The objective of this study is to identify, in a sample of very mild Alzheimer disease (AD) patients, factors associated with disease progression. The authors followed 160 AD patients from a multicenter cohort with a Clinical Dementia Rating (CDR) of 0.5, corresponding to very mild AD but with impairment insufficient to be classified as dementia. Patients with disease progression were defined as those with CDR> or =1 at 1 year; those with no progression (stable) remained at CDR 0.5. The baseline characteristics of these 2 groups of patients were compared in search of predictors of progression. After a 1-year follow-up, 84 (52.5%) of the patients remained stable, CDR 0.5; 76 (47.5%) progressed to a CDR score > or =1. A baseline lower nutritional status assessed by the Mini Nutritional Assessment [odds ratio 0.80, 95% confidence interval (0.68-0.94), P=0.007] and a lower cognitive performance on the Alzheimer Disease Assessment Scale [odds ratio 1.22, 95% confidence interval (1.07-1.39), P=0.003] were found as predictors of progression. The results suggest that clinical assessment of nutritional status, along with cognitive data, may help detect patients at risk of progression in very early AD. Nutritional assessment should therefore form part of clinical evaluation of patients with AD at an early stage of the disease.