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Yıl:2019; Cilt: 56; Sayı: 3>> Özet
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Nöropsikiyatri Arşivi; 2019;56(3):173-177
Göz Tutulumu Olan Behçet Hastalığında Bilişsel İşlevler ve Sessiz Nörolojik Bulgular
Y Altunkaynak, Ş Usta, DH Ertem, A Köksal, AC Dirican, S Baybaş
Bakırköy Ruh Sağlığı ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesi, İstanbul
Amaç: Behçet Hastalığında bilişsel işlev bozukluğunu bildiren çeşitli araştırmalar mevcuttur. Bu çalışmada göz tutulumu olan Behçet hastalarında sessiz nörolojik bulgularla birlikte davranışsal ve nöropsikolojik bozuklukların varlığını araştırmayı amaçladık. Yöntem: Hastalıklarının aktif fazında olmayan göz tutulumlu 30 Behçet hastasının ayrıntılı nörolojik değerlendirmesi ve manyetik rezonans (MR) görüntülemeleri yapıldı. Hastalara nöropsikolojik testler uygulanarak, demografik olarak benzer 20 sağlıklı kontrolle test performansları karşılaştırıldı. Bulgular: Hastaların nörolojik bulguları sıklık sırasına göre baş ağrısı (%56,6), pirimidal bulgular (%13,3), davranışsal değişiklikler (%3,3) ve duysal yakınmalardı (%3,3). Dört olgunun T2/FLAIR MR kesitlerinde ak maddede hiperintens non-spesifik lezyonlar mevcuttu. On dört olguda (%46) saptanan bozulmuş bilişsel işlevler şunlardır: Sözel bellek (anlık bellek p=0,000, maksimum öğrenme kapasitesi p=0,009, tekrar etme sayısı p=0,000, toplam öğrenme kapasitesi p=0,001, hatırlama p=0,033), sözel olmayan bellek (anlık bellek p=0,029, hatırlama p=0,001), mantıksal bellek (anlık bellek p=0,001, hatırlama p=0,001), yönetici işlevler (saat çizme testi p=0,000, Stroop test p=0,001, sözel akıcılık testi p=0,000). Behçet hastalarının Standardize Minimental Test ve saat çizme test skorları kontrol grubundan anlamlı olarak düşüktü (p=0,03). Dikkat eksikliği saptanmadı. Behçet hastalarının depresyon skorları kontrol grubundan yüksek bulundu (p=0,001) ancak anksiyete skorlarında istatistiksel olarak anlamlı fark yoktu. Sonuç: Belirgin nörolojik bulguları olmayan göz tutulumlu Behçet hastalarında, özellikle bellek ve yürütücü işlevlerin etkilendiği nöropsikolojik bozukluklar, subkortikal MR lezyonları ve baş ağrısı görülebilir
Cognitive Functioning and Silent Neurological Manifestations in Behçet’sDisease with Ocular Involvement
Introduction: Various reports have revealed a cognitive dysfunction in Behçet’s disease (BD). In this study, we aimed to assess the silent neurological manifestations, behavioral and neuropsychiological impairments of Behçet’s disease patients with ocular involvement. Methods: Thirty BD patients with ocular involvement in the nonactive phase of their illness were applied detailed neurological examination and magnetic resonance imagining (MRI). Neuropsychological tests were performed. Patients’ neuropsychological performances were compared to those of healthy, demographically matched twenty subjects. Results: Neurological manifestations of patients were headache (56.6%), pyramidal signs (13.3%), behavioral changes (3.3%) and sensory symptoms (3.3%). Four patients (13.3%) had white matter hyperintensities lesions on T2/FLAIR brain MRI. Fourteen patients (46%) had impaired cognitive performances on the following tasks: verbal memory (immediate memory p=0.000, maximal learning capacity p=0.009, number of repetitions p=0.000, total learning capacity p=0.001, recall p=0.033), nonverbal memory (immediate memory p=0.029, recall p=0.001), logical memory (immediate memory p=0.001, recall p=0.001), executive (frontal) functions (clock-drawing test p=0.000, Stroop test p=0.001, verbal fluency tests p=0.000). Patients’ MMSE and clock drawing test scores were significantly lower than controls (p=0.03). Attention deficit was not detected. Behçet’s disease patients showed higher scores on depression scales than healthy subjects but there was no statistically significant difference between anxiety scores. Conclusion: Neuropsychological deficits, involving mainly memory and executive functioning, subcortical MRI lesions, and non-structural headache may be present in Behçet’s disease patients with ocular involvement without overt neurological manifestations.

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