Abstract
Cognitive and psychiatric aspects of neuro-Behçet’s disease remain obscure despite considerable research. The complicated and yet unrevealed pathophysiology contributes to the puzzling nature of the process. Predominant involvement of the brainstem and diencephalic regions may result in significant neurological disability along with dysfunction in higher intellectual functions. Several studies reported variable cognitive and psychiatric involvement profiles, although having some common features. Patients predominantly have attention deficit and frontal executive dysfunction, primary and secondary memory impairment, and even personality changes. Several psychiatric symptoms, such as depression, anxiety, mood disorders, and psychosis may be encountered. However, heterogeneous study designs make it difficult to interpret the results and to draw a clear-cut conclusion. Interestingly, some magnetic resonance imaging (MRI) and single-photon emission computerized tomography (SPECT) studies revealed apparent abnormalities in specific brain regions that were unaffected by the disease process, which may be associated with the occurrence of neuropsychiatric symptoms. Neuropsychological profiles and SPECT findings in patients with isolated cerebellar and brainstem involvement show striking similarities with neuro-Behçet’s disease patients, which requires more extensive research studies in the future.
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References
Abdelraheem T, Habib HM, Eissa AA, Radwan NM. Psychiatric disorders and MRI brain findings in patients with systemic lupus erythematosus and Behcet’s disease: a cross sectional study. Acta Reumatol Port. 2013;38(4):252–60.
Akman-Demir G l, Serdaroglu P, Taççı B. Clinical patterns of neurological involvement in Behcet’s disease: evaluation of 200 patients. Brain. 1999;122(11):2171–81.
Alevizos B, Anagnostara C, Christodoulou GN. Resistant bipolar disorder precipitated by Behcet’s syndrome. Bipolar Disord. 2004;6(3):260–3.
Arai T, Mizukami K, Sasaki M, Tanaka Y, Shiraishi H, Horiguchi H, Ogata T. Clinicopathological study on a case of neuro-Behcet’s disease: in special reference to MRI, SPECT and neuropathological findings. Jpn J Psychiatry Neurol. 1994;48(1):77–84.
Arkin L, Talasila S, Paller AS. Mycophenolate Mofetil and mood changes in children with skin disorders. Pediatr Dermatol. 2016;33(3):e216–7.
Aydin N, Aydin MD, Deniz O, Kirpinar I. Neuro-Behcet’s disease involving the pons with initial onset of affective symptoms. Eur Arch Psychiatry Clin Neurosci. 2002;252(1):44–6.
Bagheri F, Mani A, Tadayyoni A, Firozi F, Nazarinia MA. The prevalence of psychiatric symptoms in the patients with Behçet’s disease in shiraz, southwest of Iran. J Mood Disord. 2013;3(1):28–32.
Bodur H, Borman P, Ozdemir Y, Atan C, Kural G. Quality of life and life satisfaction in patients with Behcet’s disease: relationship with disease activity. Clin Rheumatol. 2006;25(3):329–33.
Bourgeois JA, Hategan A. Immunosuppressant-associated neurotoxicity responding to olanzapine. Case Rep Psychiatry. 2014;2014:250472.
Calikoglu E, Onder M, Cosar B, Candansayar S. Depression, anxiety levels and general psychological profile in Behcet’s disease. Dermatology. 2001;203(3):238–40.
Cavaco S, Da Silva AM, Pinto P, Coutinho E, Santos E, Bettencourt A, Pinto C, Gonçalves A, Silva S, Gomes F, Carvalho L, Pereira C, Martins B, Correia J, Vasconcelos C. Cognitive functioning in Behçet’s disease. Ann N Y Acad Sci. 2009;1173(1):217–26.
Chuang YW, Hsu CC, Huang YF, Lin HF, Chang CC, Lin CY, Tyan YC. Brain perfusion SPECT in patients with Behcet’s disease. J Neuroradiol. 2013;40(4):288–93.
D’Aes T, Marien P. Cognitive and affective disturbances following focal brainstem lesions: a review and report of three cases. Cerebellum. 2015;14(3):317–40.
D’Angelo E, Casali S. Seeking a unified framework for cerebellar function and dysfunction: from circuit operations to cognition. Front Neural Circuits. 2012;6:116.
Deniz O, Caykoylu A, Vural G, Albayrak Y, Temel S, Aydin I, Kuloglu M. A case study of neuro-psycho-Behcet’s syndrome presenting with psychotic attack. Clin Neurol Neurosurg. 2009;111(10):877–9.
Draper HM. Depressive disorder associated with mycophenolate mofetil. Pharmacotherapy. 2008;28(1):136–9.
Dursun R, Uguz F, Kaya N, Savas Cilli A, Endogru H. Psychiatric disorders in patients with Behcet’s disease. Int J Psychiatry Clin Pract. 2007;11(1):16–20.
Dutra LA, de Souza AW, Alessi H, Guedes Bde V, Braga-Neto P, Pedroso JL, Goncalves CR, da Rocha AJ, Bertolucci PH, Barsottini OG. Cognitive impairment in Brazilian patients with Behcet’s disease occurs independently of neurologic manifestation. J Neurol Sci. 2013;327(1–2):1–5.
Elisa B, Beny L. Induction of manic switch by the tumour necrosis factor-alpha antagonist infliximab. Psychiatry Clin Neurosci. 2010;64(4):442–3.
Epstein RS, Cummings NA, Sherwood EB, Bergsma DR. Psychiatric aspects of Behcet’s syndrome. J Psychosom Res. 1970;14(2):161–72.
Eshuis EJ, Magnin KM, Stokkers PC, Bemelman WA, Bartelsman J. Suicide attempt in ulcerative colitis patient after 4 months of infliximab therapy--a case report. J Crohns Colitis. 2010;4(5):591–3.
Fisher CA, Sewell K, Baker A. Chronic behavior disturbance and neurocognitive deficits in neuro-Behcet’s disease: a case study. Neurocase. 2016;22(3):332–8.
Garcia-Burillo A, Castell J, Fraile M, Jacas C, Vilardell M, Ortega D, Bosch JA. Technetium-99m-HMPAO brain SPECT in Behcet’s disease. J Nucl Med. 1998;39(6):950–4.
Gökçay F, Celebisoy N, Kisabay A, Kumral E, Akyürekli O. P300 and neuropsychological evaluation in Behçet’s disease with and without neurological manifestations. J Neurol. 2004;251(6):676–9.
Gunduz T, Emir O, Kurtuncu M, Mutlu M, Tumac A, Akca S, Coban O, Bahar S, Oktem-Tanor O, Tuzun E, Eraksoy M, Gurvit H, Akman-Demir G. Cognitive impairment in neuro-Behcet’s disease and multiple sclerosis: a comparative study. Int J Neurosci. 2012;122(11):650–6.
Haber SN. Corticostriatal circuitry. Dialogues Clin Neurosci. 2016;18(1):7–21.
Hibberd O, Bhomra P, Ahmad A. Radiological neuro-Behçet’s associated with bipolar disorder: first presentation of a multisystem disease. J R Coll Physicians Edinb. 2018;48(4):323–7.
Hoche F, Guell X, Vangel MG, Sherman JC, Schmahmann JD. The cerebellar cognitive affective/Schmahmann syndrome scale. Brain. 2018;141(1):248–70.
Huang WS, Chiu PY, Kao A, Tsai CH, Lee CC. Decreased cerebral blood flow in neuro-Behcet’s syndrome patients with neuropsychiatric manifestations and normal magnetic resonance imaging--a preliminary report. J Neuroimaging. 2002;12(4):355–9.
Karlidag R, Unal S, Evereklioglu C, Sipahi B, Er H, Yologlu S. Stressful life events, anxiety, depression and coping mechanisms in patients with Behcet’s disease. J Eur Acad Dermatol Venereol. 2003;17(6):670–5.
Kececi H, Akyol M. P300 in Behcet’s patients without neurological manifestations. J Can Sci Neurol. 2001;28(1):66–9.
Kenna HA, Poon AW, de los Angeles CP, Koran LM. Psychiatric complications of treatment with corticosteroids: review with case report. Psychiatry Clin Neurosci. 2011;65(6):549–60.
Koziol LF, Budding D, Andreasen N, D’Arrigo S, Bulgheroni S, Imamizu H, Ito M, Manto M, Marvel C, Parker K, Pezzulo G, Ramnani N, Riva D, Schmahmann J, Vandervert L, Yamazaki T. Consensus paper: the cerebellum’s role in movement and cognition. Cerebellum. 2014;13(1):151–77.
Melikoglu MA, Melikoglu M. The relationship between disease activity and depression in patients with Behcet disease and rheumatoid arthritis. Rheumatol Int. 2010;30(7):941–6.
Mimura M, Kato M, Kashima H. Neuro-Behcet’s disease presenting with amnesia and frontal dysfunction. Clin Neurol Neurosurg. 2009;111(10):889–92.
Mitolo M, Venneri A, Wilkinson ID, Sharrack B. Cognitive rehabilitation in multiple sclerosis: a systematic review. J Neurol Sci. 2015;354(1–2):1–9.
Mizukami K, Shiraishi H, Tanaka Y, Terashima Y, Kawai N, Baba A, Arai T, Koizumi J. CNS changes in neuro-Behcet’s disease: CT, MR, and SPECT findings. Comput Med Imaging Graph. 1992;16(6):401–6.
Monastero R, Camarda C, Pipia C, Lopez G, Camarda LK, Baiamonte V, Ferrante A, Triolo G, Camarda R. Cognitive impairment in Behcet’s disease patients without overt neurological involvement. J Neurol Sci. 2004;220(1–2):99–104.
Nakano Y, Hatanaka Y, Ikebuchi E, Shimizu T, Nanko S, Utsumii T. A case of Neuro-Behcet’s disease with early onset of bipolar mood disorder. Seishin Shinkeigaku Zasshi. 2004;106(5):564–73.
Nkam I, Cottereau MJ. Acute psychosis and Behcet’s disease: a case report. Encéphale. 2006;32(3 Pt 1):385–8.
Oktem-Tanör O, Baykan-Kurt B, Gürvit IH, Akman-Demir G, Serdaroğlu P, Öktem-Tanör Ö, Baykan-Kurt B, Gürvit IH, Akman-Demir G, Serdaroğlu P. Neuropsychological follow-up of 12 patients with neuro-Behçet disease. J Neurol. 1999;246(2):113–9.
Otsuka Y, Yumoto T, Ihoriya H, Matsumoto N, Sato K, Abe K, Naito H, Nakao A. Acute agitation as an initial manifestation of neuro-Behçet’s disease. Case Rep Emerg Med. 2018;2018:5437027.
Palesi F, De Rinaldis A, Castellazzi G, Calamante F, Muhlert N, Chard D, Tournier JD, Magenes G, D’Angelo E, Gandini Wheeler-Kingshott CAM. Contralateral cortico-ponto-cerebellar pathways reconstruction in humans in vivo: implications for reciprocal cerebro-cerebellar structural connectivity in motor and non-motor areas. Sci Rep. 2017;7(1):12841.
Patel P, Steinschneider M, Boneparth A, Lantos G. Neuro-Behcet disease presenting with acute psychosis in an adolescent. J Child Neurol. 2014;29(9):86–91.
Rosti-Otajärvi EM, Hämäläinen PI. Neuropsychological rehabilitation for multiple sclerosis. Cochrane Database Syst Rev. 2014;(2):CD009131. https://doi.org/10.1002/14651858.cd009131.pub3.
Schmahmann JD. The cerebellum and cognition. Neurosci Lett. 2018;688:62–75.
Shrestha R, Erfan A. Behavioral and cognitive impairments as presenting features of Behcet’s disease. J Neuropsychiatry Clin Neurosci. 2013;25(4):E05–7.
Sokolov AA, Miall RC, Ivry RB. The cerebellum: adaptive prediction for movement and cognition. Trends Cogn Sci. 2017;21(5):313–32.
Taner E, Coşar B, Burhanoğlu S, Çalıkoğlu E, Önder M, Arıkan Z, Calikoğlu E, Onder M, Arikan Z. Depression and anxiety in patients with Behçet’s disease compared with that in patients with psoriasis. Int J Dermatol. 2007;46(11):1118–24.
Tursen U, Gurler A, Boyvat A. Evaluation of clinical findings according to sex in 2313 Turkish patients with Behcet’s disease. Int J Dermatol. 2003;42(5):346–51.
Uguz F, Dursun R, Kaya N, Cilli AS. Quality of life in patients with Behcet’s disease: the impact of major depression. Gen Hosp Psychiatry. 2007;29(1):21–4.
Uygunoglu U, Siva A. Behcet’s syndrome and nervous system involvement. Curr Neurol Neurosci Rep. 2018;18(7):35.
van der Hoeven J, Duyx J, de Langen JJ, van Royen A. Probable psychiatric side effects of azathioprine. Psychosom Med. 2005;67(3):508.
van Ham C, Schrijvers D, De Picker L, Vandendriessche F, Sabbe B. Neuropsychiatric features in Behcet’s disease: a case report. Clin Neurol Neurosurg. 2014;127:13–4.
Vignola S, Nobili F, Picco P, Gattorno M, Buoncompagni A, Vitali P, Mariani G, Rodriguez G. Brain perfusion spect in juvenile neuro-Behcet’s disease. J Nucl Med. 2001;42(8):1151–7.
Hoffmann M, Cases LB. Etiology of frontal network syndromes in isolated subtentorial stroke. Behav Neurol. 2008;20(3):101–105. https://doi.org/10.3233/BEN-2008-0220
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Gündüz, T., Ertekin, E. (2021). Neuropsychiatric Symptoms in Neuro-Behçet’s Disease. In: Tüzün, E., Kürtüncü, M. (eds) Neuro-Behçet’s Disease. Springer, Cham. https://doi.org/10.1007/978-3-030-55273-2_11
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