Abstract Background This study compares age-specific and overall prevalence rates for dementia and Alzheimer's disease (AD) in two nonoverlapping, population-based cohorts of elderly African Americans in Indianapolis in 2001 and 1992. Methods We used a two-stage design. The first stage involves the Community Screening Interview for Dementia (CSI-D). The CSI-D scores are grouped into good, intermediate, and poor performance before selection for clinical assessment. Diagnoses were performed using standard criteria in a consensus diagnosis conference; clinicians were blind to performance groups. In 1992, interviewers visited randomly sampled addresses to enroll self-identified African Americans aged ≥65 years. Of 2582 eligible, 2212 enrolled (9.6% refused, and 4.7% were too sick). In 2001, Medicare rolls were used for African Americans aged >70 years. Of 4260 eligible, 1892 (44%) enrolled, 1999 (47%) refused, and the remainder did not participate for other reasons. Results The overall age-adjusted prevalence rate for dementia at age ≥70 years in 2001 was 7.45% (95 confidence interval CI, 4.27–10.64), and in the 1992 cohort, this prevalence rate was 6.75% (95% CI, 5.77–7.74). The overall age-adjusted prevalence rate at age ≥70 years for AD in the 2001 cohort was 6.77% (95% CI, 3.65–9.90), and for the 1992 cohort, it was 5.47% (95% CI, 4.51–6.42). Rates for dementia and AD were not significantly different in the two cohorts (dementia, P = .3534; AD, P = .2649). Conclusions We found no differences in the prevalence rates of dementia and AD between 1992 and 2001, despite significant differences in medical history and medical treatment within these population-based cohorts of African American elderly.