Inclusion Criteria- Diagnosis of aphasia with relatively spared comprehension.
- Onset 6 months or greater prior to enrollment.
- Native English speaker
- Adults (18 years of age or older).
Exclusion Criteria- Patients receiving ongoing individual speech therapy. (Most patients are no longer eligible for individualized speech therapy after 6 months from stroke onset, thus this should not eliminate many patients).
- Extremely mild or extremely severe aphasia. (Boston Naming Test Score <3 or >45 items named from 60 items).
- Global dementia (and any other patient with reduced decisional capacity requiring a legally authorized representative for consent).
- Presence of major cognitive deficit other than aphasia caused by stroke related disease.
- Contraindications to cholinomimetic agents: History of active peptic ulcer disease within 1 year, Severe asthma, unstable angina, bradyarrhythmia with resting pulse less than 50, sick sinus syndrome, or seizures.
- Major psychiatric disorders that affect cognition including: psychosis, major depression, bipolar disorder, alcohol or substance abuse.
- Major medical conditions that alter cognition (e.g., heart failure, dialysis dependent renal failure, hepatic failure, active cancer).
- Impairments that affect metabolism of the medication including: Severe renal impairment (Creatinine clearance equal to or greater than 9), and moderate or severe hepatic impairment (Child-Pugh score >7)
- Patients using medications that have major effects on brain neurotransmitter systems or cognition within 2 months of enrollment. Exclusionary medications are: medications with significant anti-cholinergic activity (tricyclic antidepressants, diphenhydramine), anti-Parkinsonian medications (including Sinemet, amantadine, bromocriptine, pergolide, selegiline), and narcotic analgesics (> 2 doses per week).