.

Both PD-MCI and PD-CU groups showed qualitative alterations compared to HC, associated with executive dysfunctions. Qualitatively, PD-CU patients showed lower scores in neatness and planning measures compared to HC, the latter particularly associated with executive alterations. Notably, patients reporting a left or right asymmetric copy were characterized by different cognitive profiles.

The here-presented results support the importance of qualitative assessment in identifying early cognitive impairments in PD patients and suggest that BQSS parameters (i.e., planning) may offer complementary insights to standard quantitative assessments in detecting subthreshold executive impairments not yet captured by conventional tests.