Episodes of Fall Asleep During Day Time in an Elder Woman with Vascular Dementia: Impact on Cerebral Ischeamic Tolerance and Utility of ECG Holter Monitoring

Michele M Ciulla 1 , 2 , *, Giulia Acquistapace 1, Roberta Paliotti1, Chiara Benfenati 1, Fabio Magrini1
1 Department of Respiratory and Cardiovascular Disease, Laboratory of Clinical Informatics and Cardiovascular Imaging, University of Milan, Milan, Italy; Fondazione IRCCS Ca’ Granda, Ospedale MAggiore Policlinico, Milan, Italy
2 Istituti Clinici di Perfezionamento, Poliambulatori, ECG Holter Monitoring Service

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© Ciulla et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Respiratory and Cardiovascular Disease, University of Milan, via F.Sforza, 35 - Milan, 20122 Italy; Tel: +39.0255033592; Fax: +39.0250320480; E-mail:


Here we report the case of an 86-year-old woman with advanced dementia addressed to our service for routinary ECG Holter Monitoring (EHM) for bradycardia in AV block type I. Several day-time episodes of fall-asleep while sitting had been previously reported by the nurse and generally attributed to the dementia itself, without taking into consideration the hypothesis of an AV block. The EHM reading reported several and often subsequent pauses (561), many of them critical, the longest lasting 15,9 s with no changes in clinical condition of the patient. The results of the EHM were reported to the physicians in charge for the patient and subsequently the woman was referred to the arrhythmology unit for pace-maker device implantation. Generalizing our experience, we suggest that advanced dementia, often associated with episodes of fall-asleep, could mask a conduction disturbance causing critical pauses with syncope; therefore we suggest screening those patients for possible arrhythmic disorders. Finally, we remark that in our patient the pauses weren’t associated with a worsening of the patient as seen in the follow-up, and this fact supports the hypothesis that vascular dementia could increase cerebral ischaemic tolerance.

Keywords: ECG Holter Monitoring, advanced dementia, total AV block, long ECG pauses, cerebral ischaemic preconditioning and tolerance..