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

鉴于全球老年人口规模空前扩大，认知障碍和痴呆症对健康长寿构成重大挑战。一半以上的痴呆症患者（约60%）生活在低收入和中等收入国家。像撒哈拉以南非洲（SSA）一样，低收入和中等收入国家是快速老龄化的社会，已经面临痴呆症的流行，预计在未来20年，痴呆症病例将上升到357%。如果不采取预防措施并加以实施，今后几年这一负担将难以克服。来自《柳叶刀》痴呆症预防、干预和护理委员会的令人鼓舞的报告估计，高达40%的痴呆症是可以预防的。世界卫生组织（世卫组织）提出了同时针对多种风险因素的减少风险战略，作为最佳预防方法。其中一个成功的策略是具有里程碑意义的芬兰老年干预研究，以预防认知障碍和残疾（FINGER）多模式生活方式改变试验，该试验表明干预后2年的认知和健康结果有所改善。全球的研究人员正在一个世界范围的网络（由研究联合CI领导，由本研究的CI领导的国际生物标本库工作）内适应和实施这种方法，但尚未在非洲实施。因此，我们建议在SSA中开展一项促进大脑健康的多国合作：非洲手指计划。“非洲手指计划”首次尝试在整个撒哈拉以南非洲协调和实施具有文化背景的多领域减少痴呆症风险干预措施，并将可持续发展目标纳入该计划。我们建议的总体目标是通过优化《柳叶刀》预防委员会确定的核心可改变风险因素的管理，促进非洲人口的认知障碍和健康老龄化，世卫组织应对非传染性疾病的政策，以及在这些土著人口中工作的我们的团队成员，以及至关重要的土著社区成员本身。在此，我们提出了两个主要目标：A)与当地利益相关者共同设计定制的个性化多领域生活方式痴呆风险调节方案，并收集干预效果、生物机制和成本效益的数据。我们建议确定和测试在环境和文化上合适、经济上可行和可持续的解决方案。B)通过在社区范围内实施，促进干预措施的持续有效性和可扩展性，并协调在伙伴国家和类似人口结构中采用的方法。“非洲手指”是一项多国脑健康促进倡议（50岁以上的高危成年人，n=600），在肯尼亚和尼日利亚已建立的学术研究基础设施中与已经表型的队列建立。该项目将嵌套在WW-FINGERS框架内，以肯尼亚内罗毕阿加汗大学脑与精神研究所（BMI）为中心枢纽。BMI解决了肯尼亚在精神和神经疾病的研究能力和干预措施方面日益严重的差距。鉴于BMI的愿景和价值观，其成员的多样化和相关专业知识，其位置和联系，包括注册的临床试验单位，实验室设施和成像核心；BMI非常适合作为非洲手指的中心枢纽和主要地点。二级站点是肯尼亚基利菲县公共卫生部；尼日利亚拉各斯大学和尼日利亚阿夫卡Nnamdi Azikiwe大学老龄化认知与心理健康研究中心；都在进行痴呆症临床研究。在MRC/NIHR复杂干预框架的指导下，该合作项目将与www - fingers、达沃斯阿尔茨海默病合作、全球脑健康研究所、全球痴呆症预防计划、神经视觉、绿洲诊断、阿尔茨海默病数据倡议和阿尔茨海默病国际合作。

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.