NAIROBI, Kenya – Dementia is rapidly becoming a significant public health concern across the globe, with projections estimating 150 million people will be affected by 2050.

“Dementia is a health, financial and social problem of almost unimaginable proportions,” said George Vradenburg, founding chairman of the board of the Davos Alzheimer’s Collaborative (DAC). “It may prove to be the sinkhole of the 21st Century.”

Sub-Saharan Africa is facing its own alarming rise, where 2.13 million people were living with dementia in 2015, a number expected to more than triple to 7.62 million by mid-century.

By 2050, Africa is expected to have the largest population of people over the age of 60. At the same time, some African countries, such as Kenya, will also have the highest number of individuals under 20.

According to Zul Merali, director of the Brain and Mind Institute at Aga Khan University, this presents not just a challenge but a significant opportunity. By studying the aging brain, dementia, and Alzheimer’s in Africa’s diverse population, researchers may gain valuable insights into risk factors and develop earlier interventions for these diseases that could help individuals worldwide.

“With 80% of the people with dementia likely to be in the Global South by 2050, it’s imperative that we bring the high-resource communities and the Global South together to solve the problem,” said Vradenburg.

More than 200 people gathered in Nairobi on Wednesday for Nature’s first-ever two-day conference on brain health and dementia in Africa, driven by the need to unite the Global North and Global South in tackling the dementia epidemic, as Vradenburg described.

The event, titled “The Future of Dementia in Africa: Advancing Global Partnerships,” brought together researchers, industry leaders, local government, policymakers, and individuals with lived experience.

The conference is focusing on key challenges, the latest research on dementia’s epidemiology, risk factors, genetic breakthroughs, clinical trials, early detection and diagnosis.

DAC and the Aga Khan University Brain and Mind Institute are co-sponsors of the event. In a joint statement with Nature, they described the event as a pivotal moment for Africa, providing an opportunity to unite efforts, exchange knowledge, and create strategies specifically designed to address the continent’s unique challenges in tackling dementia.

Merali said that Africa is largely unprepared for the spike in people with dementia.

“If you look at the world literature, you will see that most of the information comes from the Global North as it pertains to dementia and Alzheimer’s disease,” Merali explained. “The data from Africa is less than 1%, so there is a huge gap. We don’t know what’s going on or how to get ready for it.”

Which risk factors are relevant to Africa?

Many dementia risk factors have been identified in the Global North, but understanding which are most relevant in Africa is crucial, Vaibhav Narayan, executive vice president for strategy and innovation at DAC, told Health Policy Watch.

He noted two possible scenarios: the same risk factors exist in the Global North and Global South but are more prevalent in Africa, leading to a more significant impact, or some risk factors are unique to the continent.

“I would call this an emerging field,” Narayan told Health Policy Watch. “Larger and larger studies are being done.”

Narayan suggested that some risk factors, particularly climate change-related ones, could be more significant in Africa.

“What most people don’t realize is that the stressors caused by climate change are both physiological—your brain may be exposed to higher temperatures for longer, you may be breathing in pollutants—but also psychological.

The stress of impending crop failure, for example, can accelerate cognitive decline and push toward dementia,” Narayan said.

He also highlighted migration patterns, especially forced migration for work or safety, as another potential stressor unique to Africa.

Merali added that another unique risk factor in Kenya may be the many people who ride motorcycles, often without helmets. Young individuals involved in motorcycle crashes could face a higher risk of developing brain disorders, including dementia and Alzheimer’s, later in life.

“We want to ensure we understand these risk factors, their impact on brain health and cognitive decline, and, perhaps most importantly, how to reduce them,” Narayan added. “What are the interventions at the policy, individual, community, societal, and national levels? That will take time.”

Dr Chi Udeh-Momoh, a translational neuroscientist affiliated with Imperial College London, the Karolinska Institute, and Bristol University, is already focused on understanding these risk factors.

She told Health Policy Watch that her team is working on developing “normative data” to better understand the causes of dementia in the Global South, particularly in Africa, which has a vast diversity.

Udeh-Momoh is researching the molecular and biobehavioral factors contributing to resilience in African populations — how individuals cope with and adapt to extreme stress while still thriving.

Udeh-Momoh and her team’s mission goes beyond identifying the causes of dementia; they aim to detect it early using cutting-edge tools and innovative approaches. These include advanced neuroimaging, retinal imaging, digital cognitive assessments, and traditional tests like paper-and-pencil exams and brain games designed to establish a baseline for memory and cognition in the local population.

How can dementia be prevented?

A peer-reviewed article in The Lancet has revealed that up to 45% of dementia cases could be prevented by addressing a small number of key risk factors.

While the Global North has primarily focused on treating Alzheimer’s at its later stages, Africa, with its younger population, has the potential to focus on modifiable risk factors and lead the way in developing pragmatic and scalable prevention programs.

“Lifestyle changes are critically important and just as important as pharmacological or drug treatments,” Merali said.

New treatments are becoming available. The first FDA-approved drugs for Alzheimer’s, such as Leqembi for mild dementia and Kisunla for adults with early symptomatic Alzheimer’s, are now on the market. However, these medications were primarily tested in clinical trials in the Global North and are prohibitively expensive, making them inaccessible to many communities.

Narayan suggested that, instead of focusing on Alzheimer’s drugs, doctors in Africa could treat identified risk factors, such as  hypertension or obesity.

Vradenburg, meanwhile, has concentrated his efforts on developing vaccines for dementia.

“We know that the Global South is experienced in administering vaccines, which are generally low-cost,” he said, adding that if researchers can identify and diagnose those at risk of dementia in the next decade, vaccines could be available by 2030. These vaccines could even achieve widespread adoption to prevent the disease and its symptoms, he said.

Why is there a stigma around dementia in Africa?

Finally, another essential factor to consider in Africa is the stigma surrounding dementia.

Merali explained that many people in Africa do not know what dementia is. Often, they believe it is a normal part of aging, and when symptoms become more severe or unusual, some attribute them to witchcraft or evil spirits.

“As a result, individuals with dementia can become targets, frequently ostracized, and in some cases, even beaten or lynched,” Merali said. “We need to educate the population.”

He emphasized that understanding dementia as a medical condition would lead to people being treated with more compassion and respect.

Narayan echoed these concerns: “Today, many people think dementia is just a part of aging. The key to removing the stigma around not only dementia but also mental health disorders like depression is to show the world that these are actual biological diseases.”

He added that the work being done by DAC and the Aga Khan University to develop objective medical tests, such as blood or imaging tests, will help people recognize that dementia is a disease and not the individual’s fault.

Vradenburg shared a historical perspective: “I’m old enough to remember when cancer was a word no one dared to say—it was referred to as the ‘big C,’ and it took decades to move past that.”

He pointed out that over time, the medical community learned that early detection, catching cancer at stage one instead of stage four, was crucial to survival.

Vradenburg said he believes dementia is undergoing a similar transition today.

Image Credits: Pexels, Maayan Hoffman.