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We wish to thank Dr Cohen for his interest in our article entitled "Improved Cognition After Control of Risk Factors for Multi-infarct Dementia." We agree that multiple bilateral cerebral embolism from cardiac disease with dysrhythmia may be a cause of MID, but it is relatively rare (2% in our series of patients). Such cases due to cardiac emboli are being investigated in our ongoing prospective studies of stroke and MID. In the series of patients we described in our article, cases of MID due to cardiac emboli were excluded. Only two of the most common forms of MID were considered in our article, those due to multiple lacunar infarctions and to watershed cerebral infarcts associated with occlusive disease of the carotid arteries. We agree that heart disease is an important risk factor associated with stroke and MID. We also agree that treatment of heart disease and cardiac dysrhythmias
Meyer JS, Rogers RL, Mortel KF. Multi-infarct Dementia-Reply. JAMA. 1987;257(8):1049. doi:10.1001/jama.1987.03390080038016