Behçet hastalığında nörolojik semptomlardan bağımsız olarak bilişsel bozukluk mevcut olabilir mi?

Öz

Amaç: Behçet hastalığı (BH) birçok sistemin etkilendiği mortalite ve morbiteye yol açan kronik inflamatuvar bir hastalıktır. BH’de nörolojik tutulum bulguları olmaksızın hastalarda bilişsel fonksiyonların etkilendiğine dair veriler olsa da bu hastaların taramasına yönelik br fikir birliğine henüz ulaşılamamıştır. Montreal Bilişsel Değerlendirme (MOBİD), hafif düzeyde bilişsel fonksiyon bozuklukları tespit edebilen pratik, kolay erişilebilir bir tarama ölçeğidir. Çalışmamızda nörolojik bulguları olmayan BH’de MOBİD ile bilişsel fonksiyon bozuklukları tespit edebilmeyi amaçladık. Gereç ve yöntem: Bu prospektif çalışmaya BH tanısı alan ve nörolojik bulgusu olmayan hastalar ile yaş, cinsiyet ve eğitim açısından eşleştirilmiş sağlıklı bireyler dahil edildi. Hastalık aktitesini belirlemek için Behçet Hastalığı Güncel Aktivite Formu (BDCAF) uygulanırken tüm katılımcılara MOBİD uygulandı. Bulgular: MOBİD ölçeğinin toplam puanı Behçet hastalarında kontrol grubuna göre belirgin olarak düşüktü (p<0.05). MOBİD alt testlerinden ‘‘Yönelim’’ ve ‘‘Soyutlama’’ açısından BH ve kontroller arasında fark saptanmamışken (p>0.05) diğer alt testlerde puan hastalarda anlamlı olarak düşüktü (p<0.05). BDCAF skorlarıyla toplam MOBİD puanı arasında negatif korelasyon saptandı (r=-0.43, p<0.001). Total MOBİD puanı ile eğitim yılı arasında pozitif korelasyon saptandı (r=0.35, p=0.007). Sonuç: BH’de nörolojik tutulum olmaksızın bilişsel fonksiyonlarda azalma mümkündür. BH’de hastaların bilişsel açıdan taranması subklinik inflmasyonun tespit edilmesi ve yaşam kalitesinin iyileştirilmesi için önemlidir. Sonuçlarımız, MOBİD tarama ölçeği ile bilişsel fonksiyonlardaki azalma pratik bir şekilde saptanabileceğini göstermiş olsa da rutin kullanıma girmesi için geniş çaplı, çok merkezli çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• Behçet hastalığı
• bilişsel bozukluk
• montreal bilişsel değerlendirme

Can cognitive impairment be observed independently of neurological symptoms in Behcet's disease?

Abstract

Purpose: Behçet's disease (BD) is a chronic, multisystem inflammatory disorder that causes mortality and morbidity. Despite data indicating cognitive impairment in patients without neurological involvement, there is currently no consensus on how to screen patients. The Montreal Cognitive Assessment (MOCA) is a practical, easy-to-use screening scale that can detect mild cognitive impairment. We aimed to detect cognitive dysfunction with MOCA in BD without neurological findings. Materials and methods: This prospective study included patients diagnosed with BD without neurological findings, and healthy individuals matched for age, gender, and education. Behçet's Disease Current Activity Form (BDCAF) was applied to determine disease activity, and MOCA was applied to all participants. Results: The total score of the MOCA scale was significantly lower in Behçet's patients than in the control group (p=0.001). While no difference was found between BD and controls in terms of MOCA subtests ‘‘Orientation’’ and ‘‘Abstraction’’ (p=0.667, p=0.077, respectively), scores in other subtests were significantly lower in patients. A negative correlation was found between BDCAF scores and total MOCA scores (r=-0.454, p=0.000). A positive correlation was found between total MOCA score and years of education (r=0.345, p=0.000). Conclusion: In BD, a decrease in cognitive functions may exist without neurological involvement. Cognitive screening of patients with BD is crucial for detecting subclinical inflammation and improving quality of life. Our results demonstrate that the MOCA is an effective tool for detecting cognitive function decline. However, further large-scale, multi-center studies are needed to establish its routine use.

Keywords

• Behçet disease
• cognitive impairment
• montreal cognitive assessment

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