This systematic review examined the longitudinal association between amyloid-β (Aβ) accumulation and cognitive decline in cognitively healthy adults. It was conducted using the PubMed, Embase, PsycInfo, and Web of Science databases. The methodological quality of the selected articles was assessed. In fine, seventeen longitudinal clinical studies were included in this review. A minority (seven out of 17) of studies reported a statistically significant association or prediction of cognitive decline with Aβ change, measured by positron emission tomography (PET; n = 6) and lumbar puncture (n = 1), with a mean follow-up duration of 3.17 years for cognition and 2.99 years for Aβ. The studies reporting significant results with PET found differences in the frontal, posterior cingular, lateral parietal and global (whole brain) cortices as well as in the precuneus. Significant associations were found with episodic memory (n = 6) and global cognition (n = 1). Five of the seven studies using a composite cognitive score found significant results. A quality assessment revealed widespread methodological biases, such as failure to report or account for loss-to follow up and missing data, and failure to report -values and effect sizes of non-significant results. Overall, the longitudinal association between Aβ accumulation and cognitive decline in preclinical Alzheimer's disease remains unclear. The discrepancy in results between studies may be explained in part by the choice of neuroimaging technique used to measure Aβ change, the duration of longitudinal studies, the heterogeneity of the healthy preclinical population, and importantly, the use of a composite score to capture cognitive changes with increased sensitivity. More longitudinal studies with larger sample sizes are needed to elucidate this relationship.