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

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.

The AFRICA-FINGERS Project is a 5-year trial aimed at reducing the risk of Alzheimer's disease and related dementias (ADRD) in Sub-Saharan Africa (SSA) using a culturally informed, multimodal precision prevention framework. Part of the World-Wide FINGERS (WW-FINGERS) network, it leverages established global partnerships and resources to build and sustain research networks in Kenya & Nigeria, supporting economic development in the region.
The project consists of four work packages: WP1 focuses on community-based participatory research to co-create an intervention protocol for dementia risk reduction. Local stakeholders will be actively involved in the process through workshops and qualitative methods.
WP2 involves conducting a 2-year randomized controlled trial (RCT) at four sites in Kenya and Nigeria, enrolling 600 participants. The trial will test a culturally adapted multimodal lifestyle intervention targeting exercise, nutrition, cognition, and cardiovascular/metabolic risk management. Various assessments will evaluate cognitive, functional and ADRD biomarker outcomes using traditional and cost-effective capture techniques. WP3 aims to estimate the cost-effectiveness of the intervention using a Bayesian framework. This includes developing simulation models and conducting a within-trial cost-effectiveness analysis. Costing activities will capture financial and economic costs and estimate biomarker method costs.
WP4 focuses on integrating a health promotion strategy within local and national networks, disseminating project findings, and promoting brain health literacy. Activities include research articles, presentations, workshops, and media engagement. The goal is to empower healthcare practitioners and patients while measuring impact via surveys.
The study provides novel insights into risk reduction strategies for indigenous Africans and develops the first culturally-appropriate dementia prevention protocol in SSA to support cognitive and physical health.