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This review aims to determine how this has altered our understanding of MRS neurometabolic markers in neurodegenerative dementias.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Our systematic review of human in vivo MRS literature since 2002 pertains to Alzheimer's disease (AD), dementia with Lewy bodies (DLB), Parkinson's disease dementia, frontotemporal dementia (FTD), prodromal and \u2018at\u2010risk\u2019 states. Studies using field strengths of 3\u2009T or more were included.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 85 studies, AD and\/or mild cognitive impairment (MCI) were the most common conditions of interest (58 papers, 68%). Only 14 (16%) studies included other dementia syndromes and 13 (15%) investigated \u2018at\u2010risk\u2019 cohorts. Earlier findings of lower <jats:italic>N<\/jats:italic>\u2010acetylaspartate and higher myo\u2010inositol were confirmed. Additionally, lower choline and creatine in AD and MCI were reported, though inconsistently. Previously challenging\u2010to\u2010measure metabolites (glutathione, glutamate and gamma\u2010aminobutyric acid) were reportedly lower in AD, FTD and DLB compared with controls.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Increasing field strength alongside targeted acquisition protocols has revealed additional metabolite changes. Most studies were small and regional metabolite differences between dementia types may not have been captured due to the predominant placement of voxels in the posterior cingulate cortex. The standard of data collection, quality control and analysis is improving due to greater consensus regarding acquisition and processing techniques. Ongoing harmonization of techniques, creation of larger and longitudinal cohorts, and placement of MRS voxels in more diverse regions will strengthen future research.<\/jats:p><\/jats:sec>","DOI":"10.1002\/nbm.4896","type":"journal-article","created":{"date-parts":[[2023,1,9]],"date-time":"2023-01-09T22:48:30Z","timestamp":1673304510000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["MRS in neurodegenerative dementias, prodromal syndromes and at\u2010risk states: A systematic review of the literature"],"prefix":"10.1002","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7076-8216","authenticated-orcid":false,"given":"Elizabeth","family":"McKiernan","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Cambridge Biomedical Campus University of Cambridge  Cambridge 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