Analysis of 1,185 cognitively normal older adults revealed distinct sex-specific patterns of cognitive decline based on subjective cognitive decline (SCD) status and amyloid pathology. Participants with both amyloid positivity and subjective cognitive concerns (A+SCD+) showed the steepest decline in global cognition and functional status. However, the manifestation differed by sex: amyloid-positive men exhibited increased functional deficits, while amyloid-positive women with subjective concerns developed language-specific impairments. These findings illuminate how early Alzheimer's pathology may progress differently in men versus women, even before clinical symptoms appear. The research addresses a critical gap in understanding preclinical dementia, as subjective cognitive decline often precedes measurable cognitive impairment by years. For clinical practice, these results suggest sex-specific cognitive assessments may better detect early decline patterns. The large sample from the National Alzheimer's Coordinating Center strengthens the findings, though this remains a preprint awaiting peer review and results may change. The discovery that language vulnerabilities emerge specifically in women with amyloid pathology could inform more targeted screening protocols and therapeutic interventions, potentially allowing earlier intervention in the dementia cascade.