Abstract
BackgroundPseudobulbar affect (PBA) is a neurological condition characterized by involuntary, sudden, and frequent episodes of laughing and/or crying, which can be socially disabling. Although PBA occurs secondary to many neurological conditions, with an estimated United States (US) prevalence of up to 2 million persons, it is thought to be under-recognized and undertreated. The PBA Registry Series (PRISM) was established to provide additional PBA symptom prevalence data in a large, representative US sample of patients with neurological conditions known to be associated with PBA.MethodsParticipating clinicians were asked to enroll ≥20 consenting patients with any of 6 conditions: Alzheimer’s disease (AD), amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), Parkinson’s disease (PD), stroke, or traumatic brain injury (TBI). Patients (or their caregivers) completed the Center for Neurologic Study−Lability Scale (CNS-LS) and an 11-point scale measuring impact of the neurological condition on the patient’s quality of life (QOL). Presence of PBA symptoms was defined as a CNS−LS score ≥13. Demographic data and current use of antidepressant or antipsychotic medications were also recorded.ResultsPRISM enrolled 5290 patients. More than one third of patients (n = 1944; 36.7%) had a CNS-LS score ≥13, suggesting PBA symptoms. The mean (SD) score measuring impact of neurological condition on QOL was significantly higher (worse) in patients with CNS-LS ≥13 vs <13 (6.7 [2.5] vs. 4.7 [3.1], respectively; P<0.0001 two-sample t-test). A greater percentage of patients with CNS−LS ≥13 versus <13 were using antidepressant/antipsychotic medications (53.0% vs 35.4%, respectively; P<0.0001, chi-square test).ConclusionsData from PRISM, the largest clinic-based study to assess PBA symptom prevalence, showed that PBA symptoms were common among patients with diverse neurological conditions. Higher CNS−LS scores were associated with impaired QOL and greater use of antipsychotic/antidepressant medications. These data underscore a need for greater awareness, recognition, and diagnosis of PBA.
Highlights
Pseudobulbar affect (PBA) is a neurological disorder of emotional expression characterized clinically by frequent, involuntary, and uncontrollable outbursts of laughing and/or crying that are incongruous with or disproportionate to the patient’s emotional state [1,2,3,4,5,6]
PBA occurs secondary to multiple neurological diseases or injury, including stroke, amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), traumatic brain injury (TBI), Alzheimer’s disease (AD), and Parkinson’s disease (PD), among others [3,7]
PBA has been correlated with brain lesions located primarily in the frontal lobes and descending pathways to the brain stem, basis pontis, and cerebellum, which comprise systems thought to be involved in motor control of emotional expression [5,10,11]
Summary
Pseudobulbar affect (PBA) is a neurological disorder of emotional expression characterized clinically by frequent, involuntary, and uncontrollable outbursts of laughing and/or crying that are incongruous with or disproportionate to the patient’s emotional state [1,2,3,4,5,6]. PBA occurs secondary to multiple neurological diseases or injury, including stroke, amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), traumatic brain injury (TBI), Alzheimer’s disease (AD), and Parkinson’s disease (PD), among others [3,7]. Because of their disruptive and often embarrassing nature, PBA episodes may have socially and occupationally disabling consequences, which are superimposed on the burden of the primary neurological disorder [2,3,8]. Pseudobulbar affect (PBA) is a neurological condition characterized by involuntary, sudden, and frequent episodes of laughing and/or crying, which can be socially disabling. The PBA Registry Series (PRISM) was established to provide additional PBA symptom prevalence data in a large, representative US sample of patients with neurological conditions known to be associated with PBA
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