Advancing brain health equity with indigenous peoples: A critical imperative.

Abstract

Indigenous communities hold rich knowledges, cultural practices, and kinship networks that sustain cognitive resilience and nurture brain health across the life course. Yet these enduring strengths are often obscured by biomedical models that overlook the structural determinants of health-including the cumulative effects of colonization, educational inequity, and socioeconomic disadvantage-that diminish brain health. Accordingly, dementia disproportionately affects Indigenous populations globally, often presenting with earlier onset and higher prevalence compared to non-Indigenous groups. This perspective synthesizes the current epidemiological evidence, situates dementia risk within its structural and historical context, and explores how Indigenous knowledges, cultural continuity, and community leadership can inform dementia research and care more broadly. Our global insights call for a decisive shift: to decolonize dementia research and policy and move beyond deficit-based narratives toward approaches that prioritize Indigenous leadership and culturally grounded, strengths-based pathways to brain health equity. HIGHLIGHTS: This perspective synthesizes global evidence on dementia epidemiology among Indigenous populations, examining structural determinants and Indigenous perspectives on brain health and dementia care. Structural inequities and the enduring legacies of colonization, rather than biology alone, underpin the disproportionate dementia burden among Indigenous peoples worldwide. Centering culture, kinship, and connection to land and community reframes brain health beyond biomedical models and reveals cultural resilience as a powerful neuroprotective resource. Key recommendations call for Indigenous leadership and locally tailored, culturally grounded approaches to advance lifelong brain health equity and develop strengths-based models of dementia care.