Letter by Riba-Llena et al Regarding Article, “Not Listened or Not Reported Rather Than Silent Stroke”

To the Editor:We read with great interest the article by Saini et al1 about the presence of incidental brain infarcts on diffusion-weighted imaging in a dementia research study and how these infarcts were not truly asymptomatic or silent but related to the lack of awareness of stroke-like symptoms in the elderly and their families.We are conducting an observational prospective study in 1039 hypertensive participants 50 to 70 years of age to determine the prevalence of silent or magnetic resonance imaging (MRI)–defined brain infarcts and cognitive impairment. Patients are excluded when they have a previous diagnosis of stroke or whenever they report previous stroke-like symptoms assessed by the Stroke Symptom Questionnaire.2 Also, demented patients determined by a clinical interview and a screening test (Dementia Rating Scale-2) are excluded. All participants undergo a brain MRI for which brain infarcts are defined as lesions ≥3 mm in their widest dimension, …