In this proton magnetic resonance spectroscopy ((1)H-MRS) study, the authors correlated cognitive improvement after 3 months of treatment with donepezil with changes of N-acetylaspartate (NAA) level and NAA/Creatine (Cr) ratio in the medial temporal and parietal lobe of 17 patients with Alzheimer disease. Treatment response was associated with an increase of NAA and NAA/Cr in the parietal lobe. Low baseline NAA/Cr in the parietal lobe predicted positive treatment outcome.