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Objective: To summarise the incidental findings detected on brain imaging and blood tests during the first wave of data collection for the Insight 46 study., Design: Prospective observational sub-study of a birth cohort., Setting: Single-day assessment at a research centre in London, UK., Participants: 502 individuals were recruited from the MRC National Survey of Health and Development (NSHD), the 1946 British birth cohort, based on pre-specified eligibility criteria; mean age was 70.7 (SD: 0.7) and 49% were female., Outcome Measures: Data regarding the number and types of incidental findings were summarised as counts and percentages, and 95% confidence intervals were calculated., Results: 93.8% of participants completed a brain scan (n=471); 4.5% of scanned participants had a pre-defined reportable abnormality on brain MRI (n=21); suspected vascular malformations and suspected intracranial mass lesions were present in 1.9% (n=9) and 1.5% (n=7) respectively; suspected cerebral aneurysms were the single most common vascular abnormality, affecting 1.1% of participants (n=5), and suspected meningiomas were the most common intracranial lesion, affecting 0.6% of participants (n=3); 34.6% of participants had at least one abnormality on clinical blood tests (n=169), but few reached the prespecified threshold for urgent action (n=11)., Conclusions: In older adults, aged 69-71 years, potentially serious brain MRI findings were detected in around 5% of participants, and clinical blood test abnormalities were present in around one third of participants. Knowledge of the expected prevalence of incidental findings in the general population at this age is useful in both research and clinical settings., Competing Interests: Competing interests: NF’s research group has received payment for consultancy or for conducting studies from Avid Radiopharmaceuticals, Biogen, Eisai, Elan, Eli Lilly Research Laboratories, GE Healthcare, IXICO, Janssen, Johnson & Johnson, Lundbeck, Pfizer, Roche, Sanofi-Aventis and Wyeth Pharmaceuticals. NF receives no personal compensation for the activities mentioned above. JMS has received research funding from Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly), has consulted for Roche Pharmaceuticals, Biogen and Eli Lilly, has given educational lectures sponsored by GE, Eli Lilly and Biogen, and serves on a Data Safety Monitoring Committee for Axon Neuroscience SE., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.)