Fallone_2026_Am.J.Ther__

BACKGROUND: Korsakoff syndrome is a neurocognitive disorder characterized by memory impairment and confabulation caused by severe or prolonged thiamine deficiency. It is preceded by a type of delirium called Wernickes Encephalopathy, which is reversible. However, once a patient progresses to Korsakoff syndrome, treatment options are limited because there are currently no FDA-approved medications for Korsakoff syndrome. Donepezil is an acetylcholinesterase inhibitor that has shown efficacy in Alzheimer disease and has been theorized to have benefit in other neurologic disorders as well. In this case, we present a patient with Korsakoff syndrome who had improvement in symptoms after starting donepezil. DATA SOURCE: The information presented here is derived directly from the clinical records and observations of the patient under our care. FINDINGS AND LIMITATIONS: The case presented here demonstrates improvement in cognition, motivation, and affect in Korsakoff dementia with the use of donepezil. Limitations of this case study and those alike include lack of generalizability, retrospective design, and absence of a control. CONCLUSIONS: The off-label use of donepezil for Korsakoff syndrome in this case and others has been shown to be beneficial and well tolerated. Ultimately, larger studies are needed to determine safety and efficacy.