Melih TUTUNCU, Ugur UYGUNOGLU, Ayhan BİNGÖL, Sabahattin SAİP, Aksel SİVA

Nöro-Behçet hastalığında kognitif fonksiyon bozukluğunun sıklığı ve örüntüsü: retrospektif bir çalışma

Amaç: Bu çalışmada parenkimal tutulumu olan Nöro-Behçet hastalarında kognitif bozukluk sıklığını ve paternini değerlendirmeyi amaçladık. Gereç ve Yöntem: Çalışmaya Cerrahpaşa Tıp Fakültesi Nöroloji Anabilim dalından takipli ve Cerrahpaşa Nörobehçet tanı kriterlerini dolduran 40 hasta dahil edildi. Olguların nörokognitif fonksiyonları seçici hatırlama testi, PASAT, görsel bellek testi, sembol sayı modaliteleri testi ve kelime akıcılığı testlerinden oluşan Brief Repeatable Battery of Neuropsychological Tests (BRB-N) ile değerlendirildi. Elde edilen sonuçlar daha önce normatif data oluşturulmak üzere kullanılan sağlıklı grup ile kıyaslandı. Bulgular: Hasta grubun ortalama hastalık yaşı 39.48±10.66 idi ve Behçet tanısından ortalama 3.3 yıl sonra Nöro-Behçet hastalığı tanısı almışlardı. Erkek hakimiyeti mevcuttu. Hasta grubun tüm nöropsikolojik test sonuçları sağlıklılara kıyasla bozulmuştu. %60 hastada dikkati sürdürmede bozulma, %55 hastada görsel hafızada etkilenme, %45 hastada yürütücü işlevlerde etkilenme, %23.5 hastada sözel hafızada etkilenme saptandı. Sonuç: Her iki hastadan birinde kognitif bozukluk tespit edildi. Gözlenen bu etkilenme sıklık sırasına göre dikkat, görsel hafıza ve yürütücü işlevlerdeydi. Bu yüksek prevelanstan dolayı Nörobehçet hastalarının klinik takibinde kognitif fonksiyonlar göz önünde bulundurulmalıdır.

Frequency and pattern of cognitive dysfunction in Neuro-Behcet’s disease: a retrospective study

Purpose: The aim of this study was to evaluate the frequency and pattern of cognitive impairment in Neuro-Behçet patients with parenchymal involvement. Materials and Methods: Forty patients who were followed up from Cerrahpaşa Medical Faculty, Department of Neurology, and diagnosed with Neurobehçet's disease according to Cerrahpaşa diagnostic criteria were included in the study. The neurocognitive functions of the subjects were evaluated with Brief Repeatable Battery of Neuropsychological Tests (BRB-N) including the selective recall test, PASAT, spatial recall test, symbol number modalities test, and word fluency tests. The results obtained were compared with the healthy group previously used to create normative data. Results: The mean age of the disease in the patient group was 39.48 ± 10.66 and they were diagnosed with Neuro-Behcet disease approximately 3.3 years after the diagnosis of Behcet disease. There was male dominance. All neuropsychological test results of the patient group were impaired compared to the healthy ones. Deterioration in maintaining attention in 60%, impairment in visual memory in 55%, impairment in executive functions in 45%, and impairment in verbal memory in 23.5% of patients were found. Conclusion: Cognitive impairment was detected in one of every two patients. The observed effects were in attention, visual memory, and executive functions in order of frequency. It is recommended that this high prevalence should be considered in the clinical follow-up of patients with Neuro-Behcet disease.

Keywords:

Behçet, Neuro-Behçet, cognitive disorder,

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1. Yazici, H., Seyahi, E., Hatemi, G. & Yazici, Y. Behçet syndrome : a contemporary view. Nature Publishing Group 14, 107–119 (2018).
2. Review, E. N. S. T. The spectrum of nervous system involvement in Behçet ’ s syndrome and its differential diagnosis. 513–529 (2009) doi:10.1007/s00415-009-0145-6.
3. Yazici, Y., Yurdakul, S. & Yazici, H. Behçet’s syndrome. Current Rheumatology Reports 12, 429–435 (2010).
4. Yazici, H., Fresko, I. & Yurdakul, S. Behçet’s syndrome: Disease manifestations, management, and advances in treatment. Nature Clinical Practice Rheumatology 3, 148–155 (2007).
5. Direskeneli, H. Autoimmunity vs autoinflammation in Behcet’s disease: Do we oversimplify a complex disorder? Rheumatology 45, 1461–1465 (2006).
6. Zeidan, M. J. et al. Behçet’s disease physiopathology: a contemporary review. Autoimmunity Highlights 7, 1–12 (2016).
7. Akman-Demir, G., Serdaroglu, P. & Tasçi, B. Clinical patterns of neurological involvement in Behcet’s disease: Evaluation of 200 patients. Brain 122, 2171–2181 (1999).
8. Uygunoğlu, U. & Siva, A. Behçet’s Syndrome and Nervous System Involvement. Current Neurology and Neuroscience Reports 18, (2018).
9. Kural-seyahi, E. et al. The Long-Term Mortality and Morbidity of Behçet Syndrome Abstract : 82, (2003).
10. Al-Araji, A. & Kidd, D. P. Neuro-Behçet’s disease: epidemiology, clinical characteristics, and management. The Lancet Neurology 8, 192–204 (2009).
11. Saip, S., Siva, A., Altintas, A., Kiyat, A. & Seyahi, E. Headache in Behc ¸ et ’ s Syndrome. (2005).
12. Akman-demir, G. Neuropsychological follow-up of 12 patients with neuro-Behçet disease. 113–119 (1999).
13. Siva, A. et al. Behçet’s disease: Diagnostic and prognostic aspects of neurological involvement. Journal of Neurology 248, 95–103 (2001).
14. Bingol, A. et al. Multipl Skleroz Nöropsikolojik Tarama Testinin( Multiple Sclerosis Neuropsychological Screening Questionnaire) Türkçe Geçerlilik Çalışması. 47. Ulusal Nöroloji Kongresi. Ozakbas, S. et al. The Turkish validation of the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) battery. BMC Neurology 17, 1–6 (2017).
15. Bingol, A. et al. Brief Repeatable Battery (Brb) Türkçe Normotif Verileri. 47. Ulusal Nöroloji Kongresi. Tutuncu, M. et al. Onset of progressive phase is an age-dependent clinical milestone in multiple sclerosis. Multiple Sclerosis Journal 19, 188–198 (2013).
16. Portaccio, E. et al. Reliability, practice effects, and change indices for Raos brief repeatable battery. Multiple Sclerosis 16, 611–617 (2010).
17. Monastero, R. et al. Cognitive impairment in Behçet’s disease patients without overt neurological involvement. Journal of the Neurological Sciences 220, 99–104 (2004).
18. Dutra, L. A. et al. Cognitive impairment in Brazilian patients with Behçet’s disease occurs independently of neurologic manifestation. Journal of the Neurological Sciences 327, 1–5 (2013).
19. Cavaco, S. et al. Cognitive functioning in Behçet’s disease. Annals of the New York Academy of Sciences 1173, 217–226 (2009).
20. Altunkaynak, Y. et al. Cognitive functioning and silent neurological manifestations in Behçet’s disease with ocular involvement. Noropsikiyatri Arsivi 56, 173–177 (2019).