Community perspectives on epigenetic dementia risk testing: Willingness, implementation preferences, and reasons for not testing in midlife and older adults

INTRODUCTION: Epigenetic assays may support non-invasive dementia risk stratification; community views on willingness and implementation remain under-characterized. METHODS: In a survey of 425 adults ≥50 years old, we assessed the willingness for a hypothetical epigenetic test, implementation preferences, reactions to a high-risk result, behavior-change intentions, and reasons for not testing using multivariable models. RESULTS: Overall, 82.1% showed a willingness. Health literacy (odds ratio [OR] = 2.61) and Alzheimer's disease (AD) concern (OR = 2.06) increased that willingness; doctor dependence decreased it (OR = 0.62). The top drivers were perceived to be accuracy and speed. The preferred modality was a combination of biomarker and cognitive over biomarker-only. Intended changes prioritized alcohol reduction, then diet, exercise, cognitive activity. Risk worry and insurance concerns exceeded stigma; higher literacy related to lower stigma, and epigenetics familiarity and AD worry related to higher insurance concern. The reasons for not testing were data privacy/accuracy concerns, logistics/costs, and needles. DISCUSSION: Findings support emphasizing test accuracy, turnaround, and governance/legal information when implementing DNAm testing for dementia risk.