Global dementia cases are rising, particularly in low- and middle-income countries with limited health-care access and scarce resources, calling for preventive strategies that align with local capital and cultural practices. The Africa-FINGERS project, an adaptation of the Finnish FINGER trial, pioneers a culturally relevant, multidomain approach to dementia risk reduction for African settings. This Perspective article explores the efficacy of multimodal lifestyle interventions in reducing risks associated with cognitive decline, addressing the unique challenges involved and examining opportunities for implementing such programmes in Africa. Drawing on preliminary insights from ongoing implementation efforts in Africa and lessons from the World Wide FINGERS global network, we describe a standardized, evidence-based precision brain health model that aims to dynamically and equitably optimize protective factors for brain health in Africa. This model is tailored to accommodate the diverse cultural, socioeconomic and logistical contexts of Africa, emphasizing culturally adapted, scalable and resource-sensitive solutions for sustainable implementation. Building on the successful execution of regional lifestyle-based interventions for other non-communicable diseases, we highlight the potential of the Africa-FINGERS programme to improve brain health and mitigate dementia risks across diverse global settings.