Willing, but unequally: Indigenous identity influences participation in Alzheimer's disease biomarker research in Chile

INTRODUCTION: This study aimed to compare the willingness to use Alzheimer's disease (AD) predictive-diagnostic procedures between Mapuche (Indigenous) and non-Indigenous older adults in Chile. METHODS: = 248) older adults. Willingness to undergo five predictive-diagnostic procedures (AD risk test, neuropsychological assessment, blood test, brain imaging, and cerebrospinal fluid analysis) was evaluated. Logistic regression models were used to identify factors associated with willingness. RESULTS: Overall willingness was high, except for cerebrospinal fluid testing (39.1%). In fully adjusted models, Mapuche participants were significantly less willing to undergo neuropsychological assessment (77.8% vs. 92.3%), blood testing (68.3% vs. 89.9%), and brain imaging (73.1% vs. 84.3%). Key determinants of willingness varied by ethnic group and included age, sex, AD-related worry, social determinants, and number of dementia risk factors. DISCUSSION: Despite high overall willingness, ethnic identity and psychosocial factors significantly influenced receptiveness to AD predictive-diagnostic procedures. Highlights: Indigenous populations in high-income countries face a higher risk of dementia, making Alzheimer's disease (AD) biomarker and diagnostic research a critical priority in these groups.Despite this, Indigenous and Latin American populations remain among the most underrepresented in dementia research.In a sample of Indigenous (Mapuche) and non-Indigenous older adults in Chile, most participants reported willingness to use AD biomarkers and diagnostic procedures.In fully adjusted models, Mapuche individuals were significantly less willing to undergo neuropsychological testing, blood tests, and brain imaging for AD risk prediction.Willingness to use AD biomarkers varied by ethnic identity and was influenced by age, social determinants, and attitudes toward AD.