A comprehensive survey of 9,506 older adults in Japan's Tottori Prefecture revealed that half would participate in dementia prevention activities if delivered through brief, 10-minute sessions with printed materials. However, awareness of existing dementia prevention programs remained critically low at just 11.9%. Concerningly, individuals with frailty and subjective cognitive decline—those at highest dementia risk—showed significantly reduced interest in prevention activities, with 23% and 14% lower odds of participation respectively. This creates a troubling paradox where those who would benefit most from interventions are least likely to engage with them. The findings illuminate a fundamental challenge in translating dementia research into real-world prevention: reaching high-risk populations requires proactive outreach rather than passive program availability. The preference for brief, accessible formats suggests that successful community programs must prioritize convenience over comprehensiveness. While these results provide valuable insights into program design and delivery preferences, this remains a preprint awaiting peer review, and conclusions may evolve. The research represents an incremental but important step toward understanding the evidence-practice gap in dementia prevention, though implementation strategies for high-risk individuals require further investigation.