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Background Accurate early diagnosis and subtype classification of mild cognitive impairment are critical for guiding emerging targeted treatments and supporting patients.Methods This six-year study examined cases of cognitive impairment referred to the regional tertiary memory clinic at Nottingham. Data were collected from Dec/2018 to Nov/2024 as part of the Cognition and NeuroImaging in Neurodegenerative Disorders study (IRAS 250525/ NCT03861884) and encompassed demographic, clinical, cognitive test, cerebrospinal fluid (CSF) biomarker, and neuroimaging data.Results 429 out of 630 individuals referred to our service were recruited into the study. The mean age of participants was 60.08 years, with 54.55% being male. The average Addenbrooke’s Cognitive Examination score was 70.29. MRI scans were performed in 77.62%, FDG-PET in 44.06%, and CSF analysis in 31.00% of participants. Alzheimer’s disease was the most common diagnosis (24.94%), with pathological confirmation (A+T+) in 42.1%. Other significant diagnoses included functional cognitive disorder (12.59%), frontotemporal dementia (6.99%), and COVID-related cognitive impairment (6.06%). Over 6 years, mortality rate was 5.13%, with 1.86% of participants transitioning to care homes.Conclusions This observational and longitudinal study provides valuable insights into the clinical spectrum encountered in Neurologist-led clinic. The findings inform policymakers about subgroups suitable for clinical trials and potential disease-modifying treatments.b.shao@nhs.net