Dementia in Africa: Focus on Nigeria Dr Temitope H. Farombi Consultant Neurologist University College Hospital

Introduction The population of the world is ageing. 2045 there will be more people who are over 65 years than people under 15 years, for the first time in the history of the world. It is estimated that nearly two-thirds of the world’s population aged over 60 years are currently living in developing countries. By 2050, the population of people aged over 60 years in Africa will be about 212 million.

Introduction The ageing population in sub-saharan Africa poses and impending crisis There is dearth of expert care and research in dementia in Africa Increase prevalence on non- communicable diseases

Prevalence of Dementia Worldwide, the prevalence of dementia among those aged 60 years and above ranges 5% to 7% 7.6 million people will be living with dementia by 2050 Alzheimer’s type is the commonest followed by vascular dementia (VaD).

Prevalence of Dementia A similar trend is predicted in most countries in sub- Saharan Africa (SSA) where the proportion of elderly people is expected to rise over the coming years. However there are scarce and conflicting reports on the prevalence of dementia and its subtypes in SSA 2.6% to 7%

Prevalence of Dementia At 2015, 2.13 million people were estimated to be living with dementia in 2015 . This number will reach 3.48 million by 2030, and 7.62 million in 2050. Between 2015 and 2050, numbers in the SSA region will increase by 257%, with the most important increases in East and Central SSA.

Prevelance and studies by region

Prevalence of dementia by region

Prevalence by region These new estimates are slightly higher than those reported in the 2015 World Alzheimer Report (1.63 million in 2015, 2.65 million in 2030 and 5.66 million in 2050) This increase is driven by both population ageing and the slightly higher prevalence of dementia estimated for SSA. The African region started from a low base but will continue to experience a rapid increase in numbers.

Dementia in Nigeria In 1992, the first community study on dementia in Ibadan, Nigeria suggested that dementia is rare in Nigeria In 1993 Hospital survey reported 37 out of 57440 admitted patients had dementia 18 (48.50%) Had vascular dementia and 1 had primary neurodegenerative disease 198 post-mortem examination showed paucity of histologic markers of AD in the brain

Dementia in Nigeria In 1995 a community longitudinal study ( Inianapolis and Ibadan) reported a prevalence of 2.29%( AD= 1.41%) In Eastern Nigeria, dementia accounted for 3% of admission of all neurological conditions between 2003 and 2007 In Northern Nigeria the prevalence among the Hausa- Fulani of 322 participants was 2.79% ( 66.7% AD) In central Nigeria dementia was slightly higher (6.4%) above what was reported in Ibadan

Risk factors for dementia Age and gender: Increasing age in SSA and female gender Vascular disease : high blood pressure had increases risk of dementia, high cholesterol and peripheral vascular disease Education and literacy : low literacy level as been associated with dementia

Risk factors contd… Lifestyle & behaviour: Diet, alcohol and exercise affect the heart and brain Psychosocial: The family unit in Africa is fast falling apart due to urban migration of young adults. HIV- Dementia: Association between cognitive impairment and long term use of HAART Environment: Toxins such as copper, lead and aluminium are associated with dementia in high income countries

The issues…… Nigeria is the most populous country in Africa. The latest estimate from the National Population Commission (NPC) puts the population of Nigeria at 198 million. The Elderly population (i.e. 60 years and above) in Nigeria is about 10% of the population of Nigeria (NPC, 2018). The population of the elderly and the associated disease burden is projected to rise exponentially by 2050.

The issues…. The most prominent NCDs in SSA and Nigeria at present is cardio-vascular diseases (CVDs) and it is the major cause of both death and disability in the overall population. This pattern remains the same for the older population, where neurological disorders rank as the 5th cause of deaths and 8th cause of DALYs. Dementia emerged globally as one of the 15 leading causes of DALYs among older people in 2010 and in the oldest age groups (75 and over), Alzheimer’s and other dementias now rank as one of the top ten leading causes of disability in 2015.

The issues….. In SSA, dementias such as Alzheimer’s are still less prominent. Nonetheless they pose a considerable disease burden on the region’s older population They identify AD as causing 2.4% of DALYs and 3% of deaths in the region’s population aged 70 years and older.

The elderly in Nigeria have combination of communicable and non-communicable diseases, with an increasing shift towards the latter. Non preparation for the health care needs of the increasing elderly population Lack of education and training of human resources for geriatric health and social care Family unit disintegration Westernisation of our diet

High illiteracy level and cultural bias Paucity of funds for research and development Poor data and information system in the country

Recommendations Urgent National Frame-Work for cognitive health and dementia care and to forge sustainable and equitable systems for providing long-term care. Comprehensive cognitive programme for person’s with dementia Community based care scheme for person’s with cognitive chilling in conjunction with civil society led initiatives

Recommendations… A concerted research effort to help promote and inform a fuller consideration of dementia and other ageing and health challenges in mainstream national and regional health agendas.

“Those with dementia are still people and they still have character and they are all individual and are unique. They just need to be interacted with on a human level.” –Carey Mulligan