Objective: To examine the effect of donepezil for the treatment of cognitive and behavioral disorders associated with thalamic lesions in a 45-year-old male who suffered an infarct in the left thalamus. Background: Recent studies suggest that donepezil may improve executive functions impairments due to subcortical ischemic lesions. Method: The effects of donepezil were analyzed in a single-case of thalamic infarction with cognitive and behavioral alterations in an open label study. Results: Significant behavioral modifications related to improved performances in executive functions were observed with the treatment. Conclusion: The results suggest that donepezil may have significant effect on executive functions that can alter behavioral outcomes after thalamic infarctions.