Enhancing Rehabilitation After Stroke

Inclusion Criteria: 1. male or female; 2. aged 18 or older; 3. new ischemic stroke within the preceding 30 days; and 4. admitted to the an inpatient facility of the UPMC Institute for Rehabilitation and Research for post-stroke rehabilitation. Exclusion Criteria: 1. primary hemorrhagic stroke; 2. current use of a cholinomimetic drug including tacrine, donepezil, galantamine, and rivastigmine; 3. contraindication to AchEi therapy including bradycardia (\< 50 bpm), severe asthma or COPD requiring nebulized medication, and active upper GI bleed or untreated gastric ulcer; 4. myocardial infarction, poorly controlled congestive heart failure, or coronary bypass surgery within the last 3 months; 5. current required use of an anticholinergic medication (e.g., for bladder spasm); 6. current aphasia severe enough to prevent valid neuropsychiatric assessment (e.g., a score \< 9 on the Token Test, part I and a score of \< 14 (or \<80% accuracy) on the repetition task of the Boston Diagnostic Aphasia Examination); 7. current Major Depressive Episode AND HRSD \> 20; 8. current active suicidal ideation, plan, or intent; 9. current mania or hypomania; 10. current psychosis; 11. meeting DMS-IV TR alcohol or substance abuse or dependence criteria within the preceding 3 months; 12. subject and/or family informant do not speak English; 13. history of a progressive or unstable CNS disease (e.g., multiple sclerosis, Parkinson's disease, HIV with CNS involvement); 14. medically unstable (determined by review of the subject's medical status with the treating (clinical) physician and by review of standard blood tests); and 15. history of sensitivity to donepezil; 16. for potential subjects without a pacemaker or implantable defibrillator, exclusion criteria will include (a) ECG evidence of second or third degree heart block ( b ) ECG evidence of a tri-fascicular block (LBBB and 1st degree AV Block; RBBB, left anterior or left posterior hemiblock, and 1st degree AV block) or ( c ) history of syncope within 1 year with a RBBB or a LBBB. 17. For females of child-bearing age, current pregnancy, plan to become pregnant while on study drug, or refusal to avoid pregnancy while on study drug. 18. For females of child-bearing age, current breast feeding. 19. suicidal attempt in the past one year, 20. an inpatient admission for depression in the past one year