A Community-Based Model for Multimodal Brain-Health Screening and Alzheimer’s Disease and Related Dementia Risk Prediction in Mid-Sized Cities and Surrounding Rural Communities: A Mixed-Methods Evaluation

Background and Objectives Rural adults (those residing in nonmetropolitan counties) face persistent barriers to brain health assessment that may help prevent or delay cognitive decline. This study reports protocol and pilot feasibility findings from year one of a three-year longitudinal project evaluating Building a Rural Aging and Intervention Network: Factors that Impact Trajectories (BRAIN-FIT), a community-embedded program to improve access to multidomain screening and awareness of modifiable dementia risk factors. Research Design and Methods Using a mixed-methods design, 119 adults aged 45+ completed a single-day interdisciplinary screening incorporating clinical-standard measures (cardiovascular, physical, lifestyle, social-emotional, sensory, cognitive, and speech-language health), followed by individualized results review. Sixty-three participants completed a four-week post-event behavior change evaluation. Results BRAIN-FIT, delivered across seven community sites in three cities through 18 events, enrolled 163 adults (aged 46–95; M = 67.5) with socioeconomic and clinical heterogeneity. Engagement was strong: 119 consented to longitudinal participation, 95% completed all stations, and rated the program highly feasible (3.7-4.4/5). Screening identified prevalent modifiable risk factors: elevated cardiometabolic indicators, reduced physical endurance, sleep disturbance, and sensory impairment. Cognitive and language performance remained largely within functional limits, suggesting engagement during a preventive window. Discussion and Implications Community-embedded multimodal screening appears to be a viable program for identifying actionable brain-health risk prior to substantial decline. By reaching diverse adults outside traditional care pathways, BRAIN-FIT advances a pragmatic population-health approach to dementia prevention. Longitudinal follow-up will evaluate sustained behavior change, strengthen referral integration, and inform hybrid effectiveness–implementation trials to promote healthier aging trajectories.