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)

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.