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

Year 2025, Volume: 18 Issue: 1, 15 - 15

Özge Sevil Karstarlı Bakay , Umut Bakay , Pinar Bora

https://doi.org/10.31362/patd.1584077

Abstract

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.

Keywords

Behçet hastalığı, bilişsel bozukluk, montreal bilişsel değerlendirme

Could cognitive impairment manifest in Behçet's disease even in the absence of neurological symptoms?

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

Behcet disease, cognitive impairment, Montreal Cognitive Assessment

Ethical Statement

Bu çalışma PAMUKKALE ÜNİVERSİTESİ Girişimsel Olmayan Klinik Araştırmalar Etik Kurulu tarafından Sayı : E-60116787-020-577147 ile etik onay 6.8.2024 tarihinde almıştır

Supporting Institution

yok

References

• Saadoun D, Bodaghi B, Cacoub P. Behçet's syndrome. N Engl J Med. 2024;390(7):640-651. doi:10.1056/NEJMra2305712
• Alpsoy E, Bozca BC, Bilgic A. Behçet disease: An update for dermatologist. Am J Clin Dermatol. 2021;22:477-502. doi:10.1007/s40257-021-00609-4
• Siva A, Saip S. The spectrum of nervous system involvement in Behçet's syndrome and its differential diagnosis. J Neurol. 2009;256:513-529. doi:10.1007/s00415-009-0145-6
• Azizlerli G, Köse AA, Sarica R, et al. Prevalence of Behçet’s disease in Istanbul, Turkey. Int J Dermatol. 2003;42:803-806. doi:10.1046/j.1365-4362.2003.01893.x
• Caruso P, Moretti R. Focus on neuro-Behçet's disease: A review. Neurol India. 2018;66(6):1619-1628. doi:10.4103/0028-3886.246252
• Borhani Haghighi A, Kardeh B, Banerjee S, et al. Neuro-Behcet's disease: An update on diagnosis, differential diagnoses, and treatment. Mult Scler Relat Disord. 2020;39:101906. doi:10.1016/j.msard.2019.101906
• Fisher CA. Psychological and neurocognitive impact of Behcet’s disease. Int J Vasc Surg Med. 2020;6:1-8. doi:10.31487/j.NNB.2020.01.05
• Kidd DP. Neurological complications of Behçet's syndrome. J Neurol. 2017;264(10):2178-2183. doi:10.1007/s00415-017-8436-9
• Fisher CA, Bernard C. A systematic review of neurocognitive functioning in Behçet’s disease. Neuropsychol Rev. 2019;29:498-521. doi:10.1007/s11065-019-09416-5
• Monastero R, Camarda C, Pipia C, et al. Cognitive impairment in Behçet’s disease patients without overt neurological involvement. J Neurol Sci. 2004;220:99-104. doi:10.1016/j.jns.2004.02.021
• Özen E, Birol A, Boratav C, Koçak M. Nörolojik tutulumu olmayan Behçet hastalarında bilişsel bozukluklar. Klinik Psikiyatri Dergisi. 2004;7(4):187-198.
• Sucullu Karadag Y, Kurt P, Sahin K, Karaaslan Y, Oztekin N, Ak F. Cognitive impairment not only in NeuroBehçet but also for all Behçet disease phenotypes. Journal of Neurological Sciences. 2014;31(3):511-520.
• Dutra LA, de Souza AW, Alessi H, et al. Cognitive impairment in Brazilian patients with Behçet's disease occurs independently of neurologic manifestation. J Neurol Sci. 2013;327:1-5. doi:10.1016/j.jns.2013.01.024
• Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53:695-699. doi:10.1111/j.1532-5415.2005.53221.x
• Ozdilek B, Kenangil G. Validation of the Turkish Version of the Montreal Cognitive Assessment Scale (MoCA-TR) in patients with Parkinson's disease. Clin Neuropsychol. 2014;28(2):333-343. doi:10.1080/13854046.2014.881554
• Beck AT, Steer RA, Ball R, Ranieri W. Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients. J Pers Assess. 1996;67(3):588-597.
• Neves FS, Moraes JC, Kowalski SC, Goldenstein Schainberg C, Lage LV, Gonçalves CR. Cross-cultural adaptation of the Behçet's Disease Current Activity Form (BDCAF) to Brazilian Portuguese language. Clin Rheumatol. 2008;26:1263-1267. doi:10.1007/s10067-006-0484-y
• Selekler K, Cangöz B, Uluç S. Power of Discrimination of Montreal Cognitive Assessment (MOCA) Scale in Turkish Patients with Mild Cognitive Impairment and Alzheimer's Disease. Turkish Journal of Geriatrics. 2010;13:166-171.
• Tunç T, Ortapamuk H, Naldöken S, et al. Subclinical neurological involvement in Behcet’s disease. Neurol India. 2006;54:408-411. doi:10.4103/0028-3886.28116
• Kececi HM, Akyol P. 300 in Behcet’s patients without neurological manifestations. Can J Neurol Sci. 2001;28:66-69. doi:10.1017/s0317167100052586
• Anlar O, Akdeniz N, Tombul T, Calka O, Bilgili SG. Visual evoked potential findings in Behcet’s disease without neurological manifestations. Intern J Neuroscience. 2006;116:281-287. doi:10.1080/00207450500403165
• Ozisik HI, Karlidag R, Hazneci E, Kizkin S, Ozcan C. Cognitive event-related potential and neuropsychological findings in Behçet's disease without neurological manifestations. Tohoku J Exp Med. 2005;206:15-22. doi:10.1620/tjem.206.15.
• Cavaco S, da Silva AM, Pinto P, et al. Cognitive functioning in Behcet's disease. Ann N Y Acad Sci. 2009;1173:217-226. doi:10.1111/j.1749-6632.2009.04670.x
• Rock PL, Roiser JP, Riedel WJ, Blackwell AD. Cognitive impairment in depression: A systematic review and meta-analysis. Psychol Med. 2014;44:2029-2040. doi:10.1017/S0033291713002535
• Goodall J, Fisher C, Hetrick S, Phillips L, Parrish EM, Allott K. Neurocognitive Functioning in Depressed Young People: A Systematic Review and Meta-Analysis. Neuropsychol Rev. 2018;28:216-231. doi:10.1007/s11065-018-9373-9
• Castaneda AE, Tuulio Henriksson A, Marttunen M, Suvisaari J, Lönnqvist J. A review on cognitive impairments in depressive and anxiety disorders with a focus on young adults. J Affect Disord. 2008;106:1-27. doi:10.1016/j.jad.2007.06.006
• Lupien SJ, Gillin CJ, Hauger RL. Working memory is more sensitive than declarative memory to the acute effects of corticosteroids: A dose–response study in humans. Behav Neurosci. 1999;113:420-430. doi:10.1037//0735-7044.113.3.420
• Brown ES, Chandler PA. Mood and Cognitive Changes During Systemic Corticosteroid Therapy. Prim Care Companion. J Clin Psychiatry. 2001;3(1):17-21. doi:10.4088/pcc.v03n0104
• Khoshbakht S, Başkurt D, Vural A, Vural S. Behçet's Disease: A Comprehensive Review on the Role of HLA-B*51, Antigen Presentation, and Inflammatory Cascade. Int J Mol Sci. 2023;24:16382. doi:10.3390/ijms242216382
• Al Araji A, Kidd DP. Neuro-Behçet's disease: epidemiology, clinical characteristics, and management. Lancet Neurol. 2009;8(2):192-204. doi:10.1016/S1474-4422(09)70015-8
• Papastefanakis E, Dimitraki G, Ktistaki G, et al. Screening for cognitive impairment in systemic lupus erythematosus: Application of the Montreal Cognitive Assessment (MoCA) in a Greek patient sample. Lupus. 2021;30(14):2237-2247. doi:10.1177/09612033211061062
• Paez Venegas N, Jordan Estrada B, Chavarria Avila E, et al. The Montreal cognitive assessment test: a useful tool in screening of cognitive impairment in patients with systemic lupus erythematosus. J Clin Rheumatol. 2019;25:325-328. doi:10.1097/RHU.0000000000000876
• Nantes SG, Su J, Dhaliwal A, et al. Performance of screening tests for cognitive impairment in systemic lupus erythematosus. J Rheumatol. 2017;44:1583-1589. doi:10.3899/jrheum.161125
• Adhikari T, Piatti A, Luggen M. Cognitive dysfunction in SLE: development of a screening tool. Lupus. 2011;20:1142-1146. doi:10.1177/0961203311405374