Prevalence and Factors Related to Pathological Laughter and Crying in Patients With Amyotrophic Lateral Sclerosis.

Qian-Qian Wei,Yongping Chen,Tianmi Yang,Yanbing Hou,Ruwei Ou,Huifang Shang,Lingyu Zhang,Junyu Lin,Bei Cao

doi:10.3389/fneur.2021.655674

Qian-Qian Wei, Yongping Chen + Show 7 more

Open Access

https://doi.org/10.3389/fneur.2021.655674

Copy DOI

Abstract

Objective: This study aimed to explore the prevalence and clinical correlates of pathological laughter and crying (PLC) in patients with amyotrophic lateral sclerosis (ALS).Methods: A total of 1,031 ALS patients were enrolled between August 2012 and August 2019. The PLC was recorded by a face-to-face interview. Other characteristics of patients, including depression, anxiety, cognition, and behavior function, were also evaluated. The potential associated factors of PLC were explored using forward binary regression analysis. Survival was analyzed in groups using propensity score matching (PSM) and Cox proportional hazards models.Results: The prevalence of PLC was 11.4% in all patients at baseline. Bulbar-onset and female patients had higher prevalence of PLC. The multivariate regression analysis indicated that PLC in ALS was associated with bulbar onset (p < 0.001), late disease stage (p < 0.001), and higher score in the Hamilton Depression Rating Scale (HDRS) (p = 0.012). The higher score of HDRS was significantly and independently associated with PLC occurrence in bulbar-onset patients (p = 0.032). The late disease stage was related to PLC occurrence in spinal-onset patients (p < 0.001). After comparison with matched pairs by using PSM, PLC at baseline had no impact on survival.Conclusion: PLC was not uncommon in ALS, especially in bulbar-onset and female patients. We highlighted that the emotional state other than cognitive function had possible relationship with PLC in ALS.

Highlights

Pathological laughing and crying (PLC) is a neuropsychiatric condition that patients demonstrated exaggerated or inappropriate episodes of laughter, crying, or both, in the absence of an apparent motivating stimulus or in response to stimuli that would not usually elicit such an emotional response [1]
We explored the relationships among PLC, emotional state, and cognitive function
According to the Frontal assessment battery (FAB) score, 28.5% of patients had abnormal frontal function, and 27.7% of patients had cognitive decline according to the ACER score

Summary

Introduction

Pathological laughing and crying (PLC) is a neuropsychiatric condition that patients demonstrated exaggerated or inappropriate episodes of laughter, crying, or both, in the absence of an apparent motivating stimulus or in response to stimuli that would not usually elicit such an emotional response [1]. Despite the differences in terminology, the phenomenon has been observed in many neurological conditions including amyotrophic lateral sclerosis (ALS) [1, 2]. PLC is negatively affecting the social functioning and quality of life of patients and their families [4, 5]. Such unscheduled episodes may contribute to significant distress and embarrassment and may result in social withdrawal [6]. ALS patients and their families usually lack awareness of the relationships between PLC and their underlying neurological condition. It was important to explore the PLC symptoms in ALS patients with high-risk conditions [7]

Results

Discussion

Conclusion