Invisible neuropsychiatric burden in Behçet's disease without central nervous system involvement: a phenotype-based comparison

Neuro-Behçet's disease (NBD) is a serious complication of Behçet's disease (BD); however, data focusing on neuropsyhiatric symptoms in patients without overt neurological involvement remain limited. The burden of neuropsychiatric symptoms in non-neuro-Behçet's disease (non-NBD) across different BD phenotypes were evaluated.

In this cross-sectional, single-centre study, 152 patients with BD were classified as mucocutaneous (mBD, n=69), ocular (oBD, n=26), vascular (vBD, n=40), or NBD (n=17); and familial mediterranean fever (FMF) patients (n=37) for autoinflammatory burden and colchicine exposure and healthy controls (HC, n=29) were included. Neuropsychiatric assessment included headache characteristics, Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI) and Mini-Mental State Examination (MMSE).

Any headache was reported in 72.5% of mBD, 69.2% of oBD, and 67.5% of vBD patients, compared with 52.9% in NBD, 64.9% in FMF, and 41.4% in HC (p=0.012). Migraine-type headache was the most frequent subtype across groups. BAI scores did not differ significantly but tended to be higher in mBD. In contrast, depressive symptoms differed significantly (p=0.005), with higher BDI scores in mBD (14) and vBD (13.5) compared with NBD (11), FMF (9) and HC (7). Cognitive impairment (MMSE ≤23) was more frequent in mBD (41.2%) and NBD (41.2%) than in vBD (15.0%), FMF (10.8%) and HC (24.1%) (p=0.001).

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. These findings support the need for routine neuropsychiatric evaluation across all BD phenotypes, extending beyond the traditional NBD framework.