The role of acetylcholinesterase and butyrylcholinesterase activity in the development of delirium in acute stroke

Lara Caeiro; Filipa Novais; Carlota Saldanha; Teresa Pinho E Melo; Patrícia Canhão; José M Ferro

doi:10.1016/j.cccb.2021.100017

The role of acetylcholinesterase and butyrylcholinesterase activity in the development of delirium in acute stroke

Cereb Circ Cogn Behav. 2021 May 29:2:100017. doi: 10.1016/j.cccb.2021.100017. eCollection 2021.

Authors

Lara Caeiro¹, Filipa Novais², Carlota Saldanha³, Teresa Pinho E Melo⁴, Patrícia Canhão⁵, José M Ferro⁵

Affiliations

¹ Institute of Molecular Medicine, Faculty of Medicine of the University of Lisbon, Portugal.
² Psychiatry Service, Department of Neurosciences, Hospital de Santa Maria/CHLN, Portugal.
³ Instituto de Bioquímica, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Portugal.
⁴ Neurology Service, Department of Neurosciences, Hospital de Santa Maria/CHLN, Portugal.
⁵ Neurology Service, Department of Neurosciences, Hospital de Santa Maria/CHLN, and Institute of Molecular Medicine, University of Lisbon, Portugal.

Abstract

Aim: Our study aimed to test whether plasma acetylcholinesterase and butyrylcholinesterase enzyme activity were related to the presence and intensity of delirium in acute stroke patients.

Methods: We carried out a matched (age and gender) case-control study, in a sample of consecutive patients with an acute infarct or intracerebral haemorrhage (≤7 days). We assessed delirium using the DSM-5 criteria and the Delirium Rating Scale, and we measured plasma acetylcholinesterase and butyrylcholinesterase enzyme activity after the patient's admission in the stroke unit and before hospital discharge. Mantel-Haenszel's chi-square was used to test bivariate associations between cases (delirious patients) and controls (non-delirious patients).

Results: At admission in the stroke unit, cases and controls did not present significant differences in plasma acetylcholinesterase or butyrylcholinesterase activity. At hospital discharge (18 cases and 21 controls) patients who have had delirium at admission had higher levels of butyrylcholinesterase activity. Butyrylcholinesterase activity may secondarily increase due to the inflammatory process associated with neuronal dysfunction in delirium patients.

Keywords: ACh, acetylcholine; AChE, acetylcholinesterase; Acetylcholinesterase; Acute; BChE, butyrylcholinesterase; Butyrylcholinesterase; Delirium; GCS, Glasgow Coma Scale; IGSAA, Global Subjective Appreciation of Atrophy; INFARMED, Instituto Nacional da Fármacia e do Medicamento; NIHSS, Neurological Institute Health Stroke Scale; Stroke.