{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T22:29:48Z","timestamp":1793831388281,"version":"4.6.1"},"reference-count":48,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"18","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,9,16]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">ARCADIA (Atrial Cardiopathy and Antithrombotic Drugs in Prevention After Cryptogenic Stroke), a secondary stroke prevention study comparing apixaban versus aspirin for cryptogenic stroke and biomarkers of atrial cardiopathy, ended prematurely for futility. In the ARCADIA\u2010Cognition study we hypothesized that cognitive decline would be slower in the apixaban arm due to less microembolization.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              ARCADIA subjects on study drug and eligible for magnetic resonance imaging participated in ARCADIA\u2010CSI (ARCADIA\u2010Cognition and Silent Infarction). Cognitive tests were administered centrally by telephone \u22653 months after the ARCADIA index stroke and yearly thereafter. Composite\n              <jats:italic toggle=\"no\">Z<\/jats:italic>\n              scores were the means of 5 standardized cognitive tests. Trajectories of the composite\n              <jats:italic toggle=\"no\">Z<\/jats:italic>\n              score and the individual test scores were compared between treatment arms using a mixed\u2010effects model.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Of 799 screened patients at 75 sites, 310 were enrolled in ARCADIA\u2010CSI. Of these, 296 completed at least 1 cognitive exam, and 47 subjects were excluded from the primary analysis for baseline dementia. For the 249 subjects included in the analysis, there were 582 cognitive assessments. Baseline characteristics were balanced between the apixaban (n=128) and aspirin (n=121) arms. Mean age was 68 (SD: 10.4) years, median modified Rankin Scale score 1 (interquartile range, 0\u20132), 52% female, and 19% Black. During median follow\u2010up of 378 (interquartile range, 183\u2013735) days, the annual change in the overall standardized composite score was 0.084 (95% CI, 0.017\u20130.149) in the aspirin arm and 0.107 (95% CI, 0.041\u20130.174) in the apixaban arm (\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              =0.62).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Cognitive trajectories did not differ between apixaban and aspirin. Further studies should address infarct location and volume and concurrent pathology to determine optimal treatment to mitigate cognitive decline with atrial disease.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Registration<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/clinicaltrials.gov\">http:\/\/clinicaltrials.gov<\/jats:ext-link>\n              ; Unique Identifier: NCT03192215.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.125.042147","type":"journal-article","created":{"date-parts":[[2025,8,23]],"date-time":"2025-08-23T05:47:48Z","timestamp":1755928068000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Apixaban Versus Aspirin to Reduce Cognitive Decline After Cryptogenic Stroke and Atrial Cardiopathy: ARCADIA\u2010Cognition Study"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7388-042X","authenticated-orcid":false,"given":"Ronald M.","family":"Lazar","sequence":"first","affiliation":[{"name":"University of Alabama at Birmingham","place":["Birmingham, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3068-5720","authenticated-orcid":false,"given":"George","family":"Howard","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham","place":["Birmingham, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7296-4035","authenticated-orcid":false,"given":"Michael T.","family":"Brewer","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham","place":["Birmingham, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0304-9833","authenticated-orcid":false,"given":"Christy","family":"Cassarly","sequence":"additional","affiliation":[{"name":"Medical University of South Carolina","place":["Charleston, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6612-698X","authenticated-orcid":false,"given":"Qi","family":"Pauls","sequence":"additional","affiliation":[{"name":"Medical University of South Carolina","place":["Charleston, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Kemp","sequence":"additional","affiliation":[{"name":"Stanford Stroke Center","place":["Palo Alto, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8059-2901","authenticated-orcid":false,"given":"David L.","family":"Tirschwell","sequence":"additional","affiliation":[{"name":"University of Washington, School of Medicine","place":["Seattle, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2003-5473","authenticated-orcid":false,"given":"Kevin N.","family":"Sheth","sequence":"additional","affiliation":[{"name":"Center for Brain & Mind Health, Yale School of Medicine","place":["New Haven, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6726-3951","authenticated-orcid":false,"given":"Max","family":"Wintermark","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center","place":["Houston, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5745-0307","authenticated-orcid":false,"given":"Hooman","family":"Kamel","sequence":"additional","affiliation":[{"name":"Weill Cornell Medicine","place":["New York, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. 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