Neuropsychiatric manifestations represent a substantial burden in BD even in the absence of overt neurological involvement, particularly in mBD with less control of inflammation and regular follow-up, supporting routine neuropsychiatric evaluation across all BD phenotypes, extending beyond the traditional NBD framework.
Key Findings
Results
Headache was more frequent in Behçet's disease patients without neurological involvement than in healthy controls, and was reported by about two-thirds or more of the mucocutaneous, ocular, and vascular groups.
Any headache was reported in 72.5% of mBD, 69.2% of oBD, and 67.5% of vBD patients.
Comparison groups: 52.9% in NBD, 64.9% in FMF, and 41.4% in healthy controls (p=0.012).
The study was cross-sectional and single-centre with 152 BD patients (mBD n=69, oBD n=26, vBD n=40, NBD n=17), 37 FMF patients, and 29 healthy controls.
Results
Migraine-type headache was the most frequent headache subtype across groups.
Headache characteristics were assessed as part of the neuropsychiatric evaluation.
The abstract reports migraine-type as most frequent across all groups, without giving subtype percentages.
Results
Anxiety scores on the Beck Anxiety Inventory did not differ significantly between groups but tended to be higher in mucocutaneous BD.
BAI was used to assess anxiety across BD phenotypes, FMF, and healthy controls.
The between-group difference was not statistically significant; the abstract describes only a tendency toward higher scores in mBD.
Results
Depressive symptoms differed significantly across groups, with the highest Beck Depression Inventory scores in mucocutaneous and vascular BD.
Group difference p=0.005.
Median BDI scores: mBD 14, vBD 13.5, NBD 11, FMF 9, HC 7.
Results
Cognitive impairment (MMSE ≤23) was most frequent in mucocutaneous BD and NBD patients.
Frequency: mBD 41.2% and NBD 41.2%, versus vBD 15.0%, FMF 10.8%, and HC 24.1% (p=0.001).
Cognitive impairment in mBD was as frequent as in the NBD group and exceeded that in healthy controls.
Discussion
The mucocutaneous phenotype carried a notable neuropsychiatric burden, which the authors link to less control of inflammation and less regular follow-up.
mBD had the highest or near-highest headache frequency, BDI scores, and rate of cognitive impairment among non-NBD groups.
FMF patients were included as a comparison for autoinflammatory burden and colchicine exposure.
Conclusions
The authors conclude that neuropsychiatric manifestations are a substantial burden across BD phenotypes even without overt neurological involvement, supporting routine neuropsychiatric evaluation.
The findings extend beyond the traditional NBD framework.
Evaluation included headache characteristics, BAI, BDI, and MMSE.
What This Means
This study looked at Behçet's disease, an inflammatory condition that can affect the skin and mouth, eyes, blood vessels, or nervous system. Researchers compared headaches, anxiety, depression, and thinking ability in 152 patients with different forms of the disease, plus patients with familial Mediterranean fever and healthy people. The main question was whether patients without obvious nervous system involvement still show neuropsychiatric problems.
Headaches were more common in patients with Behçet's disease affecting the skin/mouth, eyes, or blood vessels (about 67–73%) than in healthy controls (41%). Depression scores were higher in the skin/mouth and vascular groups than in the other groups. Scores on a cognitive screening test suggested impairment in about 41% of the skin/mouth group, a rate similar to that in patients with confirmed nervous system involvement and higher than in the other groups. Anxiety scores did not differ significantly between groups.
This research suggests that people with Behçet's disease who do not have recognized neurological disease may still carry a hidden burden of headache, low mood, and cognitive difficulty. The authors suggest that routine neuropsychiatric evaluation across all forms of the disease may be worthwhile. The study was cross-sectional and from one centre with modest group sizes, so it shows associations rather than cause and effect.
Tansu Yavuz C, Deniz R, Karabulut Gök S, Yavuz B, Bes C. (2026). Invisible neuropsychiatric burden in Behçet's disease without central nervous system involvement: a phenotype-based comparison.. Clinical and experimental rheumatology. https://doi.org/10.55563/clinexprheumatol/leo5kr