Lake Prespa, in the Balkans, contains an important palaeo-archive in a key location for understanding Quaternary climate variability in the transition between Mediterranean and central European climate zones. Previous palaeoenvironmental research on sediment cores indicates that the lake is highly sensitive to climate change and that diatoms are likely to be strong palaeohydrological proxies. Here, we present new results from diatom analysis of a ca. 91 ka sequence, core Co1215, which spans the time from the end of the last interglacial to the present. Fluctuations in the diatom data were driven primarily by changes in lake level, as a function of shifts in moisture availability. Warmer interglacial (MIS 5, MIS 1) and interstadial (MIS 3) phases exhibit higher lake levels in spite of enhanced evaporative concentration, underlining the importance of changes in precipitation regimes over time. Low lake levels during glacial phases indicate extreme aridity, common to all Mediterranean lakes. Evidence for fluctuations in trophic status is linked, in part, to lake-level change, but also reflects nutrient enrichment from catchment processes. MIS 5a is characterized by the highest lake productivity in the sequence, but low lake levels, which are ascribed primarily to very low precipitation. On a suborbital timescale, the diatoms provide evidence for correlation to the millennial-scale variability recorded in the Greenland oxygen isotope records and clearly reflect the impact of the Heinrich H6, H5 and H3-1 ice-rafting events, suggesting the dominant influence of North Atlantic forcing in this region. Although the highestamplitude shift in the diatom assemblages occurs