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One in two-stroke patients suffer dementia

Dr Rufus Olusola Akinyemi, is a physician – Scientist and a Senior Research at the Institute for Advanced Medical Research and Training, College of Medicine University of Ibadan. He is also a Consultant Neurologist to the University College Hospital, UCH. Recently, he was among the 30 young researchers from Africa selected from a pool of 700 researchers all over Africa honoured with $391,500 grants under 2019 Future Leaders – African Independent Research, FLAIRS. In this chat, with Chioma Obinna, he sheds light on his research work on stroke which is to make discoveries that can empower Africans with appropriate interventions to prevent, detect and treat stroke early. Excerpts:

My research, in a nutshell, is aimed at discovering new genes that are important and related to memory problems that develop following vascular injury. Vascular injury implies injuries like stroke because from previous research we have undertaken, we found that three months after stroke, one out of every two stroke patients did have some evidence of memory problems after a stroke.

Rufus Akinyemi, stroke
Dr Rufus Akinyemi

As we know, dementia is a growing global problem and the whole family of cognitive impairment. It is projected by the World Health Organisation, WHO, that by 2030 about 25 million people globally will be living with cognitive impairment and dementia.  The worrisome aspect of the statistics is that majority of these people are going to be from low and middle-income countries including countries in Africa and as we know Nigeria is the most populous country in the continent.

So Nigeria is going to be hit by these epidemics that are growing.  This is why we are racing up our research efforts to make discoveries that can empower us with appropriate interventions that we can use to detect the problem early, diagnose and treat, monitor and prevent.

As you know most diseases that afflict humans are a product of interactions between nature and nature. In other words, there are genetic factors and non-genetic factors.

Now, from our previous genetic studies on genetic risk factors for stroke in Africans, we discovered an association between a particular gene and small vessels type of stroke in Africans and this is helping us. There are other genes that we discover but now we are beginning to unravel the genetic architecture of stroke. We are beginning to understand why and how Africans develop stroke. Why the outcome and severity of a stroke is different from what we see in Caucasians. So this sort of knowledge will empower us with relevant information that we can use to design appropriate intervention strategies to mitigate the impact and the burden of stroke.  So we are using the same approach to look at memory problems that are of vascular origin. Specifically, we are looking at people who have survived a stroke. Those who survived we are going to have data on them and with this data of memory functions we are going to classify them into those who have memory problems and those who don’t have memory problems.

Now because we already have information on their genetic make-up through the high current state of the art technology to analyse the genes of about 3,800 individuals of indigenous African ancestry.

We are going to look at those factors in their genes that could make some to develop memory problems while some don’t.   We want to know what separates the sheep from the goat.  So when we have this information we will be able to do additional studies to look at the mechanism and when we know the mechanism we will then know how to intervene to design strategies that can mitigate these mechanistic processes so that we can possibly prevent or reduce the progression of people having a stroke and then going on to develop memory problems that will lead to dementia.

Apart from looking at the genetic factors, we are also going to examine the known genetic factors like lifestyle factors, demographic factors, age, the presence of risk factors like high blood pressures etc.  But most important is how they interact with genetic factors.

Our goal is to decipher genetic factors and when we do this, we will be able to do research to understand the function of these genes. How this gene is functioning that leads on to stroke and dementia, when we understand the pathways and red flashpoints we will know how to develop interventions.

In my previous research, we discovered that individuals who ate a lot of fish before they had a stroke were protected from memory complications than those who ate less fish.

In our stroke research too, we have discovered that the intake of green  vegetables protects against stroke. We also found that physical exercise also protects against stroke and memory problems after a stroke.    These are very important information people need to know. For instance, we need to encourage the intake of green vegetables.  It is cheap and everybody can grow it.  It has a lot of nutrients and resources that can help protect against stroke and dementia after stroke. In some research we have done before, it was found that excessive intake of meat was a risk factor for stroke, meaning that a simple lifestyle of reducing intake of meat and improving intake of vegetables has a protective effect against stroke.  So we are going to be examining whether the protective effect is going to demonstrate against memory problem after stroke.   We are grateful to the Royal Society and the Africa Academy of Science for coming up with FLAIRS.   We are grateful because it has given us the opportunity to pursue some research questions that have bordered our minds for some years.

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Although this grant is only for two years it is our hope that we will undertake this research rigorously with integrity and excellence and generate some output that will enable us to obtain additional funding for the next three years.

We have usually depended on exporting our data to the Western countries to analyse. For this research,  we are going to develop infrastructure at the College of Medicine, the University of Ibadan to do an analysis of genomic data. We are building a bioinformatics laboratory in Ibadan.

We are going to train students in Ibadan and also send them abroad so that they will have the capacity to do this analysis domesticated on Nigerian soil.  That has implications for reducing unemployed graduates in the job market.    This will help us build more capacity for research, help pharmaceutical companies produce more drugs for different ailments. Science communicators will have a lot to write to educate the public. We need to educate the community.

Funding for health and research in Nigeria is still very low. For instance, the budget for health is less than 5 per cent compare to the WHO recommendation of about 20 per cent.  It may not be completely negative, we appreciate the establishment of the TETFUND for funding of researches in universities but we want the government to increase allocation to TETFUND which is a form of research fund so that we can really do research that can answer questions that are relevant to our priorities as a nation. The challenge is that many of the foreign-funded projects are that your research must be tailored to the priorities of the funders but we need funding from our national government so that we can do research on priority areas that are important to us as a country.

We are encouraging the government to put money into research. For instance, Nigeria has the National Institute of Research, in Ibadan we have Institute of medical research and training, and government can make provisions for these research institutes so that we can target research questions of national relevance. I want to tell young researchers not to be discouraged because of lack of funding but to have a clear purpose, research questions, pursue it with passion it may not bring financial gains immediately but as you are solving problems of humanity the joy that comes with it cannot be quantified.   When you do research that is impactful, a time will come when your work will attract attention. If you do not persevere your work will never get recognised.

I will like to end with a quote by the late Prof, Benjamin Oshitokun that by the grace and power of God I will continue to pursue excellence in research because success alone is not sufficient but it is excellence that counts and it is what will put your name in the footprints of time.

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