Trial of Donezepil as an adjunct treatment to speech therapy when managing severe receptive aphasia in an inpatient rehabilitation setting. A case report.

Case Diagnosis: Global aphasia in the setting of acute left posterior MCA and left PCA distribution infarcts

Case Description or Program Description: A 65 year old male presents to acute inpatient rehabilitation hospital following hospitalization for an acute ischemic stroke with left posterior MCA and left PCA region infarcts. On initial evaluation, patient presenting with severe receptive and expressive aphasia. His aphasia was initially addressed with one week of intense speech therapy alone. After 7 days, he continued to display severe global aphasia. On day 7 of his admission, he was started on a course of 5 mg of Donezepil daily as an adjunctive treatment with daily intense speech therapy.

Setting: Inpatient rehabilitation hospital

Assessment/Results: Prior to initiating Donezepil treatment, his aphasia was measured by the Mississippi Aphasia Screening Test (MAST). MAST evaluation performed with an expressive sub scale of 2/50, receptive sub scale 18/50, with a total score of 20/100. After 7 days of daily Donezepil treatment in conjunction with speech therapy, his MAST evaluation was repeated; again scoring an expressive sub scale of 2/50. However, his receptive sub scale improved to 30/50, with a total score of 32/100.

Discussion (relevance): Aphasia is one of the most common post stroke neurological deficits. Although intense speech therapy is considered the primary method of treatment, there have been observed beneficial effects of Donezepil on aphasia in post-stroke patients. In our case, we observed a patient with severe global aphasia, who after initiation of Donezepil as an adjunct to daily speech therapy displayed an improvement in the expressive component of his aphasia.

Conclusions: This case illustrates the potential benefit Donezepil could play in recovery of post stroke receptive aphasia. Donezepil, an an adjunctive treatment with speech therapy, may benefit both receptive and expressive aphasia. Randomized controlled studies are needed to further determine and understand the effects of Donezepil on post stoke receptive aphasia.