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

鉴于全球老年人口的空前扩张，认知障碍和痴呆症对健康长寿构成了重大挑战。超过一半的痴呆症患者(60%)生活在低收入和中等收入国家。像撒哈拉以南非洲(SSA)这样的LMIC是快速老龄化的社会，已经面临痴呆症流行，预计未来20年病例将上升到357%。如果找不到并应用预防措施，未来几年的负担将是无法克服的。柳叶刀痴呆症预防、干预和护理委员会的鼓励性报告估计，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。其中一项成功的策略是具有里程碑意义的芬兰老年干预研究，以预防认知损害和残疾(Finger)多模式生活方式调整试验，该试验表明干预2年后认知和健康结果有所改善。全球的研究人员正在全球范围的网络(由研究合作组织领导，生物标本库的国际努力由本研究的合作组织领导)内适应和实施这一方法，但在非洲还没有。因此，我们建议在SSA中开展一个促进脑健康的跨国合作：非洲手指计划。非洲--Finger代表着在整个SSA协调和实施文化信息多领域痴呆症风险降低干预措施的首次尝试，可持续发展目标嵌入了该倡议。我们建议的总体目标是通过优化对柳叶刀预防委员会确定的可改变的核心风险因素的管理，世卫组织应对非传染性疾病的政策，以及我们在这些土著人口中工作的小组成员以及至关重要的土著社区成员本身，减少非洲人口的认知障碍和促进健康老龄化。在这里，我们提出了两个主要目标：a)与当地利益相关者共同设计一个定制的个性化多领域生活方式痴呆风险调整方案，并收集有关干预效果、生物机制和成本效益的数据。我们建议确定和测试在背景和文化上合适、经济上可行和可持续的解决方案。b)通过社区范围的实施来促进干预的持续有效性和可扩展性，并协调在伙伴国家和类似人口统计学中采用的方法。AFRICA-Finger是一个跨国脑健康促进计划(高危成年人&GT；50年，n=600)，建立在肯尼亚和尼日利亚已有表型队列的现有学术研究基础设施内。该项目将嵌套在WW-Finger框架内，中心中心设在肯尼亚内罗毕阿加汗大学的大脑和思维研究所(BMI)。BMI解决了肯尼亚在精神和神经疾病的研究能力和干预方面存在的严重和日益严重的差距。鉴于BMI的愿景和价值观、其成员多样化和相关的专业知识、其地理位置和联系，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及其主要站点的中心枢纽。次要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那南迪阿齐基韦大学(NAU)奥卡的老龄化认知和心理健康研究中心；所有这些站点都在进行痴呆症临床研究。在MRC/NIHR复杂干预框架的指导下，这个合作项目将与WW-Finger、达沃斯阿尔茨海默氏症合作组织、全球脑健康研究所、全球痴呆症预防计划、NeuroVision、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.