Cognitive impairment (CI) is a common non-motor symptom in Parkinson’s disease (PD), usually seen in more advanced stages. However, early onset CI questions the contribution of other factors. A cross-sectional study was conducted on 409 PD patients aged 64.61(±6.63) years stratified by MoCA cognitive status at Diomid Gherman Institute of Neurology and Neurosurgery from 2020 to 2022 aiming to delineate the profile of early PD-CI patients. Clinical evaluation and standardized questionnaires were used to assess PD and vascular status. Brain structure was examined using 1.5 T MRI. Epi Info™ software was used for statistical analysis. PD-CI subjects registered worse non-motor symptoms (p = 0.002), depression (p = 0.004) and apathy (p = 0.021) levels; had akinetic-rigid phenotype (p = 0.002) requiring greater LEDD (p < 0.01) compared to those without CI. Up to 93.5% of PD-CI subjects had cerebrovascular risk factors, the majority multiple ones. Hypertension, atherosclerosis and dyslipidemia prevailed. Statistically fewer PD-CI subjects administered antiarrhythmic medication (9.5% vs. 4.9%, p < 0.05) despite atrial fibrillation diagnosis. Brain CSVD-related MRI markers were more common in PD-CI individuals – correlating to the ventricular system dilation (35.3% vs. 22.3%, p = 0.015) and lacune number (7.79 ± 4.95 vs. 4.00 ± 2.39, p = 0.044). White matter hyperintensities were more frequent in the periventricular white matter (53.9%), relative to the deep regions (45.7%). The study revealed that early PD-CI involved poorer clinical status, higher vascular risk and inadequate preventive care. Results were supported by specific CSVD-MRI markers: internal atrophy and increased number of lacunas; indicating the need for combined clinical and imaging assessment.