017-20 | ARCADIA-CSI (Cognition and Silent Infarcts)

Post-stroke cognitive decline and dementia pose a significant public health problem. The risk of dementia is more than doubled after stroke, and over 2 million American stroke survivors sufferfrom dementia. Silent (or ‘covert’) infarcts are likely an important cause of cognitive decline in stroke survivors, particularly in patients at high risk for cardioembolism. This notion is supported by studies that describe a relationship between atrial fibrillation and incidentdementia, studies demonstrating that patients with cardioembolic stroke are at greatest risk of cognitive decline5, and studies showing that anti-coagulation reduces the occurrence of infarcts and cognitive decline in stroke survivors with atrial fibrillation. The evidence suggesting that silent infarcts caused by cardioembolism plays an important role in the development of post-stroke cognitive decline prompted the design of ARCADIA-CSI, anancillary study to the ARCADIA trial, that will test if treatment with apixaban is an effective strategy to prevent silent infarcts and preserve cognitive function in patients with stroke of unknown cause and atrial cardiopathy.