Dementia in Africa: Preventive Strategies
Dementia is a term that describes a group of symptoms affecting memory, thinking and social abilities severely enough to interfere with daily functioning. It is caused by various diseases and disorders that affect the brain, such as Alzheimer’s disease, vascular dementia, Lewy body dementia and frontotemporal dementia. Dementia is more common in older people, but it is not a normal part of aging.
According to Alzheimer’s Disease International (ADI), dementia affects about 2.3 million people in sub-Saharan Africa (SSA) and is expected to increase by 250 percent to 7.6 million by 2050. This poses a major challenge for the region, which has limited resources and capacity to provide adequate care and support for people living with dementia and their families. Moreover, dementia has significant economic and social impacts, costing the region an estimated $6.2 billion each year.
Therefore, there is an urgent need to identify and address the risk factors for dementia in SSA and to develop effective preventive strategies that can reduce the burden of the disease. This paper will review the current evidence on the dominant and modifiable risk factors for dementia in SSA and suggest some possible interventions that can be implemented at individual and population levels.
Dominant Risk Factors for Dementia in SSA
The dominant risk factors for dementia are those that are not easily changed or controlled by individuals or interventions. They include age, gender, genetics and ethnicity.
Age: Age is the strongest risk factor for dementia, as the prevalence and incidence of the disease increase exponentially with advancing age. The aging of the population in SSA is driven by improved life expectancy, reduced fertility rates and decreased mortality from infectious diseases. However, this also means that more people will be exposed to the risk of developing dementia as they grow older.
Gender: Women are more likely to develop dementia than men, especially Alzheimer’s disease. This may be due to biological factors, such as hormonal changes during menopause, or social factors, such as lower educational attainment, lower socioeconomic status and higher caregiving burden among women in SSA.
Genetics: Genetics play a role in the development of some forms of dementia, such as early-onset Alzheimer’s disease (EOAD), which occurs before the age of 65 and is caused by mutations in specific genes. However, EOAD is rare and accounts for less than 5 percent of all cases of Alzheimer’s disease. Most cases of dementia are late-onset, which occur after the age of 65 and are influenced by a combination of genetic and environmental factors.
Ethnicity: Ethnicity may affect the risk of dementia through genetic variations, cultural practices, lifestyle factors and access to health care. For example, some studies have found that people of African origin have a lower risk of dementia than people of European origin, possibly due to protective genetic variants or environmental exposures. However, this may change as people migrate and adopt different lifestyles and behaviors.
Modifiable Risk Factors for Dementia in SSA
The modifiable risk factors for dementia are those that can be changed or controlled by individuals or interventions. They include education, cognitive function, vascular health, lifestyle behaviors and psychosocial factors.
Education: Education is one of the most important modifiable risk factors for dementia, as it has been consistently associated with a lower risk of the disease across different settings and populations. Education may protect against dementia by enhancing cognitive reserve, which is the ability of the brain to cope with damage or decline by using alternative neural pathways or strategies. Education may also improve health literacy, access to information and health care services, and adherence to preventive measures.
Cognitive function: Cognitive function refers to mental processes such as memory, attention, language, reasoning and problem-solving. Cognitive impairment is a common feature of dementia, but it can also precede the onset of the disease by several years. Therefore, detecting and treating cognitive impairment early may delay or prevent the progression to dementia. Cognitive function can be assessed by various tests and tools that measure different domains and levels of cognition.
Vascular health: Vascular health refers to the health of the blood vessels that supply oxygen and nutrients to the brain. Vascular diseases such as hypertension, diabetes, stroke, heart disease and high cholesterol can damage the blood vessels and impair blood flow to the brain, leading to cognitive decline and dementia. Vascular health can be improved by controlling blood pressure, blood sugar and blood lipids, preventing and treating cardiovascular events, and taking medications as prescribed.
Lifestyle behaviors: Lifestyle behaviors such as diet, physical activity, smoking and alcohol consumption can affect the risk of dementia through their effects on vascular health, inflammation, oxidative stress and neurogenesis. A healthy diet that is rich in fruits,
