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Dysfunction of the basal ganglia and frontal subcortical structures occurs in both obsessive-compulsive disorder and parkinsonism. Treatment of obsessive-compulsive disorder with parkinsonism is a therapeutic challenge, especially in old age as selective serotonin reuptake inhibitors may aggravate motor symptoms and worsen clinical conditions. The authors present a series of patients with late onset obsessive-compulsive disorder demonstrating improvement in obsessive-compulsive disorder as well as parkinsonian signs.

Viral encephalitis is often followed by cognitive sequelae including intellectual decline whose pathophysiology remains obscure till date. Based on recent laboratory studies implicating the cholinergic system in viral encephalitis, the authors postulate the hypothesis that cholinergic deficit might account for some of the cognitive sequelae in at least some types of viral encephalitis, which might be benefited by central acetyl cholinesterase inhibitors. The case of an adolescent with postencephalitic intellectual decline responding robustly to donepezil is presented.

Adults with traumatic brain injury (TBI) are often severely impaired and inadequately rehabilitated due to deficits in memory and behavioral problems like apathy, irritability and depression, and it has been suggested that an acetylcholine deficit could be contributory to these deficits. Central Acetyl cholinesterase Inhibitors (CAI) are being reported to have a beneficial impact in treatment of memory deficits in adults with TBI, with Donepezil studied most extensively. The authors present two patients with TBI with long term static dysfunction of memory and behavior who responded to Donepezil in terms of attention, memory and apathy. Donepezil appears to be a valuable pharmacological option for treatment of memory and behavioral deficits in TBI.