{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T17:47:41Z","timestamp":1790444861430,"version":"4.1.0"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T00:00:00Z","timestamp":1771804800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Aging Neurosci."],"abstract":"<jats:p>\n                    Traditional motor and cognitive assessments for people with Parkinson\u2019s disease (PD) have long faced challenges related to accessibility, scalability, and geographical diversity when administered in-person. Remote cognitive testing offers the promise of improved accessibility, reduced participant burden, and greater scalability, particularly for individuals with mobility limitations or limited access to specialized care. While remote cognitive assessments are increasingly used in PD research and clinical settings, it remains unclear whether these measures provide an informative index of PD severity. These gaps limit the interpretability and broader adoption of remote cognitive measures as accessible and scalable indicators of PD severity. To establish a benchmark, we first analyzed a large in-person dataset (PPMI;\n                    <jats:italic>n<\/jats:italic>\n                    \u202f=\u202f1,417). We found significant, negative, and small correlations between a cognitive measure (MoCA) scores and two motor measures (MDS-UPDRS III,\n                    <jats:italic>\u03c1<\/jats:italic>\n                    \u202f=\u202f\u22120.17; and H&amp;amp;Y scores,\n                    <jats:italic>\u03c1<\/jats:italic>\n                    \u202f=\u202f\u22120.12). Second, we administered remote assessments to 152 individuals with PD across 60+\u202fgeographical locations, including a videoconference-based MoCA (MoCA-VC) and online versions of the MDS-UPDRS III and H&amp;amp;Y. Consistent with in-person findings, we found significant, negative, and small correlations between the MoCA-VC scores and the two motor measures (MDS-UPDRS III,\n                    <jats:italic>\u03c1<\/jats:italic>\n                    \u202f=\u202f\u22120.32; and H&amp;amp;Y scores,\n                    <jats:italic>\u03c1<\/jats:italic>\n                    \u202f=\u202f\u22120.16). Additionally, we examined the decrease in the MoCA score as a function of disease stage. A multivariable regression model demonstrated that each one disease stage increase in H&amp;amp;Y was associated with a 0.65-point decrease in MoCA (in-person settings) and a 1.16-point decrease in MoCA-VC (online settings). Together, these findings demonstrate that a remote, home-based cognitive assessment captures motor\u2013cognitive associations comparable to those observed in large in-person settings, supporting its potential utility as an accessible and scalable cognitive index of PD severity.\n                  <\/jats:p>","DOI":"10.3389\/fnagi.2026.1787521","type":"journal-article","created":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T06:31:29Z","timestamp":1771828289000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Characterizing motor\u2013cognitive associations in Parkinson\u2019s disease using digital assessments"],"prefix":"10.3389","volume":"18","author":[{"given":"Avigail Lithwick","family":"Algon","sequence":"first","affiliation":[{"name":"Center for Accessible Neuropsychology","place":["Tel Aviv, Israel"]},{"name":"Department of Occupational Therapy, Gray Faculty of Medical and Health Sciences, Tel Aviv University","place":["Tel Aviv, Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Saban","sequence":"additional","affiliation":[{"name":"Center for Accessible Neuropsychology","place":["Tel Aviv, Israel"]},{"name":"Department of Occupational Therapy, Gray Faculty of Medical and Health Sciences, Tel Aviv University","place":["Tel Aviv, Israel"]},{"name":"Sagol School of Neuroscience, Tel Aviv University","place":["Tel Aviv, Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,23]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1038\/s41572-021-00280-3","article-title":"Parkinson disease-associated cognitive impairment","volume":"7","author":"Aarsland","year":"2021","journal-title":"Nat. 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Neurol."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1643","DOI":"10.1002\/mds.27431","article-title":"Movement disorder society criteria for clinically established early Parkinson\u2019s disease","volume":"33","author":"Berg","year":"2018","journal-title":"Mov. Disord."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1363513","DOI":"10.3389\/fneur.2024.1363513","article-title":"Online cognitive testing in Parkinson\u2019s disease: advantages and challenges","volume":"15","author":"Binoy","year":"","journal-title":"Front. Neurol."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1325215","DOI":"10.3389\/fnhum.2023.1325215","article-title":"Remote assessment of cognition in Parkinson\u2019s disease and cerebellar Ataxia: the MoCA test in English and Hebrew","volume":"17","author":"Binoy","year":"","journal-title":"Front. Hum. 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Neurol."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"3806","DOI":"10.3390\/ijerph20053806","article-title":"Multidisciplinary intensive rehabilitation program for people with Parkinson\u2019s disease: gaps between the clinic and real-world mobility","volume":"20","author":"Cohen","year":"2023","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1717","DOI":"10.1212\/WNL.0b013e3181fc29c9","article-title":"The MoCA: well-suited screen for cognitive impairment in Parkinson disease","volume":"75","author":"Dalrymple-Alford","year":"2010","journal-title":"Neurology"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1634","DOI":"10.1080\/13854046.2024.2397835","article-title":"Large-scale evidence for the validity of remote MoCA administration among people with cerebellar ataxia","volume":"39","author":"De Picciotto","year":"2024","journal-title":"Clin. Neuropsychol."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1007\/PL00007856","article-title":"The heterogeneity of idiopathic Parkinson\u2019s disease","volume":"249","author":"Foltynie","year":"2002","journal-title":"J. Neurol."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1001332","DOI":"10.37349\/emed.2025.1001332","article-title":"A prospective study of cognitive impairment in Parkinson\u2019s disease: clinical, neuropsychological, and neuroimaging correlates","volume":"6","author":"Gaballa","year":"2025","journal-title":"Explor. Med."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"e000953","DOI":"10.1136\/bmjno-2024-000953","article-title":"Visual processing capacity and cognitive decline in Parkinson\u2019s disease","volume":"7","author":"Gerner","year":"2025","journal-title":"BMJ Neurol. 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Neuropsychol."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1212\/wnl.17.5.427","article-title":"Parkinsonism: onset, progression, and mortality","volume":"17","author":"Hoehn","year":"1967","journal-title":"Neurology"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1056","DOI":"10.1002\/mds.27002","article-title":"Mild cognitive impairment as a risk factor for Parkinson\u2019s disease dementia","volume":"32","author":"Hoogland","year":"2017","journal-title":"Mov. Disord."},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1738","DOI":"10.1212\/WNL.0b013e3181c34b47","article-title":"Validity of the MoCA and MMSE in the detection of MCI and dementia in Parkinson disease","volume":"73","author":"Hoops","year":"2009","journal-title":"Neurology"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"16893","DOI":"10.1038\/s41598-020-73756-z","article-title":"Non-motor symptom burden in patients with Parkinson\u2019s disease with impulse control disorders and compulsive behaviours: results from the COPPADIS cohort","volume":"10","author":"Jes\u00fas","year":"2020","journal-title":"Sci. Rep."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1038\/s41746-025-01938-y","article-title":"A systematic review of real-world gait-related digital mobility outcomes in Parkinson\u2019s disease","volume":"8","author":"Kirk","year":"2025","journal-title":"NPJ Digit. Med."},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1114","DOI":"10.3390\/brainsci13071114","article-title":"Remote assessment of Parkinson\u2019s disease patients amidst the COVID-19 lockdown in Mexico","volume":"13","author":"Le\u00f3n-Garc\u00eda","year":"2023","journal-title":"Brain Sci."},{"key":"ref26","doi-asserted-by":"publisher","first-page":"439","DOI":"10.2174\/187152712800792893","article-title":"Motor and non-motor features of Parkinson\u2019s disease \u2013 a review of clinical and experimental studies","volume":"11","author":"Lima","year":"2012","journal-title":"CNS Neurol. Disord. 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Soc."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1749","DOI":"10.1002\/mds.29129","article-title":"Resolving missing data from the Movement Disorder Society unified Parkinson\u2019s disease rating scale: implications for telemedicine","volume":"37","author":"Luo","year":"2022","journal-title":"Mov. Disord."},{"key":"ref30","doi-asserted-by":"publisher","first-page":"742654","DOI":"10.3389\/fneur.2021.742654","article-title":"Remote evaluation of Parkinson\u2019s disease using a conventional webcam and artificial intelligence","volume":"12","author":"Monje","year":"2021","journal-title":"Front. Neurol."},{"key":"ref31","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1016\/j.neubiorev.2016.07.010","article-title":"Motor symptoms in Parkinson\u2019s disease: a unified framework","volume":"68","author":"Moustafa","year":"2016","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1111\/ncn3.53","article-title":"Correlation between motor and cognitive functions in the progressive course of Parkinson\u2019s disease","volume":"1","author":"Murakami","year":"2013","journal-title":"Neurol. Clin. Neurosci."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1111\/j.1532-5415.2005.53221.x","article-title":"The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment","volume":"53","author":"Nasreddine","year":"2005","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref34","doi-asserted-by":"publisher","first-page":"e20230102","DOI":"10.1590\/1980-5764-dn-2023-0102","article-title":"Associations between cognitive screening performance and motor symptoms in Parkinson\u2019s disease:a systematic review and meta-analysis","volume":"18","author":"Patrick","year":"2024","journal-title":"Dement. Neuropsychol."},{"key":"ref35","doi-asserted-by":"publisher","first-page":"1330321","DOI":"10.3389\/fneur.2023.1330321","article-title":"Luxembourg Parkinson\u2019s study -comprehensive baseline analysis of Parkinson\u2019s disease and atypical parkinsonism","volume":"14","author":"Pavelka","year":"2023","journal-title":"Front. Neurol."},{"key":"ref37","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1007\/s00702-025-02990-4","article-title":"Motor and non-motor fluctuations in Parkinson\u2019s disease: the knowns and unknowns of current therapeutic approaches","volume":"133","author":"Regensburger","year":"2025","journal-title":"J. Neural Transm."},{"key":"ref38","doi-asserted-by":"publisher","first-page":"2413","DOI":"10.1162\/jocn_a_01767","article-title":"PONT: a protocol for online neuropsychological testing","volume":"33","author":"Saban","year":"2021","journal-title":"J. Cogn. Neurosci."},{"key":"ref39","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1016\/j.parkreldis.2021.11.028","article-title":"An equation to calculate UPDRS motor severity for online and rural assessments of Parkinson\u2019s","volume":"94","author":"Sangarapillai","year":"2022","journal-title":"Parkinsonism Relat. Disord."},{"key":"ref40","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1136\/jnnp-2017-316213","article-title":"Baseline prevalence and longitudinal evolution of non-motor symptoms in early Parkinson\u2019s disease: the PPMI cohort","volume":"89","author":"Simuni","year":"2018","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"668","DOI":"10.1002\/mds.25383","article-title":"How to identify tremor dominant and postural instability\/gait difficulty groups with the movement disorder society unified Parkinson\u2019s disease rating scale: comparison with the unified Parkinson\u2019s disease rating scale","volume":"28","author":"Stebbins","year":"2013","journal-title":"Mov. Disord."},{"key":"ref42","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1037\/0033-2909.87.2.245","article-title":"Tests for comparing elements of a correlation matrix","volume":"87","author":"Steiger","year":"1980","journal-title":"Psychol. Bull."},{"key":"ref43","doi-asserted-by":"publisher","first-page":"1779","DOI":"10.3233\/JPD-202163","article-title":"Feasibility, reliability, and value of remote video-based trial visits in Parkinson\u2019s disease","volume":"10","author":"Tarolli","year":"2020","journal-title":"J. Parkinsons Dis."},{"key":"ref44","doi-asserted-by":"publisher","first-page":"1576","DOI":"10.1002\/mdc3.14203","article-title":"In-home remote assessment of the MDS - UPDRS part III: multi-cultural development and validation of a guide for patients","volume":"11","author":"Tosin","year":"2024","journal-title":"Mov. Disord. Clin. Pract."},{"key":"ref45","doi-asserted-by":"publisher","first-page":"1659581","DOI":"10.3389\/fneur.2025.1659581","article-title":"Mediation analysis for integrating motor symptoms of Parkinson\u2019s disease, cognitive function, and gait characteristics","volume":"16","author":"Yin","year":"2025","journal-title":"Front. 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