To the Editor.—
The article by Meyer et al1 on the natural history of multi-infarct dementia (MID) and its reversibility with control of certain risk factors represents a major contribution to the study of dementia. However, it is surprising that the authors have not noted another potentially important risk factor—the high incidence of supraventricular arrhythmias in MID—or commented on the possibility that many strokes among patients with MID may be caused by arrhythmia-induced embolism rather than thrombosis.The high incidence of heart disease and arrhythmias in patients with MID has been noted before,2 and I have found a 59% incidence of major supraventricular arrhythmias in 27 consecutive patients with dementia. Forty-four percent had sick sinus syndrome, including three with paroxysmal atrial fibrillation as part of a bradycardia-tachycardia variant of sick sinus syndrome. Four more had paroxysmal or fixed atrial fibrillation as a primary arrhythmic disorder. (Twenty-six percent of
Herbert Emmanuel Cohen. Multi-infarct Dementia. JAMA. 1987;257(8):1048. doi:10.1001/jama.1987.03390080038014
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