{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T13:30:47Z","timestamp":1773927047404,"version":"3.50.1"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2014,5]]},"abstract":"<jats:sec>\n            <jats:title>Background and Purpose\u2014<\/jats:title>\n            <jats:p>Atrial fibrillation is associated with decline of cognitive function. Observational evidence suggests that anticoagulation might protect against this decline. We report the first randomized controlled trial evidence on the effect of anticoagulation on cognitive function in elderly patients with atrial fibrillation.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods\u2014<\/jats:title>\n            <jats:p>A total of 973 patients aged \u226575 years with atrial fibrillation were recruited from primary care and randomly assigned to warfarin (n=488; target international normalized ratio, 2\u20133) or aspirin (n=485; 75 mg\/d). Neither participants nor investigators were masked to group assignment. Follow-up was for a mean of 2.7 years (SD, 1.2). Cognitive outcome was assessed using the Mini-Mental State Examination at 9-, 21-, and 33-month follow-up. Participants who had a stroke were censored from the analysis, which was by intention to treat with imputation for missing data.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results\u2014<\/jats:title>\n            <jats:p>There was no difference between mean Mini-Mental State Examination scores in people assigned to warfarin or aspirin at 9 or 21 months. At 33-month follow-up, there was a nonsignificant difference of 0.56 in favor of warfarin that decreased to 0.49 (95% confidence interval, \u20130.01 to 0.98) after imputation.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>We found no evidence that anticoagulation confers clinically important protection over aspirin against cognitive decline as measured by the Mini-Mental State Examination in atrial fibrillation in the first 33 months of treatment other than that provided by preventing clinical stroke.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Clinical Trial Registration\u2014<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.controlled-trials.com\">http:\/\/www.controlled-trials.com<\/jats:ext-link>\n              . Unique identifier: ISRCTN89345269.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.113.004009","type":"journal-article","created":{"date-parts":[[2014,4,2]],"date-time":"2014-04-02T01:42:54Z","timestamp":1396402974000},"page":"1381-1386","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":69,"title":["Warfarin Versus Aspirin for Prevention of Cognitive Decline in Atrial Fibrillation"],"prefix":"10.1161","volume":"45","author":[{"given":"Nahal","family":"Mavaddat","sequence":"first","affiliation":[{"name":"From the Primary Care Unit, Strangeways Laboratory, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom (N.M., J.M.); Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom (A.R., K.F., D.F.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); and Department of Primary Care Health Sciences, New Radcliffe House, Radcliffe Observatory Quarter, University..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Roalfe","sequence":"additional","affiliation":[{"name":"From the Primary Care Unit, Strangeways Laboratory, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom (N.M., J.M.); Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom (A.R., K.F., D.F.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); and Department of Primary Care Health Sciences, New Radcliffe House, Radcliffe Observatory Quarter, University..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kate","family":"Fletcher","sequence":"additional","affiliation":[{"name":"From the Primary Care Unit, Strangeways Laboratory, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom (N.M., J.M.); Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom (A.R., K.F., D.F.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); and Department of Primary Care Health Sciences, New Radcliffe House, Radcliffe Observatory Quarter, University..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory Y.H.","family":"Lip","sequence":"additional","affiliation":[{"name":"From the Primary Care Unit, Strangeways Laboratory, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom (N.M., J.M.); Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom (A.R., K.F., D.F.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); and Department of Primary Care Health Sciences, New Radcliffe House, Radcliffe Observatory Quarter, University..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F.D. Richard","family":"Hobbs","sequence":"additional","affiliation":[{"name":"From the Primary Care Unit, Strangeways Laboratory, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom (N.M., J.M.); Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom (A.R., K.F., D.F.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); and Department of Primary Care Health Sciences, New Radcliffe House, Radcliffe Observatory Quarter, University..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Fitzmaurice","sequence":"additional","affiliation":[{"name":"From the Primary Care Unit, Strangeways Laboratory, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom (N.M., J.M.); Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom (A.R., K.F., D.F.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); and Department of Primary Care Health Sciences, New Radcliffe House, Radcliffe Observatory Quarter, University..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Mant","sequence":"additional","affiliation":[{"name":"From the Primary Care Unit, Strangeways Laboratory, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom (N.M., J.M.); Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom (A.R., K.F., D.F.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); and Department of Primary Care Health Sciences, New Radcliffe House, Radcliffe Observatory Quarter, University..."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(09)70236-4"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e31820f2e38"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.111173"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2006.05.058"},{"key":"e_1_3_4_6_2","first-page":"143","article-title":"Atrial fibrillation and mild cognitive impairment: what correlation?","volume":"57","author":"Puccio D","year":"2009","unstructured":"Puccio D, Novo G, Baiamonte V, Nuccio A, Fazio G, Corrado E, et al.. 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