P4‐336: Clinical, behavioral and treatment differences in nursing home residents with dementia, with and without PBA symptomatology

Abstract

Pseudobulbar affect (PBA) is a neurologic condition characterized by sudden, frequent and involuntary episodes of crying or laughing which occurs secondary to neurologic conditions or brain injury. PBA-associated crying episodes may be inaccurately attributed to a mood disorder. Our objective was to characterize the prevalence and impact of symptoms suggestive of PBA in residents of nursing facilities with Alzheimer's disease (AD) and non-AD dementia. Data were extracted retrospectively from a large repository of de-identified and linked Minimum Data Set 2.0 (MDS) and prescription claims records of US nursing home residents between 10/1/2009 and 9/30/2010. PBA symptomatology was defined as a score of 1 or 2 on MDS item E1m (“crying, tearfulness”). Concomitant diagnoses, MDS mood and behavioral indicators, and psychopharmacologic medication use in residents with PBA symptoms were compared with a group of residents without PBA symptoms who were propensity-matched for age, gender, diagnosis of AD or non-AD dementia, and diagnosis of depression. A total of 137,829 residents underwent at least one MDS assessment during the study period. Of these, 12,595 (9.1%) had item E1m (“crying, tearfulness”) scored as a 1 or 2 on their MDS assessments. Ten thousand residents were then randomly selected from this group and matched to 10,000 controls without crying/tearfulness for analysis. A total of 4786 (48%) unique residents with symptoms of PBA had a diagnosis of AD or non-AD dementia. All of the MDS mood indicators were at least twice as prevalent in the group with PBA symptomatology compared to those without. Additionally, mood symptoms such as anger, worried/pained facial expressions, and repetitive verbalizations; and behavioral symptoms such as verbal/physical abuse and socially inappropriate/disruptive behavior were more than twice as frequent in the PBA symptomatology group. Antipsychotic medications were also used more often in the group with PBA symptoms (50% vs 36.1%), as were antidepressants (59.1% vs 49.8%). Nursing home residents with dementia and symptoms suggestive of PBA had a higher prevalence of mood and behavioral symptoms, and antipsychotic use. Further research should better-elucidate PBA symptoms in this population.