Brain health inequity during midlife: An evolutionary concept analysis of mild neurocognitive disorder

Background Brain health inequity emerging in midlife contributes to unequal cognitive ageing trajectories and dementia risk, particularly among individuals living with mild neurocognitive disorder (mNCD). Although brain health is increasingly framed as a life-course and multidimensional construct, the concept of brain health inequity in midlife remains inconsistently defined across brain health, dementia prevention, ageing, and equity literature. Aim This concept analysis aimed to clarify the concept of brain health inequity in midlife among individuals with mNCD using Rodgers’ evolutionary concept analysis framework. Method Four databases, CINAHL, PubMed, Embase and PsycINFO, were searched for literature published since 2015. Seventeen articles were included in this analysis to identify the concept’s defining attributes, antecedents, consequences, and related terminology. Findings Brain health inequity was rarely defined explicitly but emerged as a socially patterned and context-dependent concept. Defining attributes included an availability-access gap, support-dependent engagement, and contextual alignment. Key antecedents included midlife cognitive vulnerability and age-related framing, predefined study requirements, competing demands and constraints, and unequal resource distribution. Consequences included unequal capacity to modify risk, constrained brain health opportunities, reduced psychosocial benefit, and representation gaps in the evidence base. Conclusion Brain health inequity in midlife is a structurally produced, context-dependent pattern of unequal opportunities to protect, maintain, and restore cognitive health. Clarifying this concept emphasises the need for equity-based research approaches and strategies to prevent inadvertent favouritism towards individuals who already have better access to resources.