From neighborhoods to brain health: an outreach model linking health literacy, cognitive care, research, and the arts, in San Francisco.

Traditional community outreach, research recruitment, and engagement strategies in aging neuroscience often fail to target and capture the diversity of structural and environmental conditions that shape the risk of age-related neurocognitive disorders (NCDs), including Alzheimer's disease. In this manuscript, we describe the rationale, implementation, and outcomes of the Community Outreach Program (COP) of the UCSF Fein Memory and Aging Center (MAC), emphasizing its neighborhood-based initiative designed to engage vulnerable populations to improve brain health literacy, access to cognitive care, and research inclusion among older adults living in underserved San Francisco neighborhoods. Guided by a social and environmental determinants of brain health framework, the program used neighborhood-level vulnerability and research representation mapping to identify neighborhoods with high vulnerability and low engagement in research, then implemented a multilingual, community-engaged model centered on four pillars: brain health education, arts- and movement-based programming, community-based cognitive clinics, and multilingual media outreach. Delivered in partnership with community organizations and safety-net providers in Mandarin, Cantonese, Spanish, Tagalog, and English, this model has generated durable partnerships across vulnerable neighborhoods, expanded access to culturally responsive cognitive care, improved inclusion in brain aging and NCDs research, and fostered innovative research projects. From 2019 to 2025, representation of individuals from vulnerable and underrepresented San Francisco neighborhoods in UCSF Fein MAC observational research increased substantially compared to previous years. These findings support place-based, multilingual, and reciprocity-centered community engagement as a promising framework for reducing and studying disparities in brain health.