Alzheimer’s disease (AD) features a dynamic sequence of amyloid deposition, neurodegeneration, and cognitive impairment. A significant fraction of AD brains also displays Lewy body pathology, suggesting that addition of classically Parkinson’s disease-related proteins to the AD biomarker panel may be of value. To determine whether addition of cerebrospinal fluid (CSF) total α-synuclein and its form phosphorylated at S129 (pS129) to the AD biomarker panel [Amyloid-β1-42 (Aβ42), tau, and phosphorylated tau (p-tau181)] improves its performance, we examined CSF samples collected longitudinally up to 7 years as part of the Alzheimer’s Disease Neuroimaging Initiative. From 87 AD, 177 mild cognitive impairment (MCI), and 104 age-matched healthy controls, 792 baseline and longitudinal CSF samples were tested for total α-synuclein, pS129, Aβ42, tau, and p-tau181. pS129, but not total α-synuclein, was weakly associated with diagnosis at baseline when t-tau/Aβ42 was included in the statistical model (β=0.0026, p=0.041, 95% CI [(0.0001)–(0.005)]). CSF α-synuclein predicted Alzheimer’s Disease Assessment Scale-Cognitive (β=−0.59, p=0.0015, 95% CI [(−0.96)–(−0.23)]), memory (β=0.4, p=0.00025, 95% CI [(0.16)–(0.59)]) and executive (0.62, <0.0001, 95% CI [(0.31)–(0.93)]) function composite scores, and progression from MCI to AD (β=0.019, p=0.0011, 95% CI [(0.002)–(0.20)]). pS129 was associated with executive function (β=−2.55, p=0.0085, 95% CI [(−4.45)–(−0.66)]). Lower values in the mismatch between α-synuclein and p-tau181 predicted faster cognitive decline (β=0.64, p=0.0012, 95% CI [(0.48)–(0.84)]). Longitudinal biomarker changes did not differ between groups, and may not reflect AD progression. The α-synuclein-p-tau181-Mismatch could better predict longitudinal cognitive changes than classical AD markers alone, and its pathological correlates should be investigated further.