Dementia in Africa: Current evidence, knowledge gaps, and future directions

Akinyemi, Rufus; Yaria, Joseph; Ojagbemi, Akin; Guerchet, Maëlenn; Okubadejo, Njideka; Njamnshi, Alfred K.; Sarfo, Fred Stephen; Akpalu, Albert; Ogbole, Godwin; Ayantayo, Temitayo; Adokonou, Thierry; Paddick, Stella‐Maria; Ndetei, David M.; Bosche, Judith; Ayele, Biniyam A.; Andrea, Damas; Coker, Motunrayo; Mbakile‐Mahlanza, Lingani; Ranchod, Kirti; Bobrow, Kirsten; Anazodo, Udunna; Damasceno, Albertino; Seshadri, Sudha; Pericak‐Vance, Margaret A.; Lawlor, Brian A.; Miller, Bruce L.; Owolabi, Mayowa; Baiyewu, Olusegun; Walker, Richard; Gureje, Oye; Kalaria, Rajesh N.; Ogunniyi, Adesola

doi:10.1002/alz.12432

Cited by 73 publications

(127 citation statements)

References 184 publications

(374 reference statements)

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“…A small fraction of familial cases, including Down syndrome patients ( 51 ), have been useful to understand pathological mechanisms and to identify heritable risk factors, although in the majority of patients, AD manifests in a sporadic form. In Africa, while there are several cases of FAD (Familial Alzheimer’s Disease), most published reports indicate the majority of AD is late-onset (LOAD) in nature ( 52 ). A review of multiple articles that included population based studies from Burkina Faso, Cameroon, Ghana, Republic of Congo, Benin Republic, Kenya, Senegal, South Africa, Central African Republic, Tanzania, and Nigeria indicates that age-adjusted prevalence of dementia varied widely ranging from 2.29% (AD 1.41%) in Nigeria-Yoruba, to 21.6% (AD prevalence not reported) in the rural Hai district of Tanzania ( 53 ).…”

Section: Alzheimer’s Disease and Neuroinflammationmentioning

confidence: 99%

Non-Communicable Neurological Disorders and Neuroinflammation

et al. 2022

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Traumatic brain injury, stroke, and neurodegenerative diseases represent a major cause of morbidity and mortality in Africa, as in the rest of the world. Traumatic brain and spinal cord injuries specifically represent a leading cause of disability in the younger population. Stroke and neurodegenerative disorders predominantly target the elderly and are a major concern in Africa, since their rate of increase among the ageing is the fastest in the world. Neuroimmunology is usually not associated with non-communicable neurological disorders, as the role of neuroinflammation is not often considered when evaluating their cause and pathogenesis. However, substantial evidence indicates that neuroinflammation is extremely relevant in determining the consequences of non-communicable neurological disorders, both for its protective abilities as well as for its destructive capacity. We review here current knowledge on the contribution of neuroinflammation and neuroimmunology to the pathogenesis of traumatic injuries, stroke and neurodegenerative diseases, with a particular focus on problems that are already a major issue in Africa, like traumatic brain injury, and on emerging disorders such as dementias.

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Section: Alzheimer’s Disease and Neuroinflammationmentioning

confidence: 99%

Non-Communicable Neurological Disorders and Neuroinflammation

et al. 2022

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“…MRI is the recommended standard of care in the diagnosis and treatment of neurological diseases, including but not limited to seizures 15 , strokes 16,17 and dementia 18 . MRI can help determine seizure etiology in epilepsy management 15 , while in stroke imaging where recent evidence suggests that the incidence and prevalence of stroke in Africa has grown to 2-3 times that in Western Europe and the USA 19 , MRI can aid assessment of tissue perfusion, vascular flow, and treatment response in acute and subsequent phases of stroke 16 . Of note, the high prevalence of sickle cell disease in SSA makes neuroimaging particularly important due to the cerebrovascular implications of the disorder.…”

Section: Introductionmentioning

confidence: 99%

A Framework for Advancing Sustainable MRI Access in Africa

Anazodo

Ehiogu

et al. 2022

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MRI technology has profoundly transformed current healthcare and research systems globally. The rapidly growing burden of non-communicable diseases in Africa has underscored the importance of improving access to MRI equipment as well as training and research opportunities on the continent. The Consortium for Advancement of MRI Education & Research in Africa (CAMERA) is a network of African experts, global partners, and ISMRM/ESMRMB members implementing novel strategies to advance MRI access and research in Africa. To identify challenges to MRI usage and provide a framework for addressing MRI needs in the region, CAMERA conducted a Needs Assessment Survey (NAS) and a series of symposia at international MRI society meetings over a 2-year period. The 68-question NAS was distributed to MRI users in Africa and completed by 157 clinicians and scientists from across Sub-Saharan Africa (SSA). On average, the number of MRI scanners per million people remained at <1, of which, 39% were obsolete low-field systems yet still in use to meet clinical needs. The feasibility of coupling stable energy supplies from various sources has contributed to the growing number of higher-field (1.5T) MRI scanners in the region. However, these systems are underutilized with only 8% of facilities reporting clinical scans of 15 or more patients daily per scanner. The most frequently reported MRI scans were neurological and musculoskeletal. Our NAS combined with the World Health Organization and International Atomic Energy Agency data provides the most up-to-date data on MRI density in Africa and offers unique insight into Africa's MRI needs. Reported gaps in training, maintenance, and research capacity indicate ongoing challenges in providing sustainable high-value MRI access in SSA. Findings from the NAS and focused discussions at ISMRM and ESMRMB provided the basis for the framework presented here for advancing MRI capacity in SSA.

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“…Data are lacking on dementia in sub-Saharan Africa, and epidemiological research has been prioritised by the World Health Organization (WHO) and the African Dementia Consortium. [3,4] The relative importance of the dementia subtypes in sub-Saharan Africa may differ to that in more intensively studied global areas due to a different risk factor landscape, such as a high incidence of stroke, [5] but lower rates of smoking, obesity, and sedentary lifestyles. [6] Additionally, a large cohort of people living with HIV are now approaching older age in sub-Saharan Africa, thanks to widely available antiretroviral therapy (ART).…”

Section: Introductionmentioning

confidence: 99%

“…[8,9] Most of the insights into dementia risk factors in Africa are derived from cross-sectional studies. [3] Yet without capturing longitudinal change in cognition over time, interpreting associations is limited by reverse causality, misclassification of people with long-term static low cognition scores, and survival bias through under-estimating dementia incidence due to differentially higher mortality. Dementia is a risk factor for death across many contexts, [10] but there are no data from Uganda, and little from other African research sites.…”

Section: Introductionmentioning

confidence: 99%

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Longitudinal change in cognition in older adults in Uganda: a prospective population study

Prynn

Davey

Davis

et al. 2022

Preprint

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Introduction Dementia is an important and growing issue in sub-Saharan Africa, but epidemiological data are lacking. Risk factors may differ from other regions due to high stroke incidence and HIV prevalence. Understanding the epidemiology of cognition in older adults in Africa is crucial for informing public health strategies to improve the lives of people with dementia and their carers. Methods The Wellbeing of Older People Study in Uganda is an open cohort of adults aged 50+ with and without HIV, established in 2009. Detailed socio-demographic and health data have been collected at four waves spanning 10 years, including cognitive assessment using internationally validated WHO-recommended tests: verbal recall, digit span, and verbal fluency. Mortality data was collected until the end of the fourth wave (2019). We examined associations of low baseline cognition scores and cognitive decline over time, care needs of people with lower cognition, and the relationship between cognition and mortality. Results Data were collected on 811 participants. Older age, lower educational attainment, lower socio-economic position, and extremes of BMI were associated with lower cognition scores. Cognition declined faster at older ages, but rate of decline was not associated with cardiovascular disease or HIV. People with lower cognition required more assistance with Activities of Daily Living, but mortality rates were similar across the range of cognition. Conclusions The crucial next step will be investigating the determinants of low cognition scores and clinical dementia, to better understand the clinical relevance of these findings to inform public health planning in sub-Saharan Africa.

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Dementia in Africa: Current evidence, knowledge gaps, and future directions

Cited by 73 publications

References 184 publications

Non-Communicable Neurological Disorders and Neuroinflammation

Non-Communicable Neurological Disorders and Neuroinflammation

A Framework for Advancing Sustainable MRI Access in Africa

Longitudinal change in cognition in older adults in Uganda: a prospective population study

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