ABSTRACT NUMBER: ESOC2026A1697 ROLE OF INCIDENT COVERT BRAIN INFARCTS IN COGNITIVE CHANGE AFTER STROKE: AN ANCILLARY STUDY OF THE ARCADIA RANDOMIZED CLINICAL TRIAL

Abstract Background and aims Cognitive decline is common after stroke. Covert (silent) brain infarcts may contribute to post-stroke cognitive decline and dementia. The objective of this investigation was to assess whether incident lacunar and non-lacunar covert infarction were associated with accelerated cognitive decline after stroke. Methods ARCADIA was a multicenter trial comparing apixaban versus aspirin for secondary stroke prevention in patients with cryptogenic stroke and atrial cardiopathy. Patients able to undergo MRI, provide self-consent in English, and with a National Institutes of Health Stroke Scale language score of 0–1 were invited to an ancillary study with cognitive and radiographic endpoints. In a post hoc analysis of patients without baseline dementia who completed at least one cognitive assessment and both baseline and end-of-study MRIs, mean annual cognitive change was compared between those with and without incident covert infarcts using linear mixed models. Results Baseline characteristics were balanced between patients with incident covert infarction (n=35) and those without (n=113). Annual change in the overall standardized cognitive composite score was 0.13 (95% CI, 0.01–0.25) in those with covert infarcts and 0.13 (95% CI, 0.06–0.19) in those without (P=0.95). No differences were observed in learning, attention, or memory. There was a trend toward smaller improvements in executive function among patients with incident covert infarcts compared to those without (0.01 [−0.11, 0.13] vs 0.15 [0.08, 0.22], P=0.06). Conclusions Incident covert infarcts were not associated with greater global cognitive decline but may be associated with reduced improvement in executive function, suggesting greater vulnerability of this domain to covert infarction. Conflict of interest Ling Yan: nothing to disclose; Hui Chen: nothing to disclose; George Howard: nothing to disclose; Qi Pauls: nothing to disclose; Stephanie Kemp: nothing to disclose; Eric E Smith: nothing to disclose; Kevin N Sheth: nothing to disclose; Joseph P Broderick: nothing to disclose; Max Wintermark: nothing to disclose; Ronald M Lazar: nothing to disclose; Maarten G Lansberg: nothing to disclose; Christy Cassarly: nothing to disclose; David L Tirschwell, Hooman Kamel, William T Longstreth Jr, and Mitchell S V Elkind: The ARCADIA trial received the study drug from the Bristol Myers Squibb–Pfizer Alliance for Eliquis and ancillary study support from Roche Diagnostics.