"Brain health"-the emergence of a new healthy construct and its role in everyday life

Emerging public health discourse increasingly frames brain health and dementia prevention as matters of personal responsibility and urge individuals to adopt modifiable behaviors across the life course. This study examines how adults at different life stages perceive dementia risk and engage with brain health practices, with particular attention to how these behaviors are socially structured and culturally mediated.

Using a life course perspective and an abductive critical realist approach, this qualitative study draws on semi-structured interviews with 33 participants (aged 19-81 years) recruited across three generational cohorts: younger adults (n = 11), middle-aged adults (n = 8), and older adults (n = 14). Abductive thematic analysis was employed to examine how participants understand brain health, dementia, and responsibility for the management and prevention of these aspects of late-life health.

Participants articulated diverse and age-contingent understandings of brain health. While younger adults associated prevention with aspirational self-optimization, middle-aged adults emphasized routine, sustainability, and caregiving-informed insight. Older adults, often informed by lived proximity to dementia, described adaptive strategies to preserve brain health amid physical limitations. Across all groups, health practices were framed through an ethos of personal accountability, although often enacted within structurally constrained contexts.

Findings emphasize the need to critically engage with how dementia prevention discourse is differentially internalized across the life course. Public health strategies should balance behavioral interventions with honest acknowledgement of the structural conditions which stratify distributions of brain health risk and opportunities for prevention.