Advertisement

A Systematic Review of Neurocognitive Functioning in Behçet’s Disease

  • Caroline A. FisherEmail author
  • Coco Bernard
Review

Abstract

Behçet’s disease (BD) is a vascular, inflammatory multisystem disorder with neuro-Behçet’s (NBD) diagnosed in a subset of patients with neurological manifestations. The objective of this review was to determine whether neurocognitive dysfunction is observed in BD, in which neurocognitive domains, and whether there are differences in rates of dysfunction observed between BD and NBD groups. Studies of any methodology were included that reported results from standardized neurocognitive assessment measures in participants with BD or NBD. Twelve group comparison studies met the criteria for inclusion in the review (totalling 284 BD and 157 NBD participants), as well as 17 case study/series papers (11 BD, 35 NBD). Issues with blinding, incomplete data reporting and selective reporting bias were found across the group and case study/series papers, as well as inadequate statistical adjustment for multiple comparisons in the group studies, and the lack of the use of appropriate norms or adjustment for premorbid ability in the case series/studies papers. These quality issues impacted on the conclusions that could be drawn from the current literature. Neurocognitive dysfunction was found in NBD compared to health controls (HC) in a higher proportion of results across studies, than in comparisons between BD and HC groups. The domains in which neurocognitive attenuation was most often reported were visual spatial ability, working memory and acquired knowledge, with more than 25% of these results showing significantly lower functioning in both the BD and NBD groups compared to HC. More than 25% of the processing speed and long-term memory encoding and retrieval results were also lower for the NBD group, compared to HC. Group comparisons between NBD and multiple sclerosis participants indicated few significant differences in neurocognitive test results. The majority of case study/series participants were found to have some degree of attenuated neurocognitive functioning, as defined by case study/series authors.

Keywords

Behçet’s Cognition Neuro-Behçet’s Neurocognitive Neuropsychology 

Notes

Acknowledgements

We would like to thank Tony Monteleone, Michael Johnston, Marie-Christina Rieder and Roy Kessels for their translation assistance.

Compliance with Ethical Standards

Conflict of Interest

Author A is also an author on one of the papers included in the systematic review.

References

  1. Al-Dalaan, A. N., al Balaa, S. R., el Ramahi, K., Al-Kawi, Z., Bohlega, S., Bahabri, S., & al Janadi, M. A. (1994). Behçet’s disease in Saudi Arabia. Journal of Rhematology, 21(4), 658–661.Google Scholar
  2. Alibaz-Oner, F., Sawalha, A. H., & Direskeneli, H. (2018). Management of Behçet's disease. Current Opinion in Rheumatology, 30(3), 238–242.CrossRefGoogle Scholar
  3. Allott, K., Fisher, C. A., Amminger, G. P., Goodall, J., & Hetrick, S. (2016). Characterizing neurocognitive impairment in young people with major depression: State, trait, or scar? Brain and Behaviour, 6(10), e00527.  https://doi.org/10.1002/brb3.527 CrossRefGoogle Scholar
  4. Arai, T., Mizukami, K., Sasaki, M., Tanaka, Y., Shiraishi, H., Horiguchi, H., et al. (1994). Clinicopathological study on a case of neuro-Behçet’s disease: In special reference to MRI, SPECT and neuropathological findings. The Japanese Journal of Psychiatry and Neurology, 48(1), 77–84.Google Scholar
  5. Bang, D., Lee, J. H., Lee, E. S., Lee, S., Choi, J. S., Kim, Y. K., ... & Park, S. D. (2001). Epidemiologic and clinical survey of Behçet’s disease in Korea: The first multicenter study. Journal of Korean Medical Science, 16(5), 615–618.Google Scholar
  6. Banich, M. T. (2009). Executive function. The search for an integrated account. Current Directions in Psychological Science, 18(2), 89–94.  https://doi.org/10.1111/j.1467-8721.2009.01615.x CrossRefGoogle Scholar
  7. Beeldman, E., Raaphorst, J., Twennaar, M. K., De Visser, M., Schmand, B. A., & De Haan, R. J. (2016). The cognitive profile of ALS: A systematic review and meta-analysis update. Journal of Neurology, Neurosurgery and Psychiatry, 87(6), 611–619.CrossRefGoogle Scholar
  8. Bingol, A., Topcular, B., Yildiz, S., Kaya, P., Tutuncu, M., Demirci, O., ... & Siva, A. (2011). Is Cognitive Dysfunction in Multiple Sclerosis and Neuro-Behçet’s Disease Similar? Paper presented at the Twenty-first Meeting of the European Neurological Society 28–31 May, Lisbon, Portugal. Journal of Neurology, 258(Supplement 1), S102.  https://doi.org/10.1007/s00415-011-6026-9
  9. Borson, S. (1982). Behçet’s disease as psychiatric disorder: A case report. American Journal of Psychiatry, 139(10), 1348–1349.CrossRefGoogle Scholar
  10. Brown, E. S., & Chandler, P. A. (2001). Mood and cognitive changes during systemic corticosteroid therapy. Primary Care Companion to the Journal of Clinical Psychiatry, 3(1), 17–21.CrossRefGoogle Scholar
  11. Bussone, G., La Mantia, L., Boiardi, A., & Giovannini, P. (1982). Chorea in Behçet’s syndrome. Journal of Neurology, 227(2), 89–92.CrossRefGoogle Scholar
  12. Castaneda, A. E., Tuulio-Henriksson, A., Marttunen, M., Suvisaari, J., & Lönnqvist, J. (2008). A review on cognitive impairments in depressive and anxiety disorders with a focus on young adults. Journal of Affective Disorders, 106(1), 1–27.CrossRefGoogle Scholar
  13. Cavaco, S., Da Silva, A. M., Pinto, P., Coutinho, E., Santos, E., Bettencourt, A., ... & Carvalho, L. (2009). Cognitive functioning in Behçet’s disease. Annals of the New York Academy of Sciences, 1173, 217–26.Google Scholar
  14. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum.Google Scholar
  15. Dalvi, S. R., Yildirim, R., & Yazici, Y. (2012). Behçet’s Syndrome. Drugs, 72(17), 2223–2241.CrossRefGoogle Scholar
  16. Davatchi, F. (2012). Diagnosis/classification criteria for behcet's disease. Pathology Research International, 2012.  https://doi.org/10.1155/2012/607921
  17. Davatchi, F., Assaad-Khalil, S., Calamia, K. T., Crook, J. E., Sadeghi-Abdollahi, B., Schirmer, M., ... & Alekberova, Z. S. (2014). The international criteria for Behçet’s disease (ICBD): A collaborative study of 27 countries on the sensitivity and specificity of the new criteria. Journal of the European Academy of Dermatology and Venereology, 28(3), 338–347.Google Scholar
  18. Davatchi, F., Chams-Davatchi, C., Ghodsi, Z., Shahram, F., Nadji, A., Shams, H., ... & Sadeghi-Abdolahi, B. (2011). Diagnostic value of Pathergy test in Behçet’s disease according to the change of incidence over the time. Clinical Rheumatology, 30(9), 1151–1155.Google Scholar
  19. Davatchi, F., Shahram, F., Chams-davatchi, C., Shams, H., Nadji, A., Akhlaghi, M., ... & Abdollahi, B. S. (2010). Behçet’s disease in Iran: Analysis of 6500 cases. International Journal of Rheumatic Diseases, 13, 367–373.Google Scholar
  20. Domingos, J., Ferrão, C., Ramalho, J., Rodrigues, T., Moreira, B., Santos, E., ... & Vasconcelos, C. (2015). Characteristics of neuro-Behçet’s disease in a case-series from a single Centre in Northern Portugal. European Neurology, 73(5–6), 321–328.Google Scholar
  21. Dutra, L. A., de Souza, A. W. S., Alessi, H., Guedes, B. D. V. S., Braga-Neto, P., Pedroso, J. L., ... & Barsottini, O. G. P. (2013). Cognitive impairment in Brazilian patients with Behçet’s disease occurs independently of neurologic manifestation. Journal of the Neurological Sciences, 327(1–2), 1–5.Google Scholar
  22. Erberk-Ozen, N., Birol, A., Boratav, C., & Kocak, M. (2006). Executive dysfunctions and depression in Behçet’s disease without explicit neurological involvement. Psychiatry and Clinical Neurosciences, 60, 465–472.CrossRefGoogle Scholar
  23. Erkol, G., Vural, M., Karantay, F., & Uluduz, D. (2009). Event-related potentials and paced auditory serial addition test (PASAT) evaluation in Behçet’s syndrome with subclinical neural involvement. Nobel Medicus, 5(2), 29–34.Google Scholar
  24. Evans, V. C., Iverson, G. L., Yatham, L. N., & Lam, R. W. (2014). The relationship between neurocognitive and psychosocial functioning in major depressive disorder: A systematic review. Journal of Clinical Psychiatry, 75(12), 1359–1370.CrossRefGoogle Scholar
  25. Farahangiz, S., Sarhadi, S., Safari, A., & Borhani-Haghighi, A. (2012). Magnetic resonance imaging findings and outcome of neuro-Behçet’s disease: The predictive factors. International Journal of Rheumatic Diseases, 15(6), 142–149.CrossRefGoogle Scholar
  26. Feng, H., Kuo, S., Chen, C., & Yeh, Y. (2014). Nocturnal bruxism in a patient with Behçet disease and posttraumatic stress disorder successfully treated with gabapentin. Clinical Neuropharmacology, 37(6), 190–191.CrossRefGoogle Scholar
  27. Fisher, C. A., Sewell, K., & Baker, A. (2016). Chronic behavior disturbance and neurocognitive deficits in neuro-Behçet’s disease: A case study. Neurocase, 22(3), 332–338.CrossRefGoogle Scholar
  28. Gabrielyan, I., Harutyunyan, K., Avagyan, G., Amirjanyan, H., Khachaturyan, S., Hambardzumyan, H., & Manvelyan, H. M. (2015). Neuro-Behcet’s disease: A case report. European Journal of Neurology, 22 (Suppl. 1, 510.Google Scholar
  29. Ganzer, F., Bröning, S., Kraft, S., Sack, P. M., & Thomasius, R. (2016). Weighing the evidence: A systematic review on long-term neurocognitive effects of Cannabis use in abstinent adolescents and adults. Neuropsychology Review, 26(2), 186–222.CrossRefGoogle Scholar
  30. Gates, N. J., & March, E. G. (2016). A Neuropsychologist’s guide to undertaking a systematic review for publication: Making the Most of PRISMA guidelines. Neuropsychology Review, 26(2), 109–120.CrossRefGoogle Scholar
  31. Goodall, J., Fisher, C., Hetrick, S., Phillips, L., Parrish, E. M., & Allott, K. (2018). Neurocognitive functioning in depressed young people: A systematic review and meta-analysis. Neuropsychology Review, 28(2), 216–213.  https://doi.org/10.1007/s11065-018-9373-9 CrossRefGoogle Scholar
  32. Gündüz, T., Emir, Ö., Kürtüncü, M., Mutlu, M., Tumaç, A., Akca, S., et al. (2012). Cognitive impairment in neuro-Behcet’s disease and multiple sclerosis: A comparative study. International Journal of Neuroscience, 122(11), 650–656.  https://doi.org/10.3109/00207454.2012.704454
  33. Haghighi, A. B., Sarhadi, S., & Farahangiz, S. (2011). MRI findings of neuro-Behçet’s disease. Clinical Rheumatology, 30, 765–770.CrossRefGoogle Scholar
  34. Hatemi, G., Yazici, Y., & Yazici, H. (2013). Behçet’s Syndrome. Rheumatic Disease Clinics of North America, 39, 245–261.CrossRefGoogle Scholar
  35. Hernández, F. J. G., Medina, C. O., Romero, L. M., Román, J. S., Solís, D. G., Franco-Baux, J. R., Merchán, J. M. (2002). Utilidad de La SPECT Cerebral Con HMPAO-99mTc Y de Los Tests Psicométricos En El Diagnóstico de La Afección Neurológica de La Enfermedad de Behçet. Medicina Clinica, 119(12), 446–450.Google Scholar
  36. Higgins, J. P. T., Altman, D. C., & Sterne, J. A. C. (2017). Chapter 8: Assessing risk of Bias in included studies. In M. S. Cumpston, J. P. T. Higgins, R. Churchill, & J. Chandler (Eds.), Cochrane handbook for systematic reviews of interventions version 5.2.0 (sections 8:1–8:73). Cochrane (p. 2017).Google Scholar
  37. Hirohata, S., Suda, H., & Hashimoto, T. (1998). Low-dose weekly methotrexate for progressive neuropsychiatric manifestations in Behçet’s disease. Journal of the Neurological Sciences, 159(2), 181–185.CrossRefGoogle Scholar
  38. Hoelzle, J.B. (2008). Neuropsychological assessment and the Cattell- horn-Carroll (CHC) cognitive abilities model. Theses and Dissertations, 1192, University of Toledo, http://utdr.utoledo.edu/theses-dissertations/1192.
  39. Ideguchi, H., Suda, A., Takeno, M., Kirino, Y., Ihata, A., Ueda, A., ... & Ishigatsubo, Y. (2010). Neurological manifestations of Behçet’s disease in Japan: A study of 54 patients. Journal of Neurology, 257, 1012–1020,  https://doi.org/10.1007/s00415-010-5454-2.
  40. International Study Group for Behçet’s Disease. (1990). Criteria for diagnosis of Behçet’s disease. International study Group for Behçet’s disease. Lancet, 335(8697), 1078–1080.Google Scholar
  41. Jewsbury, P. A., & Bowden, S. C. (2017). Construct validity of fluency and implications for the factorial structure of memory. Journal of Psychoeducational Assessment, 35(5), 460–481.CrossRefGoogle Scholar
  42. Jewsbury, P. A., Bowden, S. C., & Duff, K. (2017). The Cattell–Horn–Carroll model of cognition for clinical assessment. Journal of Psychoeducational Assessment, 35(6), 547–567.  https://doi.org/10.1177/0734282916651360 CrossRefGoogle Scholar
  43. Jewsbury, P. A., Bowden, S. C., & Strauss, M. E. (2016). Integrating the switching, inhibition, and updating model of executive function with the Cattell-horn-Carroll model. Journal of Experimental Psychology: General, 145(2), 220–245.CrossRefGoogle Scholar
  44. Kale, N., Agaoglu, J., Icen, M., Yazici, I., & Tanik, O. (2008). The presentation of headache in neuro-Behçet’s disease: A case-series. Headache, 49(3), 467–470.CrossRefGoogle Scholar
  45. Kalra, S., Silman, A., Akman-Demir, G., Bohlega, S., Borhani-Haghighi, A., Constantinescu, C., ... & Siva, A. (2014). Diagnosis and Management of Neuro-Behçet’s disease: International consensus recommendations. Journal of Neurology, 261(9), 1662–1676.Google Scholar
  46. Kawanishi, Y., Hori, T., Suzuki, T., Mizukami, K., Sasaki, M., & Shiraishi, H. (1995). A clinical case of neuro-Behçet syndrome without Mucocutaneo-ocular symptoms: Relationship with brain stem encephalitis. Psychiatry and Clinical Neurosciences, 49(5), 263–266.CrossRefGoogle Scholar
  47. Kidd, D. P. (2017). Neurological complications of Behçet’s syndrome. Journal of Neurology, 264(10), 2178–2183.CrossRefGoogle Scholar
  48. Kikuchi, H., Sawada, T., Okada, M., Takeno, M., Kuwana, M., Ishigatsubo, Y., ... & Hirohata, S. (2017). Recommendations for the management of neuro-Behçet’s disease by the Japanese national research committee for Behçet’s disease. Journal of the Neurological Sciences, 381, 646–647.Google Scholar
  49. Koçer, N., Islak, C., Siva, A., Saip, S., Akman, C., Kantarci, O., & Hamuryudan, V. (1999). CNS Involvement in Neuro-Behçet Syndrome: An MR Study. American Journal of Neuroradiology, 20(6), 1015–1024.Google Scholar
  50. Kronborg, C., Mahar, P. D., & Kelly, R. (2014). Should we keep changing the diagnostic criteria for Behçet’s disease? Dermatology, 228, 1–4.CrossRefGoogle Scholar
  51. Larrabee, G. J. (2014). Test validity and performance validity: Considerations in providing a framework for development of an ability-focused neuropsychological test battery. Archives of Clinical Neuropsychology, 29(7), 695–714.CrossRefGoogle Scholar
  52. Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P., ... & Moher, D. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. British Medical Journal, 6(7), e1000100,  https://doi.org/10.1136/bmj.b2700
  53. Lupien, S. J., Gillin, C. J., & Hauger, R. L. (1999). Working memory is more sensitive than declarative memory to the acute effects of corticosteroids: A dose–response study in humans. Behavioral Neuroscience, 113(3), 420–430.CrossRefGoogle Scholar
  54. Madanat, W., Fayyad, F., Verity, D., & Zureikat, H. (2000). Influence of sex on Behçet’s disease in Jordan. In D. Bang, E. Lee, & S. Lee (Eds.), Behçet’s disease (pp. 90–93). Seoul: Design Mecca Publishing.Google Scholar
  55. Mason, R. M., & Barnes, C. G. (1969). Behçet's syndrome with arthritis. Annals of the Rheumatic Diseases, 28(2), 95.CrossRefGoogle Scholar
  56. Matsui, T., Ishida, T., Tono, T., Yoshida, T., Sato, S., & Hirohata, S. (2010). An Attache of cute neuro-Behçet’s disease during the course of chronic progressive neuro-Behçet’s disease: Report of two cases. Modern Rheumatology, 20, 621–626.CrossRefGoogle Scholar
  57. Melillo, N., Sangle, S., Stanford, M. R., Andrews, T. C., & D’Cruz, D. P. (2007). Low-dose intra-venous cyclophosphamide therapy in a patient with neurological complications of Behçet’s disease. Clinical Rheumatology., 26(8), 1365–1367.  https://doi.org/10.1007/s10067-006-0385-0 CrossRefGoogle Scholar
  58. Mimura, M., Kato, M., & Kashima, H. (2009). Neuro-Behcet’s disease presenting with amnesia and frontal dysfunction. Clinical Neurology and Neurosurgery, 111(10), 889–892.  https://doi.org/10.1016/j.clineuro.2009.08.002 CrossRefGoogle Scholar
  59. Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. British Medical Journal, 339(b2535), 332–336.Google Scholar
  60. Monastero, R., Camarda, C., Pipia, C., Lopez, G., Camarda, L. K., Baiamonte, V., ... & Camarda, R. (2004). Cognitive impairment in Behçet’s disease patients without overt neurological involvement. Journal of the Neurological Sciences, 220, 99–104.Google Scholar
  61. Noel, N., Bernard, R., Wechsler, B., Resche-Rigon, M., Depaz, R., Le Thi Huong Boutin, D., ... & Saadoun, D. (2014). Long term outcomes in neuro-Behçet’s disease. Arthritis & Rheumatology, 66(5), 1306–14.Google Scholar
  62. Nurova, B., Kurtuncu, M., Coban, A., Birday, E., & Eraksoy, M. (2014). Computer assisted cognitive rehabilitation in patients with multiple sclerosis and parenchymal neuro-Behçet’s disease. Journal of Neurology, 261(supplement 1), S246.Google Scholar
  63. O'Duffy, J. D., & Goldstein, N. P. (1976). Neurologic involvement in seven patients with Behçet's disease. The American Journal of Medicine, 61(2), 170–178.CrossRefGoogle Scholar
  64. Oktem-Tanör, O., Baykan-Kurt, B., Gürvit, I. H., Akman-Demir, G., & Serdaroğlu, P. (1999). Neuropsychological follow-up of 12 patients with neuro-Behçet disease. Journal of Neurology, 246, 113–119.  https://doi.org/10.1007/s004150050317 CrossRefGoogle Scholar
  65. Özdemir, D. F., Özsoylar, G., Candansayar, S., Coşar, B., & Önder, M. (2004). Psychiatric findings related to neurological complications in Behçet’s disease: A short review and a case presentation. International Journal of Psychiatry in Clinical Practice, 8, 185–190.CrossRefGoogle Scholar
  66. Özen, N. E., Birol, A., Boratav, C., & Koçak, M. (2004). Nörolojik Tutulumu Olmayan Behçet Hastalarýnda Biliþsel Bozukluklar. Klinik Psikiyatri, 7, 187–198.Google Scholar
  67. Ozguler, Y., & Hatemi, G. (2016). Management of Behçet's syndrome. Current Opinion in Rheumatology, 28(1), 45–50.CrossRefGoogle Scholar
  68. Patten, S. B. (2000). Exogenous corticosteroids and major depression in the general population. Journal of Psychosomatic Research, 49(6), 447–449.CrossRefGoogle Scholar
  69. Park, K. W., Seo, J. H., & Yoon, G. U. (2007). Selective anterograde amnesia with thalamus and hippocampal lesions in neuro-Behcet’s disease. Clinical Neurology and Neurosurgery, 109(5), 470–473.  https://doi.org/10.1016/j.clineuro.2007.02.016 CrossRefGoogle Scholar
  70. Polman, C. H., Reingold, S. C., Banwell, B., Clanet, M., Cohen, J. A., Filippi, M., ... & Lublin, F. D. (2012). Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Annals of Neurology, 69(2), 292–302.Google Scholar
  71. Remmers, E. F., Cosan, F., Kirino, Y., Ombrello, M. J., Abaci, N., Satorius, C., ... & Aglar, O. (2010). Genome-wide association study identifies variants in the MHC class I, IL10, and IL23R-IL12RB2 regions associated with Behçet’s disease. Nature Genetics, 42(8), 698–702.Google Scholar
  72. Rock, P. L., Roiser, J. P., Riedel, W. J., & Blackwell, A. D. (2014). Cognitive impairment in depression: A systematic review and meta-analysis. Psychological Medicine, 44(10), 2029–2040.CrossRefGoogle Scholar
  73. Ségbédji, K. K. F., Abdulrazak, S., Nubukpo-Guménu, A. A., Benzagmout, M., Aggouri, M., Chakour, K., & Chaoui, M. F. (2017). A fatal case of probable Neurobehcet. Interdisciplinary Neurosurgery: Advanced Techniques and Case Management, 8, 14–16.  https://doi.org/10.1016/j.inat.2017.01.008 CrossRefGoogle Scholar
  74. Shahram, F., Latifi, G., Noroozian, M., Ghadiri, N.K., Abdollahi, B.S., Mohammad, H.F., & Davatchi, F. (2010). 14th International Conference on Behçet’s Disease, London, United Kingdom. In Cognitive Impairment in Patients with Behçet’s Disease: A Case-Control Study, S159. London, United Kingdom.Google Scholar
  75. Shakir, R. A., Sulaiman, K., Kahn, R. A., & Rudwan, M. (1990). Neurological presentation of neuro-Behçet’s syndrome: clinical categories. European Neurology.  https://doi.org/10.1159/000117356
  76. Siva, A., & Saip, S. (2009). The Spectrum of nervous system involvement in Behçet’s syndrome and its differential diagnosis. Journal of Neurology, 256(4), 513–529.CrossRefGoogle Scholar
  77. Soyka, M. (1987). Rezidivierende Verwirrtheitszustande Bei Zerebraler Manifestation Eines Morbus Behçet. Nervenarzt, 58, 388–391.Google Scholar
  78. Sucullu Karadag, Y., Kurt, P., Sahin, K., Karaaslan, Y., Oztekin, N., & Ak, F. (2014). Cognitive impairment not only in NeuroBehçet but also for all Behçet disease phenotypes. Journal of Neurological Sciences, 31(3), 511–520.Google Scholar
  79. Suda, H. (1999). Low-dose weekly methotrexate therapy for progressive neuro-Behçet’s disease. Japanese Journal of Clinical Immunology, 22(1), 13–22.CrossRefGoogle Scholar
  80. Tosto, G., Letteri, F., Canevelli, M., & Bruno, G. (2013). Efficacy of sertraline in a patient with neuro-Beçhet’s disease. Journal of Clinical Neuroscience, 20 (6). Elsevier Ltd: 896–897.  https://doi.org/10.1016/j.jocn.2012.05.044.
  81. Topicular, B., Bingol, A., Kaya, P., Yildiz, S., Uluduz, D., Siva, A., & Saip, S. (2011). Cognitive dysfunction in neuro-Behcet’s disease. Journal of Neurology, 258(Suppl 1), S102.Google Scholar
  82. Tsai, K. Y., Chen, J. T., Guo, W. Y., Fuh, J. L., & Liao, K. K. (2001). Behcet’s disease with pathologic laughing and crying: A case report and literature review. Acta Neurologica Taiwanica, 10(4), 271–276.Google Scholar
  83. Tursen, U., Gurler, A., & Boyvat, A. (2006). Evaluation of clinical findings according to sex in 2313 Turkish patients with Behçet’s disease. International Journal of Dermatology, 42, 346–351.CrossRefGoogle Scholar
  84. Türsen, Ü., & Türsen, B. (2014). Treatment options in Behçet’s disease. Global Journal of Dermatology & Venereology, 2, 27–49.CrossRefGoogle Scholar
  85. Uǧuz, F., Dursun, R., Kaya, N., & Cilli, A. S. (2007). Quality of life in patients with Behçet’s disease: The impact of major depression. General Hospital Psychiatry, 29, 21–24.CrossRefGoogle Scholar
  86. Valesini, G., Pezzi, P. P., Catarinelli, G., Accorinti, M., & Priori, R. (1991). Clinical manifestations of Behçet’s disease in Italy: Study of 155 patients at Rome University. In J. D. O’Duffy & E. Kokmen (Eds.), Behçet’s disease basic and clinical aspects (pp. 279–289). New York: Marcel Decker Inc..Google Scholar
  87. Wada, T., & Takahashi, T. (1969). Psychiatric signs of Behcet’s disease. Nihon Rinsho (Japanese Journal of Clinical Medicine), 27(9), 2328–2332.Google Scholar
  88. Yamada, M., Kashiwamura, K., Nakamura, Y., Ota, T., & Nakamura, K. (1978). On psychiatric symptoms of neuro-Behçet’s syndrome. Folia Psychiatrica et Neurologica Japonica, 32(2), 191–197.Google Scholar
  89. Zayed, H., Effat, D., Nawito, Z., Abdou, A. A., Nasr El Din, M., El-Refaei, S., … Abu El-Einin, K. (2011). Silent central nervous system involvement in Egyptian Behçet’s disease patients: clinical, psychiatric, and neuroimaging evaluation. Clinical Rheumatology, 30, 1173–1180.Google Scholar
  90. Zuliani, C., Boni, P., & Fattorello, C. (1998). Valutazione Neuropsicologica in Un Caso Di Neuro-Behcet. Rivista Medica, 4(1), 67–70.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Allied Health - Psychology, Melbourne HealthRoyal Melbourne HospitalMelbourneAustralia
  2. 2.Neuropsychology Service, The Melbourne ClinicHealthscopeMelbourneAustralia
  3. 3.Adult Neuropsychology Service, Rehabilitation and Aged Care Services, Monash HealthKingston CentreCheltenhamAustralia
  4. 4.Adult Neuropsychology Service, Rehabilitation and Aged Care, Monash HealthCaulfield HospitalCaulfieldAustralia

Personalised recommendations