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World J Clin Cases. Sep 26, 2026; 14(27): 128223
Published online Sep 26, 2026. doi: 10.12998/wjcc.128223
Published online Sep 26, 2026. doi: 10.12998/wjcc.128223
Suspected donepezil withdrawal syndrome in an older woman with Alzheimer disease of abrupt cessation: A case report
Takahiko Nagamine, Department of Psychiatric Internal Medicine, Sunlight Brain Research Center, Hofu 7470066, Yamaguchi, Japan
Author contributions: Nagamine T contributed to study concept, clinical care, acquisition, analysis and interpretation of data, drafting of the manuscript, critical revision, and approval of the final version.
AI contribution statement: AI tools were utilized only for English language editing and proofreading. The generated text does not contain any AI-created content, and all ideas and text were originally produced by the authors.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Takahiko Nagamine, MD, PhD, Department of Psychiatric Internal Medicine, Sunlight Brain Research Center, 4-13-18 Jiyugaoka, Hofu 7470066, Yamaguchi, Japan. anagamine@yahoo.co.jp
Received: September 17, 2026
Revised: September 30, 2026
Accepted: October 10, 2026
Published online: September 26, 2026
Processing time: 26 Days and 10.1 Hours
Revised: September 30, 2026
Accepted: October 10, 2026
Published online: September 26, 2026
Processing time: 26 Days and 10.1 Hours
Core Tip
Core Tip: Abrupt discontinuation of long-term donepezil was followed 48 hours later by agitation, insomnia and gait instability in an 89-year-old woman who had taken 10 mg/day for more than five years. Symptoms improved after rechallenge with 5 mg/day, but interpretation is limited by pre-existing cognitive decline, nursing-home relocation, concomitant quetiapine and other unmeasured factors. The case illustrates why suspected withdrawal may be considered in the differential diagnosis without assuming that all post-discontinuation deterioration is drug-related.