Multi-National Implementation of Multimodal Strategies to promote Healthy Brain Ageing in Sub-Saharan Africa (The AFRICA-FINGERS Project)

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Given unprecedented expansions in aged populations globally, cognitive impairment and dementia present significant challenges for healthy longevity. More than half of all dementia patients (>60%) are living in low- and middle-income countries (LMICs). LMICs, like Sub-Saharan Africa (SSA) are fast-aging societies facing the dementia epidemic already, with cases projected to rise to 357% in the next two decades. The burden will be insurmountable in the coming years if preventive measures are not found and applied.Encouraging reports from the Lancet Commission on Dementia Prevention, Intervention, and Care estimates up to 40% of dementia as preventable. Risk reduction strategies simultaneously targeting multiple risk factors have been proposed by the World Health Organization (WHO) as optimal prevention approaches. One such successful strategy is the landmark Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) multimodal lifestyle modification trial that demonstrated improvements in cognitive and health outcomes 2-years post-intervention. Researchers globally are adapting and implementing this approach, within a World-Wide network (led by study co-CI, with the international efforts for bio-specimen repository led by this study's CI), but not yet in Africa. Therefore, we propose a multi-national collaboration towards brain health promotion in SSA: The AFRICA FINGERS Program. AFRICA-FINGERS represents the first attempt to coordinate and implement culturally informed multidomain dementia-risk reduction interventions across SSA, with sustainability goals embedded within the initiative. The overarching aim of our proposal is to reduce cognitive impairment and promote healthy aging in African populations by optimizing the management of core modifiable risk factors identified by the Lancet Commission on prevention, the WHO policy for addressing NCDs and, by members of our teams working within these indigenous populations as well as, crucially, the indigenous community members themselves. Here we propose two primary objectives:A) To co-design with local stakeholders a bespoke personalized multidomain lifestyle dementia risk-modification protocol, and collect data on intervention effectiveness, bio-mechanisms and cost-effectiveness. We are proposing to identify and test solutions that are contextually and culturally appropriate, economically viable, and sustainable.B) To promote sustained efficacy of the intervention and scalability via community-wide implementation and harmonize methods for adoption in partner countries and across similar demographics.AFRICA-FINGERS is a multinational brain health promotion initiative (at-risk adults >50years, n=600) set within established academic research infrastructures with already-phenotyped cohorts in Kenya and Nigeria. The program will be nested within the WW-FINGERS framework, with the central hub at the Brain and Mind Institute (BMI), Aga Khan University in Nairobi, Kenya. The BMI addresses acute and rising gaps in research capacity and interventions for mental and neurological conditions in Kenya. Given the BMI Vision and Values, diverse and relevant expertise of its members, its location and connections, including a registered Clinical Trials Unit, Lab facility and Imaging core; the BMI is ideally suited as the central hub for AFRICA FINGERS and its primary site. The secondary sites are Department of Public Health, Kilifi county, Kenya; University of Lagos, Nigeria and The Research Centre for Ageing Cognition and Psychological Health, Nnamdi Azikiwe University (NAU) Awka, Nigeria; all conducting dementia clinical studies.Guided by the MRC/NIHR framework for complex interventions, this collaborative project will partner with WW-FINGERS, Davos Alzheimer's Collaborative, Global-Brain-Health-Institute, Global-Dementia-Prevention-Program, Neurovision, Oasis Diagnostics, Alzheimer's Disease Data Initiative and Alzheimer's Disease International.