Abstract Introduction 18FAZD4694 is an amyloid beta (Aβ) imaging agent used in several observational studies and clinical trials. However, no studies have yet published data on longitudinal Aβ accumulation measured with 18FAZD4694. Methods We assessed 146 individuals who were evaluated with 18FAZD4694 at baseline and 2‐year follow‐up. We calculated annual rates of 18FAZD4694 change for clinically defined and biomarker‐defined groups Results Cognitively unimpaired (CU) older adults displayed subtle 18FAZD4694 standardized uptake value ratio (SUVR) accumulation over the follow‐up period. In contrast, Aβ positive CU older adults displayed higher annual 18FAZD4694 SUVR increases. 18FAZD4694 SUVR accumulation in Aβ positive mild cognitive impairment (MCI) and dementia was modest across the neocortex Discussion Larger increases in 18FAZD4694 SUVR were observed in CU individuals who had abnormal amyloid positron emission tomography levels at baseline. 18FAZD4694 can be used to monitor Aβ levels in therapeutic trials as well as clinical settings, particularly prior to initiating anti‐amyloid therapies.