# ARCADIA CSI (Cognition and Silent Infarcts)

> **NIH NIH U01** · STANFORD UNIVERSITY · 2023 · $208,562

## Abstract

Project Summary:
Cognitive decline and dementia after stroke is a major public health problem, with risk of dementia more
than doubling after stroke and affecting more the 2 million people in the United States alone. Yet, there
are no effective treatments to prevent cognitive decline and dementia after stroke. Silent brain infarction
has been associated with cognitive decline, especially among those at high risk for cardio-embolism. It is
therefore likely that treatments that reduce the incidence of silent infarcts in stroke patients at high risk for
cardio-embolism, will also reduce the rate of cognitive decline and dementia. To test this, we propose to
conduct an ancillary study to the NINDS-sponsored ARCADIA trial. ARCADIA compares treatment with
apixaban versus aspirin to prevent a recurrent clinical stroke in patients with cryptogenic stroke and left
atrial cardiopathy. We are taking advantage of the parent trial to address the possibility that apixaban might
also reduce the incidence of silent infarction and be associated with better cognitive function over time
compared to aspirin. We will enroll 500 patients from the 1,100 that will participate in ARCADIA. Patients
who participate in the ancillary study (ARCADIA-CSI) will receive cognitive assessments at baseline and
yearly thereafter using a telephone-based cognitive battery. We will test the hypothesis that the slope of
change in cognitive function is less steep in patients on apixaban compared to patients on aspirin therapy.
We will also collect an initial MRI around the time of the qualifying stroke and a follow-up MRI at the time
that the subject completes participation in the ARCADIA parent study. Based on these two MRI scans we
will assess the incidence of new silent infarcts during the follow-up period and test the hypothesis that
apixaban treatment results in a reduction of the percentage of patients with silent infarcts compared to
aspirin therapy. An explorative analysis will also look for the relationship between new silent infarcts and
cognitive change. Our project will be among the first to determine prospectively the impact of silent
infarction on cognitive function. And, if cognitive decline can be ameliorated by apixaban, then we will have
established the first ever treatment for the prevention of post-stroke cognitive decline.

## Key facts

- **NIH application ID:** 10450768
- **Project number:** 5U01NS110728-04
- **Recipient organization:** STANFORD UNIVERSITY
- **Principal Investigator:** MAARTEN G LANSBERG
- **Activity code:** U01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $208,562
- **Award type:** 5
- **Project period:** 2019-07-01 → 2024-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10450768

## Citation

> US National Institutes of Health, RePORTER application 10450768, ARCADIA CSI (Cognition and Silent Infarcts) (5U01NS110728-04). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10450768. Licensed CC0.

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