Individuals with intellectual disability (ID) are now living longer with the majority of individuals reaching middle and even “old age.” As a consequence of this extended longevity they are vulnerable to the same age‐associated health problems as elderly adults in the general population without ID. This includes dementia, a general term referring to a variety of diseases and conditions causing substantial loss of cognitive ability and functional declines; adults with Down syndrome are at especially high risk. A great deal of recent effort has focused on the very earliest detectable indicators of decline (and even prodromal stages of dementia‐causing diseases). A condition called mild cognitive impairment (MCI) has been conceptually defined as a decline in functioning that is more severe than expected with typical brain aging but not severe enough to meet criteria for a diagnosis of dementia. Consensus criteria for both dementia and MCI have been developed for typically developing adults but are of limited applicability for adults with ID, given their pre‐existing cognitive impairments. Early diagnosis will continue to be of growing importance, both to support symptomatic treatment and to prevent irreversible neuropathology when interventions are developed to slow or halt the progression of underlying disease. While the intellectual and developmental disabilities field has for some time recognized the need to develop best‐practices for the diagnosis of MCI and dementia, there remains a pressing need for empirically based assessment methods and classification criteria. © 2013 Wiley Periodicals, Inc. Dev Disabil Res Rev 2013;18:31–42.