Recent studies indicate that neuroimaging techniques such as magnetic resonance imaging, positron emission tomography, and single-photon emission computed tomography can accurately differentiate patients with Alzheimer's disease (AD) from elderly controls. This report reviews the results of neuroimaging studies of two at-risk populations: subjects with the ε4 allele of the apolipoprotein E and those with mild cognitive impairment. The results of the work published to date indicate that the presence of the ε4 allele is a risk factor for AD and that its predictive validity can be enhanced by neuropsychological and/or neuroimaging evaluation. The results also show that patients with mild cognitive impairment display a number of structural and functional imaging abnormalities that are more pronounced in the temporal and parietal lobes. We suggest that the use of neuroimaging techniques can improve the detection of subjects early in the course of AD, although the sensitivity and the specificity of this approach still await a more detailed prospective evaluation.