Inclusion Criteria- Definite or probable acute ischemic cerebrovascular syndrome (AICS), as defined by Kidwell et al (Stroke. 2003;34:2995-8).
- Experimental treatment started within 24 hours of onset of symptoms.
- Age ≥ 18 years.
- Ability and willingness to return for follow-up visits.
- Willingness of an available informant who knows the patient well to participate in informant-based questionnaires for the duration of the follow-up period.
- Living in independent or semi-independent living situation before the stroke.
- Fluent in English before the stroke.
- Provides written informed consent.
- Near visual acuity of at least 20/200 in at least one eye.
- Auditory acuity of at least having the ability to detect finger rubbing in at least one ear.
Exclusion Criteria- Parkinson's disease or restless leg syndrome.
- Partial or generalized seizures.
- No acute decompensated heart failure
- Routinely requiring daytime supplemental oxygen before the stroke; study participants on continuous positive air pressure (CPAP) for obstructive sleep apnea remain eligible.
- Gastrointestinal or genitourinary surgery within 1 month of screening.
- Gastrointestinal bleeding.
- Syncope or symptomatic bradycardia.
- Creatinine ≥ 3.5 mg/dL or requiring dialysis.
- Peptic ulcer disease.
- Tracheostomy or endotracheal intubation.
- Taking donepezil or other acetylcholinesterase inhibitor at screening.