Introduction Automated speech analysis has emerged as a scalable, cost-effective tool to identify persons with Alzheimer's disease dementia (ADD). Yet, most research is undermined by low interpretability and specificity. Methods Combining statistical and machine learning analyses of natural speech data, we aimed to discriminate ADD patients from healthy controls (HCs) based on automated measures of domains typically affected in ADD: semantic granularity (coarseness of concepts) and ongoing semantic variability (conceptual closeness of successive words). To test for specificity, we replicated the analyses on Parkinson's disease (PD) patients. Results Relative to controls, ADD (but not PD) patients exhibited significant differences in both measures. Also, these features robustly discriminated between ADD patients and HC, while yielding near-chance classification between PD patients and HCs. Discussion Automated discourse-level semantic analyses can reveal objective, interpretable, and specific markers of ADD, bridging well-established neuropsychological targets with digital assessment tools.