A Multi‐National Collaboration to Assess the Feasibility and Sustainability of Implementing Multimodal Brain Health Promotion Strategies in Sub‐Saharan Africa (The AFRICA‐FINGERS Project)
Authors: Udeh‐Momoh Chi T. , Solomon Alina , Jiang Fanny , Hannan Sehaan , Mangialasche Francesca , de Jager Celeste A , Lane Kathleen A. , Gao Sujuan , Watermeyer Tam J , Bassil Darina T. , Chan Kit Yee , Ucheagwu Valentine A , Allen Isabel Elaine , Grinberg Lea T. , Yokoyama Jennifer S. , Akinyemi Rufus , Ezzati Ali , Slowey Paul , Valcour Victor , Miller Bruce L , Ikanga Jean N , Perneczky Robert , Middleton Lefkos T , Mielke Michelle M. , Zetterberg Henrik , Merali Zul , Hendrie Hugh C , Ogunniyi Adesola , Kivipelto Miia 
Published: December 2023

Background

Multimodal interventions targeting modifiable disease‐associated risk factors may support large‐scale population brain health. The landmark Finnish‐Geriatric‐Intervention‐Study‐to‐Prevent‐Cognitive‐Impairment‐and‐Disability(FINGER) demonstrated improvements in cognition and health outcomes 2‐years post‐intervention. Researchers now seek to adapt and implement this approach internationally, within the World‐Wide FINGERS (WW‐FINGERS) network.

Dementia prevalence in Africa is rising; however, scant research examines the impact of lifestyle factor changes on dementia risk in African populations. Furthermore, no interventional studies have assessed the feasibility or efficacy of culturally sensitive risk‐reduction approaches. Overcoming these gaps, our multi‐national collaboration with established rural and urban cohorts in Kenya and Nigeria in the first instance will leverage expertise from WW‐FINGERS, Global‐Brain‐Health‐Institute (GBHI), Davos Alzheimer’s Collaborative (DAC) and Global‐Dementia‐Prevention‐Program (GloDePP) partners.

Methods

The AFRICA‐FINGERS study will recruit older adults at risk of cognitive impairment based on a well‐validated dementia risk score. The adapted interventions comprise physical/social activity, healthy diet, cognitive stimulation and vascular risk monitoring. Initially, we externally validated six existing dementia risk scores using data from the Ibadan cohort of the Indianapolis‐Ibadan‐Dementia study (1992‐2022, n = 4353). We examined the association between common dementia risk factors, validated risk scores and time to incident dementia or cognitive impairment. Sex‐specific interactions were further investigated.

Results

7% of the cohort developed dementia (mean±SD follow‐up: 7±4 years). Of the risk factors studied, older age (HR:1.09, 95%CI:1.07‐1.10), higher systolic blood pressure (HR:1.01, 95%CI:1.00‐1.02), history of stroke (HR:3.06, 95%CI:1.44‐6.48), smoking (HR:1.41, 95%CI:1.10‐1.99) and lower social engagement (HR:4.11, 95%CI: 1.90‐8.89) were associated with higher dementia risk; while being male (HR:0.49, 95%CI: 0.36 ‐ 0.67) was associated with lower risk. The best predictive models were lifestyle and vascular‐based dementia risk scores that included ethnicity. Sex‐specific diagnostic accuracy for predicting incident dementia and cognitive impairment will be presented.

Conclusions

Our preliminary independent validation of Western‐derived dementia risk scores in a rural Nigeria cohort provides a cursory estimation of the proportion of elders who may meet the planned study’s eligibility criteria in terms of at‐risk‐for‐dementia status. The next step will explore facilitators/barriers to adherence and sustainability of the intervention in Nigeria, Kenya, South Africa, Cameroon, Congo and DRC via stakeholder focus‐groups, to inform development of the intervention protocol.