Dementia risk reduction in the African context: Multi-national implementation of multimodal strategies to promote healthy brain aging in Africa (the Africa-FINGERS project)

Chinedu T Udeh-Momoh^{1

2

3

4

5

6

7}, Rachel Maina¹, Udunna C Anazodo^{8

9

10}, Rufus Akinyemi^{5

6

11}, Lukoye Atwoli^{1

12}, Laura Baker², Darina Bassil¹³, Karen Blackmon¹, Edna Bosire¹, Gloria Chemutai¹, Lucia Crivelli¹⁴, Laz U Eze^{5

6}, Agustin Ibanez^{5

6

15}, Dimitra Kafetsouli¹⁶, Thomas K Karikari¹⁷, Linda Khakali¹, Manasi Kumar¹⁸, Imre Lengyel¹⁹, Celeste A de Jager Loots^{4

16}, Francesca Mangialasche^{3

4}, Sylvia Mbugua¹, Zul Merali¹, Michelle Mielke², Cyprian Mostert¹, Eunice Muthoni²⁰, Olivera Nesic-Taylor^{1

21}, Anthony Ngugi²⁰, Samuel Nguku²², Adesola Ogunniyi¹¹, Adedoyin Ogunyemi^{5

6

23}, Ozioma C Okonkwo²⁴, Njideka Okubadejo²⁵, Robert Perneczky^{7

16

26

27

28

29}, Tunde Peto¹⁹, Roselyter M Riang'a²⁰, Mansoor Saleh³⁰, Shaheen Sayed³¹, Jasmit Shah¹, Sheena Shah³², Alina Solomon^{3

4

16

33}, Thomas Thesen^{1

34}, Dominic Trepel^{5

6

14}, Valentine Ucheagwu³⁵, Victor Valcour^{5

6

36}, Sheila Waa²², Tamlyn Watermeyer³⁷, Jennifer Yokoyama³⁶, Henrik Zetterberg^{38

39

40

41

42

43}, Miia Kivipelto^{3

4

16

44}; Africa‐FINGERS Study Team

Affiliations

¹ Brain and Mind Institute, Aga Khan University, Nairobi, Kenya.
² School of Public Health Sciences, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA.
³ Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.
⁴ FINGERS Brain Health Institute, Stockholm, Sweden.
⁵ Global Brain Health Institute (GBHI), UCSF, San Francisco, California, USA.
⁶ Trinity College Dublin, Dublin, Ireland.
⁷ Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK.
⁸ Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.
⁹ Medical Artificial Intelligence Laboratory, Crestview Radiology, Ltd., Lagos, Nigeria.
¹⁰ Department of Medicine & Clinical & Radiation Oncology, University of Cape Town, Cape Town, South Africa.
¹¹ Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria.
¹² Department of Medicine, Medical College East Africa, the Aga Khan University, Nairobi, Kenya.
¹³ Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, USA.
¹⁴ Department of Cognitive Neurology, Fleni, Buenos Aires, Argentina.
¹⁵ Trinity College Institute for Neuroscience, Trinity College Dublin, Dublin, Ireland.
¹⁶ Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK.
¹⁷ Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
¹⁸ Grossman School of Medicine, New York University, New York, New York, USA.
¹⁹ School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.
²⁰ Department of Population Health, Aga Khan University, Nairobi, Kenya.
²¹ Tilman J. Fertitta Family College of Medicine, Houston, Texas, USA.
²² Department of Radiology, Aga Khan University Hospital, Nairobi, Kenya.
²³ Department of Community Health and Primary Care, University of Lagos, Lagos, Nigeria.
²⁴ Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA.
²⁵ Neurology Unit, Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria.
²⁶ Ludwig Maximilien University, Munich, Germany.
²⁷ Department of Psychiatry and Psychotherapy, LMU Hospital, Ludwig Maximilians Universität Munich, Munich, Germany.
²⁸ German Center for Neurodegenerative Diseases (DZNE) Munich, Munich, Germany.
²⁹ Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.
³⁰ Cancer Research Unit, Aga Khan University, Nairobi, Kenya.
³¹ Department of Pathology, Aga Khan University, Nairobi, Kenya.
³² Department of Ophthalmology, Aga Khan University, Nairobi, Kenya.
³³ Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
³⁴ Department of Medical Education, Geisel School of Medicine at Dartmouth, Dublin, Ireland.
³⁵ Department of Psychology, Nnamdi Azikiwe University Awka, Anambra, Nigeria.
³⁶ University of California, San Francisco, San Francisco, California, USA.
³⁷ Centre for Dementia Prevention, Clinical Brain Sciences, The University of Edinburgh, Edinburg, UK.
³⁸ Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.
³⁹ Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.
⁴⁰ Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK.
⁴¹ UK Dementia Research Institute at UCL, London, UK.
⁴² Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China.
⁴³ Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA.
⁴⁴ Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.

PMID: 39511921
PMCID: PMC11667543
DOI: 10.1002/alz.14344

Dementia risk reduction in the African context: Multi-national implementation of multimodal strategies to promote healthy brain aging in Africa (the Africa-FINGERS project)

Chinedu T Udeh-Momoh et al. Alzheimers Dement. 2024 Dec.

. 2024 Dec;20(12):8987-9003.

doi: 10.1002/alz.14344. Epub 2024 Nov 7.

Authors

Affiliations

¹ Brain and Mind Institute, Aga Khan University, Nairobi, Kenya.
² School of Public Health Sciences, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA.
³ Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.
⁴ FINGERS Brain Health Institute, Stockholm, Sweden.
⁵ Global Brain Health Institute (GBHI), UCSF, San Francisco, California, USA.
⁶ Trinity College Dublin, Dublin, Ireland.
⁷ Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK.
⁸ Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.
⁹ Medical Artificial Intelligence Laboratory, Crestview Radiology, Ltd., Lagos, Nigeria.
¹⁰ Department of Medicine & Clinical & Radiation Oncology, University of Cape Town, Cape Town, South Africa.
¹¹ Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria.
¹² Department of Medicine, Medical College East Africa, the Aga Khan University, Nairobi, Kenya.
¹³ Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, USA.
¹⁴ Department of Cognitive Neurology, Fleni, Buenos Aires, Argentina.
¹⁵ Trinity College Institute for Neuroscience, Trinity College Dublin, Dublin, Ireland.
¹⁶ Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK.
¹⁷ Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
¹⁸ Grossman School of Medicine, New York University, New York, New York, USA.
¹⁹ School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.
²⁰ Department of Population Health, Aga Khan University, Nairobi, Kenya.
²¹ Tilman J. Fertitta Family College of Medicine, Houston, Texas, USA.
²² Department of Radiology, Aga Khan University Hospital, Nairobi, Kenya.
²³ Department of Community Health and Primary Care, University of Lagos, Lagos, Nigeria.
²⁴ Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA.
²⁵ Neurology Unit, Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria.
²⁶ Ludwig Maximilien University, Munich, Germany.
²⁷ Department of Psychiatry and Psychotherapy, LMU Hospital, Ludwig Maximilians Universität Munich, Munich, Germany.
²⁸ German Center for Neurodegenerative Diseases (DZNE) Munich, Munich, Germany.
²⁹ Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.
³⁰ Cancer Research Unit, Aga Khan University, Nairobi, Kenya.
³¹ Department of Pathology, Aga Khan University, Nairobi, Kenya.
³² Department of Ophthalmology, Aga Khan University, Nairobi, Kenya.
³³ Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
³⁴ Department of Medical Education, Geisel School of Medicine at Dartmouth, Dublin, Ireland.
³⁵ Department of Psychology, Nnamdi Azikiwe University Awka, Anambra, Nigeria.
³⁶ University of California, San Francisco, San Francisco, California, USA.
³⁷ Centre for Dementia Prevention, Clinical Brain Sciences, The University of Edinburgh, Edinburg, UK.
³⁸ Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.
³⁹ Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.
⁴⁰ Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK.
⁴¹ UK Dementia Research Institute at UCL, London, UK.
⁴² Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China.
⁴³ Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA.
⁴⁴ Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.

PMID: 39511921
PMCID: PMC11667543
DOI: 10.1002/alz.14344

Abstract

Dementia prevention in Africa is critically underexplored, despite the continent's high prevalence of modifiable risk factors. With a predominantly young and middle-aged population, Africa presents a prime opportunity to implement evidence-based strategies that could significantly reduce future dementia cases and mitigate its economic impact. The multinational Africa-FINGERS program offers an innovative solution, pioneering culturally sensitive, multidomain interventions tailored to the unique challenges of the region. Leveraging insights from landmark global studies such as Worldwide-FINGERS and Alzheimer's Disease Neuroimaging Initiative, the program employs a multideterminant precision prevention framework, grounded in community based systems dynamics. Africa-FINGERS further integrates cutting-edge state-of-the-art multimodal biomarker evaluations tailored to regional contexts, with the goal of advancing brain health and establishing a global standard for dementia prevention. This groundbreaking initiative highlights the potential for scalableand sustainable interventions, thus is poised to transform dementia risk reduction efforts across the continent. HIGHLIGHTS: Dementia rates are escalating in Africa, largely due to longer life spans and increased prevalence of modifiable risk factors. Yet, few regional interventions have directly targeted lifestyle factors to reduce dementia risk. The multinational Africa-FINGERS study will address this gap by adapting the successful FINGERS lifestyle intervention to African populations. Africa-FINGERS will pioneer a culturally informed, multidomain dementia risk reduction intervention in the African region through feasibility dementia prevention trials in rural and urban sites across Kenya and Nigeria in the first instance, enrolling 600 at-risk adults (≥ 50 years). The program adopts participatory research methods to develop culturally appropriate interventions and build infrastructure to evaluate dementia biomarkers from ante and post mortem samples. A cost-effectiveness analysis will be conducted to guide the strategic implementation of Africa-FINGERS into regional health systems. The Africa-FINGERS strategy aligns with the Worldwide-FINGERS framework and integrates the global Alzheimer's Disease Neuroimaging Initiative approach, emphasizing multimodal analysis.

Keywords: Alzheimer's disease; brain banking; community‐based participatory research; dementia prevention trials; fluid and neuroimaging biomarkers; health economics; implementation science; retinal imaging.

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Conflict of interest statement

H.Z. has served at scientific advisory boards and/or as a consultant for Abbvie, Acumen, Alector, Alzinova, ALZPath, Amylyx, Annexon, Apellis, Artery Therapeutics, AZTherapies, Cognito Therapeutics, CogRx, Denali, Eisai, LabCorp, Merry Life, Nervgen, Novo Nordisk, Optoceutics, Passage Bio, Pinteon Therapeutics, Prothena, Red Abbey Labs, reMYND, Roche, Samumed, Siemens Healthineers, Triplet Therapeutics, and Wave; has given lectures in symposia sponsored by Alzecure, Biogen, Cellectricon, Fujirebio, Lilly, Novo Nordisk, and Roche; and is a co‐founder of Brain Biomarker Solutions in Gothenburg AB (BBS), which is a part of the GU Ventures Incubator Program (outside submitted work). IL receives unrestricted research funding from OPTOS Plc. The other authors declare no competing interests. Author disclosures are available in the supporting information.

Figures

**FIGURE 1**
Conceptual diagram of the Africa‐FINGERS Project. Multideterminant framework for dementia risk reduction in Africa via pioneering precision prevention approach.

**FIGURE 2**
Proposed plan of the Africa‐FINGERS randomized control trial.

**FIGURE 3**
Africa‐FINGERS implementation plan adopting RE‐AIM framework. RE‐AIM, Reach, Effectiveness, Adoption, Implementation, and Maintenance.

**FIGURE 4**
Participating countries in the Africa‐FINGERS program. African countries currently involved in the first Worldwide‐FINGERS program in Africa adopting CBPR approach toward culturally informed multimodal interventions with bespoke implementation and integration strategy. CBPR, community‐based participatory research.

See this image and copyright information in PMC

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Dementia risk reduction in the African context: Multi-national implementation of multimodal strategies to promote healthy brain aging in Africa (the Africa-FINGERS project)

Affiliations

Dementia risk reduction in the African context: Multi-national implementation of multimodal strategies to promote healthy brain aging in Africa (the Africa-FINGERS project)

Authors

Affiliations

Abstract

Conflict of interest statement

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References

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Grants and funding

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Medical

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