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Background Aboriginal Australians are disproportionately affected by dementia compared to other Australians and many populations globally. Dementia incidence and risk factors have not been identified for Aboriginal Australians living in urban or regional areas (comprising ∼80% of First Nations Australians). There is also a pressing need in this population for non‐pharmacological interventions that are culturally‐grounded and target dementia risk‐reduction. Psychological wellbeing is a risk factor for dementia, and is relevant for Aboriginal communities where there are high levels of exposure to stress and trauma. Method The Koori Growing Old Well Study (KGOWS) is a longitudinal, population‐based study with Aboriginal Australians aged 60+ years; participants were from 5 partnering communities in New South Wales (N=336 at baseline; n=165 at follow‐up; n=68 died before follow‐up; mean follow‐up=6 years). Biomedical and psychosocial risk factors (baseline assessment) were examined for cognitive decline (incident MCI or dementia) using logistic regression. To address the impact of lifecourse stress and trauma on dementia risk, a comprehensive co‐design process was employed to develop the Ngarraanga Giinganay (‘thinking peacefully’) mindfulness‐based program, including expert working group, community focus group and pilot trial (n=7 older Aboriginal Australians), with quantitative and qualitative outcomes. Result KGOWS demonstrated high rates of incident dementia (17.55/1000 person‐years; age‐standardised rate=34.71) and cognitive decline (42.34/1000 person‐years; age‐standardised rate=73.51), comparable to a remote Aboriginal population. In models adjusted for age (OR=2.12), factors predicting cognitive decline included male sex (OR=2.91), lower education (OR=0.51), moderate to severe hearing (OR=4.80) and vision (OR=3.78) problems, greater waist‐hip ratio (OR=1.56), polypharmacy (OR=2.61) and unskilled work history (OR=5.27). The working group and focus group feedback strongly guided Ngarraanga Giinganay program development, ensuring content and activities aligned with cultural understandings and practices for that community (Gumbaynggirr people). Results from the Ngarraanga Giinganay pilot demonstrated feasibility, acceptability and preliminary effectiveness of mindfulness‐based stress‐reduction; and highlighted aspects for refinement and further evaluation. Conclusion These findings provide the first urban incidence rates and identify potentially modifiable risk factors for cognitive decline in Aboriginal Australians. Our work with communities provides insight into partnering with underrepresented populations for dementia research; and highlights the effectiveness of co‐design approaches when developing culturally‐specific interventions.