Toggle Main Menu Toggle Search

Open Access padlockePrints

Stroke, cerebrovascular diseases and vascular cognitive impairment in Africa

Lookup NU author(s): Dr Rufus Akinyemi, Dr Masafumi Ihara, Dr Catherine DotchinORCiD, Dr Stella Paddick, Professor Richard Walker, Professor Raj Kalaria


Full text for this publication is not currently held within this repository. Alternative links are provided below where available.


© 2018 Elsevier Inc. With increased numbers of older people a higher burden of neurological disorders worldwide is predicted. Stroke and other cerebrovascular diseases do not necessarily present with different phenotypes in Africa but their incidence is rising in tandem with the demographic change in the population. Age remains the strongest irreversible risk factor for stroke and cognitive impairment. Modifiable factors relating to vascular disease risk, diet, lifestyle, physical activity and psychosocial status play a key role in shaping the current spate of stroke related diseases in Africa. Hypertension is the strongest modifiable risk factor for stroke but is also likely associated with co-inheritance of genetic traits among Africans. Somewhat different from high-income countries, strokes attributed to cerebral small vessel disease (SVD) are higher >30% among sub-Saharan Africans. Raised blood pressure may explain most of the incidence of SVD-related strokes but there are likely other contributing factors including dyslipidaemia and diabetes in some sectors of Africa. However, atherosclerotic and cardioembolic diseases combined also appear to be common subtypes as causes of strokes. Significant proportions of cerebrovascular diseases are ascribed to various forms of infectious disease including complications of human immunodeficiency virus. Cerebral SVD leads to several clinical manifestations including gait disturbance, autonomic dysfunction and depression. Pathological processes are characterized by arteriolosclerosis, lacunar infarcts, perivascular spaces, microinfarcts and diffuse white matter changes, which can now all be detected on neuroimaging. Except for isolated cases of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy or CADASIL, hereditary arteriopathies have so far not been reported in Africa. Prevalence estimates of vascular dementia (2–3%), delayed dementia after stroke (10–20%) and vascular cognitive impairment (30–40%) do not appear to be vastly different from those in other parts of the world. However, given the current demographic transition in both urban and rural settings these figures will likely rise. Wider application of neuroimaging modalities and implementation of stroke care in Africa will enable better estimates of SVD and other subtypes of stroke. Stroke survivors with SVD type pathology are likely to have low mortality and therefore portend increased incidence of dementia.

Publication metadata

Author(s): Akinyemi RO, Owolabi MO, Ihara M, Damasceno A, Ogunniyi A, Dotchin C, Paddick S-M, Ogeng'o J, Walker R, Kalaria RN

Publication type: Article

Publication status: Published

Journal: Brain Research Bulletin

Year: 2019

Volume: 145

Pages: 97-108

Print publication date: 01/02/2019

Online publication date: 25/05/2018

Acceptance date: 22/05/2018

ISSN (print): 0361-9230

ISSN (electronic): 1873-2747

Publisher: Elsevier Inc.


DOI: 10.1016/j.brainresbull.2018.05.018


Altmetrics provided by Altmetric