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

多国实施多模式战略，促进撒哈拉以南非洲地区大脑健康老化（AFRICA-FINGERS 项目）

• 批准号: MR/Y019822/1
• 负责人: Chinedu Udeh-Momoh
• 金额: $ 273.04万
• 依托单位: Aga Khan University
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2024
• 资助国家: 英国
• 起止时间: 2024 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FY019822%2F1
• 关键词: Multi; National; Implementation; Multimodal; Strategies

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.

鉴于全球老年人口空前增长，认知障碍和痴呆症对健康长寿提出了重大挑战。超过一半的痴呆症患者 (>60%) 生活在低收入和中等收入国家 (LMIC)。撒哈拉以南非洲地区 (SSA) 等中低收入国家是快速老龄化的社会，已经面临痴呆症流行，预计未来 20 年患病率将上升至 357%。如果不找到并应用预防措施，未来几年的负担将是难以克服的。柳叶刀痴呆症预防、干预和护理委员会的令人鼓舞的报告估计，高达 40% 的痴呆症是可以预防的。世界卫生组织 (WHO) 提出同时针对多种风险因素的降低风险策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预防认知障碍和残疾老年干预研究 (FINGER) 多模式生活方式改变试验，该试验证明干预后两年认知和健康结果有所改善。全球研究人员正在全球网络内（由研究联合 CI 领导，国际生物样本库工作由本研究 CI 领导）内采用和实施这种方法，但尚未在非洲进行。因此，我们建议开展多国合作，以促进 SSA 的脑健康：非洲手指计划。非洲手指代表了在整个撒哈拉以南非洲地区协调和实施文化背景下的多领域痴呆症风险降低干预措施的首次尝试，并将可持续发展目标嵌入到该倡议中。我们提案的总体目标是通过优化柳叶刀预防委员会确定的核心可改变风险因素的管理、世界卫生组织解决非传染性疾病的政策以及我们的团队成员的工作，减少认知障碍并促进非洲人口的健康老龄化。这些土著居民以及最重要的是土著社区成员本身。在这里，我们提出两个主要目标：A）与当地利益相关者共同设计定制的个性化多领域生活方式痴呆症风险修改方案，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适合具体情况和文化、经济上可行且可持续的解决方案。B) 通过社区范围内的实施来促进干预措施的持续有效性和可扩展性，并协调合作伙伴国家和类似人口统计中采用的方法。 AFRICA-FINGERS 是一项跨国脑健康促进计划（50 岁以上的高危成年人，n=600），设立在已建立的学术研究基础设施内，在肯尼亚和尼日利亚已经有表型队列。该项目将嵌套在 WW-FINGERS 框架内，中心枢纽位于肯尼亚内罗毕阿迦汗大学大脑与思维研究所 (BMI)。 BMI 解决了肯尼亚在精神和神经系统疾病的研究能力和干预措施方面严重且不断扩大的差距。鉴于 BMI 的愿景和价值观、其成员的多元化和相关专业知识、其位置和联系，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 AFRICA FINGERS 的中心枢纽及其主要站点。第二个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纳姆迪·阿齐基韦大学 (NAU) 老年认知和心理健康研究中心；所有这些都在进行痴呆症临床研究。在 MRC/NIHR 复杂干预框架的指导下，该合作项目将与 WW-FINGERS、达沃斯阿尔茨海默病合作组织、全球脑健康研究所、全球痴呆症预防计划、Neurovision、Oasis 合作诊断、阿尔茨海默病数据倡议和阿尔茨海默病国际。