Neuroimaging biomarkers are increasingly being used in clinical practice for early diagnosis and differential diagnosis of dementia and in clinical trials as an outcome measure. Proton magnetic resonance spectroscopy has shown promise in dementia as a diagnostic biomarker with the ability to detect preclinical disease and amnestic mild cognitive impairment and provide ancillary information to distinguish among dementia subtypes. Alzheimer’s disease is characterized by decreased N-acetylaspartate-to-creatine (NAA/Cr) and elevated myo-inositol-to-creatine (mI/Cr) levels. Dementia with Lewy bodies is characterized by normal NAA/Cr levels in the posterior cingulate and elevated choline-to-creatine (Cho/Cr). Vascular dementia demonstrates decreased NAA/Cr but preserved Cho/Cr and mI/Cr in the posterior cingulate. Despite promising studies, MRS is not routinely used in the evaluation for dementia in clinical practice. Improving knowledge of the pathological basis of the metabolite ratio abnormalities, longitudinal studies, and better standardization of the MRS technique may improve the application in dementia.