cholinergic agents will improve naming ability in fluent aphasia due to temporal lobe lesions. All participants gave verbal informed consent. We studied four right-handed patients with fluent aphasia and anomia after unilateral left cerebral infarction 6–8 weeks poststroke (4 male, age 54–65 years). Individuals were allocated to treatment (n=2) and non-treatment (n=2) groups by coin-toss, and the treated group was given the cholinergic agent bifemelane 300 mg daily. All individuals received the standard language test for aphasia (SLTA) immediately before study entry and 1 month after the first examination. We studied specifically subtests of auditory comprehension, animal category naming, and confrontation naming. All individuals received the same conventional aphasia therapy thrice weekly from a (blinded) speech therapist until the second evaluation. Therapy was started after administration of the drug was begun in the treated group and co-incidentally in the nontreated group. All patients underwent a cerebrospinal fluid (CSF) examination for analysis of acetylcholinesterase (AChE) before administration of bifemelane and after treatment, or for the non-treated group, twice, at a 1month interval. Computerised tomographic (CT) was done at the same time as the initial language evaluation to compare lesion site and size, and showed no significant differences between groups. In the non-treated aphasics, the language scores did not improve, and CSF AChE decreased slightly (table). In the treated group, language scores increased significantly during cholinergic treatment and CSF AChE increased slightly. Cholinergic treatment was significantly correlated with increases in language scores (p<0·01 Fisher’s exact test), and improvement in language function significantly correlated with increases in CSF AChE (p<0·01). In this open-label, pilot study of four fluent aphasic patients with left temporal lesions, we found improvement in naming and comprehension after treatment with a cholinergic agent. Non-treated patients showed no improvement in language performance on second testing. Evidence is emerging that cholinergic activity influences speech and language function. Anticholinergic agents impair verbal memory, causing increased verbal perseveration in healthy volunteers, 3 and have improved speech and language function after focal brain damage. Physostigmine enhances confrontation naming ability in anomic persons. 4 This study provides additional evidence that selected features of aphasic syndromes may benefit from a theoretically rational approach to pharmacotherapy. 5