Background: Fear of dementia is increasingly recognized as an important psychological concern in ageing populations and may contribute to reduced well-being, avoidance of preventive health behaviors, and even higher amyloid burden. However, little is known about how fear of dementia is experienced and managed in non-Western settings, and individuals’ needs for potential support are poorly understood.

Methods: This qualitative study explored how middle-aged and older adults experience fear of dementia, cope with related concerns, and their needs regarding potential interventions. Semi-structured interviews were conducted with adults aged ≥45 years in China. A fictional third-person vignette was used in the interview guide to facilitate discussion of dementia-related concerns. Data were analyzed using framework analysis informed by the Theoretical Domains Framework.

Results: Twenty participants described fear of dementia as a socially embedded and future-oriented experience shaped by dementia-related knowledge, exposure, family roles, and concerns about autonomy, dignity, and burdening others. Coping strategies ranged from proactive self-management to avoidance and distraction, often supported by family members or peers. Participants consistently expressed a need for practical information, reassurance, and actionable strategies to maintain cognitive health. Preferred interventions were accessible, low-burden, and professionally guided. Although digital delivery was generally viewed as acceptable, engagement was perceived to depend on usability, trust, and digital literacy.

Conclusions: Fear of dementia among Chinese middle-aged and older adults reflects broader concerns about ageing, dependency, and social roles in later life. Person-centered, co-created, and culturally sensitive support approaches may help promote psychological well-being and engagement with healthy ageing behaviors.

Keywords: fear; dementia; digital inclusion; qualitative research; person-centered care; cognitive ageing