Ishaq Oyeshina Sanusi¹, Tejiri Great Napoleon, Bachelor of Medicine and Bachelor of Surgery², Deborah Akinride¹, Emmanuela Ojoagefu Egwu³, Ogheneakpobor Ogbodu⁴, Emmanuel Kodizuru Chukwuemeka¹, Ojo Israel Ifeoluwa¹, Elete Shola Tabitha⁵, Eleyinmi Oluwafunmilayo Dorcas⁶, Ogunmekan Precious Anuoluwapo⁷, Ucheobi Nonso Christopher⁸, Olaniran Oluwatosin Emmanuel¹, Ogban Nsenanzama Eko⁹, Chioma Nnedinma Duru¹⁰, Ehiwogwu Victoria Ifeoma¹¹.
¹College of Medicine, University Of Ibadan, Ibadan, Nigeria, ²Federal Medical Centre, Abeoukuta, Ogun State, Abeoukuta, Nigeria, ³Department of Medicine and Surgery, Bowen University Iwo, Osun, Nigeria, Iwo, Nigeria, ⁴Delta State University Teaching Hospital, Oghara, Oghara, Nigeria, ⁵Grodno State Medical University, Belarus., Grodno, Belarus, ⁶Sofia University 'St. Kliment Ohridski faculty of Medicine, Sofia, Bulgaria., Sofia, Bulgaria, ⁷Afe Babalola University, Ekiti state, Ekiti, Nigeria, ⁸Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, Anamebra state., Awka, Nigeria, ⁹University of Calabar Teaching Hospital., Calabar, Nigeria, ¹⁰Gregory University Uturu, Abia State, Abia, Nigeria, ¹¹Delta state University Teaching Hospital, Oghara, Oghara, Nigeria.

Abstract:
Background: Despite Africa's rapidly ageing demographic, Alzheimer’s disease (AD) epidemiology and structural care deficits remain poorly characterized, severely limiting global biomarker validation and clinical trial generalizability This study presents a pooled synthesis, triangulating historically fragmented multicountry prevalence data with recent specialist workforce registry updates, to urgently quantify the continent’s escalating diagnostic and care crisis.
Methods: We conducted a systematic epidemiological and health-systems synthesis mapping pan-African diagnostic infrastructure and specialist density. Baseline prevalence trajectories were anchored to George-Carey et al.’s systematic analysis and projected forward. Geographic disparities were modelled using multisite data from Guerchet et al. across Central and West Africa. Specialist workforce constraints were quantified utilizing World Congress of Neurology registry metrics, while caregiving economic impact assessments were derived from Alzheimer’s Disease International parameters.
Results: Harmonized analyses indicate 2.76 million Africans (2.4% prevalence) currently live with AD, with the sub-Saharan burden (2.1 million) projected to quadruple to 8 million by 2050. Pronounced geographic inequities persist; based on seminal regional cohorts, urban AD prevalence (6.0-7.6%) significantly exceeds rural estimates (2.0-3.7%), largely reflecting disparities in diagnostic accessibility. Workforce mapping exposes a critical bottleneck: Africa averages an abysmal 0.12 neurologists per 100,000 population, compared to 7.12 in high-income nations. Furthermore, hospital-based research in West Africa reveals vascular dementia accounts for 20-30% of cognitive presentations, which remain phenotypically inseparable from AD without accessible fluid or imaging biomarkers. Consequently, informal family caregivers absorb over 70% of the societal dementia economic burden.
Conclusion: Triangulating foundational epidemiological estimates with updated workforce mapping demonstrates that centralized, specialist-dependent AD care is structurally unviable in Africa. Addressing this public health crisis demands the rapid implementation of culturally agnostic diagnostics and decentralized care models utilizing task-shifting via the WHO mhGAP framework. For global trial readiness, establishing pan-African diagnostic infrastructure is a critical, immediate mandate.