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Survival in a non-stationary, potentially adversarial environment requires animals to detect sensory changes rapidly yet accurately, two oft competing desiderata. Neurons subserving such detections are faced with the corresponding challenge to discern “real” changes in inputs as quickly as possible, while ignoring noisy fluctuations. Mathematically, this is an example of a change-detection problem that is actively researched in the controlled stochastic processes community. In this paper, we utilize sophisticated tools developed in that community to formalize an instantiation of the problem faced by the nervous system, and characterize the Bayes-optimal decision policy under certain assumptions. We will derive from this optimal strategy an information accumulation and decision process that remarkably resembles the dynamics of a leaky integrate-and-fire neuron. This correspondence suggests that neurons are optimized for tracking input changes, and sheds new light on the computational import of intracellular properties such as resting membrane potential, voltage-dependent conductance, and post-spike reset voltage. We also explore the influence that factors such as timing, uncertainty, neuromodulation, and reward should and do have on neuronal dynamics and sensitivity, as the optimal decision strategy depends critically on these factors.