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Effect of Donepezil on Wernicke Aphasia After Bilateral Middle Cerebral Artery Infarction: Subtraction Analysis of Brain F-18 Fluorodeoxyglucose Positron Emission Tomographic Images

Yoon, Seo Yeon MD*; Kim, Je-Kyung MD*; An, Young-sil MD, PhD; Kim, Yong Wook MD, PhD*

doi: 10.1097/WNF.0000000000000089
Case Reports

Aphasia is one of the most common neurologic deficits occurring after stroke. Although the speech-language therapy is a mainstream option for poststroke aphasia, pharmacotherapy is recently being tried to modulate different neurotransmitter systems. However, the efficacy of those treatments is still controversial. We present a case of a 53-year-old female patient with Wernicke aphasia, after the old infarction in the territory of left middle cerebral artery for 8 years and the recent infarction in the right middle cerebral artery for 4 months. On the initial evaluation, the Aphasia Quotient in Korean version of the Western Aphasia Battery was 25.6 of 100. Baseline brain F-18 fluorodeoxyglucose positron emission tomographic images demonstrated a decreased cerebral metabolism in the left temporoparietal area and right temporal lobe. Donepezil hydrochloride, a reversible acetylcholinesterase inhibitor, was orally administered 5 mg/d for 6 weeks after the initial evaluation and was increased to 10 mg/d for the following 6 weeks. After the donepezil treatment, the patient showed improvement in language function, scoring 51.0 of 100 on Aphasia Quotient. A subtraction analysis of the brain F-18 fluorodeoxyglucose positron emission tomographic images after donepezil medication demonstrated increased uptake in both middle temporal gyri, extended to the occipital area and the left cerebellum. Thus, we suggest that donepezil can be an effective therapeutic choice for the treatment of Wernicke aphasia.

*Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul; and †Department of Nuclear Medicine, Ajou University School of Medicine, Suwon, Republic of Korea.

Address correspondence and reprint requests to Yong Wook Kim, MD, PhD, Department of Rehabilitation Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul 120-752, Republic of Korea; E-mail:

Conflicts of Interest and Source of Funding: The authors have no conflicts of interest to declare.

This study was supported by grants from the National Research Foundation of Korea (NRF-2010-0009090), Republic of Korea.

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