Perioperative medicine & outcomes
Associations between blood cholin-esterase activity and postoperative basal forebrain cholinergic system atrophy: A secondary analysis of the BioCog cohort with exploration of potential mechanisms
Authors' conclusion
We observed an association between plasma BuChE activity and postoperative NBM atrophy.
Study context
- Population
- Cognitively healthy (MMSE≥24) patients ≥65 years undergoing elective surgery
- Participants
- 170 participants
- Comparison
- Perioperative butyryl-ChE activity vs postoperative nucleus basalis of Meynert (NBM) volume
- Primary endpoint
- Postoperative nucleus basalis of Meynert (NBM) volume (MRI volumetry), adjusted for age, sex, MMSE score and preoperative NBM volume
- Follow-up
- 3 months after surgery
Primary result
As reported in the abstract
Baseline-adjusted NBM volume per U/L BuChE activity
Postoperative butyryl-ChE (BuChE) activity, B (95% CI 0.0055; 0.0227), mm3 per U/L
0.0141
Perioperative change in BuChE activity, B (95% CI 0.0088; 0.0321), mm3 per U/L
0.0205
Preoperative BuChE activity, B (95% CI 0.0014; 0.0203), mm3 per U/L
0.0109
Further findings
Postoperative delirium (POD) and POCD
- No relationship between BuChE activity, NBM atrophy and POD or POCD
Postoperative inflammatory response
- Associated with BuChE inhibition, but not NBM atrophy
Duration of surgery, sevoflurane-maintained anaesthesia (subgroup)
- Significantly associated with BuChE inhibition and NBM atrophy
Original publication
Associations between blood cholin-esterase activity and postoperative basal forebrain cholinergic system atrophy: A secondary analysis of the BioCog cohort with exploration of potential mechanisms. J Clin Anesth. Published 24 July 2026. doi:10.
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