pseudobulbar affect

Pseudobulbar Affect (PBA) is a neurological disorder that causes uncontrollable

bouts of emotion such as laughing and crying. PBA can affect people at any age,

but generally accompanies another neurological disease such as Multiple Sclerosis

or Alzheimer's, according to This website is dedicated to raising

awareness about this little-known and misunderstood disorder.


In people with Alzheimer’s disease (AD) and dementia such a diagnosis can be

particularly difficult. PBA is common, affecting between 10–40 % of people with

AD but is frequently not detected or is misdiagnosed. According to figures from

The National Stroke Association, 20% of stroke survivors will experience PBA in

the year following their stroke.


Differentiating PBA from depression and other behavioral disturbances in AD and

dementia is helpful to identify a specific cause of their symptoms and assist with appropriate management. A person can have both PBA and depression, but they

are two separate diagnoses.





        • Emotional outbursts that are sudden and uncontrollable.

        • Outbursts can include laughing, crying, and can last as long as a few

          minutes, or be as short as a few seconds. According to the American Stroke

          Association, these episodes can strike a person up to 100 times a day.

        • Besides being out of the control of the person experiencing them, the

          emotional spells caused by PBA may not reflect the actual feelings of that

          individual. A person may cry in response to a joke or have a laughing fit

          during a sad time.

        • Outbursts may also be overly exaggerated, for example a person may display

          a bout of boisterous laughter in response to a neutral or mildly humorous






PBA is thought to be triggered by a traumatic injury, or a neurological disease that

affects the parts of the brain that deal with the processing and expression of emotions. People with PBA suffer from an injury-induced, "short-circuiting" of the signals that

govern their emotions.


Some health problems that can give rise to PBA include:


        • A stroke

        • Multiple Sclerosis

        • Alzheimer's disease

        • Parkinson's disease

        • Brain trauma

        • Lou Gehrig's disease (ALS)





PBA is a separate neurological disorder that can be diagnosed and treated

independently of other health related diagnoses. Diagnosing PBA can often be

challenging as the symptoms of this disease closely mirror those of depression

and other mood disorders.


Current diagnostic methods for PBA are relatively sparse. There are essentially

the two tests a physician may utilize to identify if person has PBA:


        • The Pathological Laughter and Crying Scale

        • The Center for Neurologic Study-Lability Scale.


These tests are designed to help a physician determine how often and severe

PBA outbursts are in a person and what their primary triggers are.


If you feel that you're caring for someone who may have undiagnosed PBA, discuss

the symptoms with their doctor.



Supporting a Loved One with PBA


PBA can have an enormous impact on a person's social life. Emotional occurrences caused by the disease can be distressing and can interfere with interpersonal relationships.


For caregivers of people with PBA, it can be difficult trying to deal with a person

who feels isolated and alone because of their disease. offers a tips for caregivers to help them interact positively with their

loved ones:


1. Let them know that you support them and they are not alone. Reassure them

    that many people suffer from the symptoms of PBA.

2. Remind them that their outbursts are caused by a physical disease, not a mental


3. Indicate your willingness to listen to their frustrations and concerns.

4. Keep an "episode diary." By recording PBA episodes, you can ensure better

    communication with your doctor and help him or her make an accurate diagnosis.