Six-year changes in immediate visual memory performance assessed by the Benton Visual Retention (BVR) test predicted Alzheimer's disease (AD) prior to its onset. Subjects of this study were 371 community-dwelling adult participants in the Baltimore Longitudinal Study of Aging, seven of whom received probable or definite AD diagnoses using DSM-III-R and NINCDS-ADRDA criteria. Subjects with diagnoses of AD had larger changes in immediate memory performance over the 6-year interval prior to the estimated onset of their disease than subjects without AD. Six-year longitudinal change as well as level in immediate visual memory performance also predicted subsequent cognitive performance 6-15 and 16-22 years later even after adjusting for the influences of age general-ability and initial immediate memory. These results provide evidence that change and level in immediate visual memory performance has long-term prognostic significance over as many as 16-22 years. These results further suggest that change in recent memory performance, an important component in AD diagnoses, may be an important precursor of the development of the disease.