Pseudobulbar Affect in Alzheimer’s Disease

Pseudobulbar affect (PBA) is a condition that causes sudden and uncontrollable bursts of emotion, such as laughing or crying, that may not reflect how a person is actually feeling.

Patients who have neurological conditions such as Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, traumatic brain injury, and strokes are all at risk of developing PBA. PBA is a distinct clinical condition, and not part and parcel of the underlying neurological disease.

How common is PBA

About two million people living in the U.S. are diagnosed with PBA, but over seven million people are thought to have symptoms suggestive of PBA. A study called PRISM, which analyzed 5,290 individuals with different neurological diseases, found that up to 29 percent of Alzheimer’s disease patients displayed symptoms of PBA.

What causes PBA?

The brain is made of two main parts, the cerebral cortex (the main bulk of the brain) and the brainstem (the stalk or ‘bulb’ of the brain). The neurological pathways between these two parts are important in regulating mood and emotion. PBA develops when a neurological disease or brain injury disrupts this connection.

Recognizing PBA

Those with PBA experience frequent and sudden, inappropriate spells of laughter or crying. These emotions may occur as an exaggerated response to situations, such as weeping instead of a frown when given bad news. Patients can also suddenly switch between laughing and crying, or vice versa.

These bursts may occur in ways that are inappropriate and confusing: for example, crying at a good news or laughing during a funeral. Patients have no control over the episodes, which may appear at any time and occasionally without any obvious trigger.

PBA versus depression

Because crying is a prominent feature of PBA, patients may be mistakenly thought to have depression.

However, people with PBA experience only short episodes in which they express sadness — lasting seconds to minutes —and do not persistently feel sad or depressed. Other symptoms common in depression, such as disturbed sleep or sleeping patterns or a loss of appetite, are also not seen in those with PBA.

Living with PBA

PBA has the ability to greatly impair a person’s social life. Unpredictable emotional outbursts can result in people developing phobias, causing them to isolate themselves at home. Educating family and friends about PBA can help in understanding the nature of this condition.

During episodes of emotional outburst, patients may find it helpful to take slow, deep breaths and try to relax until the episode passes. Changing body position (standing when previously sitting down and vice versa) may also help them to cope with such attacks.

PBA treatment

Nuedexta (dextromethorphan and quinidine) is the first, and currently only, treatment approved by the U.S. Food and Drug Administration (FDA) for PBA. It was tested in people with PBA secondary to dementia and brain injuries and reported to be effective.


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