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Transcranial sonography (TCS) is a valuable tool in the diagnosis of Parkinson’s disease (PD). However, substantia nigra hyperechogenicity (SN+) in TCS has been shown to be also evident in about 8–10% of healthy persons. Neuroimaging studies and slight motor deficits in subjects with SN+ indicate functional impairment of the nigrostriatal system associated with the ultrasound sign. We questioned, whether SN+ may also be associated with neuropsychological deficits and whether there is a relation to other PD premotor markers. Thirty-six subjects with SN+ and 34 control persons (SN−) older than 50 years were investigated. The delayed verbal memory recall (LogII) of subjects with SN+ was significantly reduced compared to the performance of the control group ( P = 0.02). Binary logistic regression analysis revealed that, besides UPDRS-III ( P < 0.001) and positive family history for PD ( P < 0.01), LogII ( P < 0.05) seems to be independently associated with SN+. [ABSTRACT FROM AUTHOR]