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Journal of Neurology

, Volume 257, Issue 8, pp 1382–1387 | Cite as

Pseudobulbar affect: prevalence and quality of life impact in movement disorders

  • Roy E. StrowdEmail author
  • Michael S. Cartwright
  • Michael S. Okun
  • Ihtsham Haq
  • Mustafa S. Siddiqui
Original Communication

Abstract

Pseudobulbar affect (PBA) is an affective disinhibition syndrome characterized by sudden, involuntary outbursts of inappropriate crying or laughing. We have previously reported the prevalence of PBA in movement disorders using an interviewer-administered questionnaire that had not been validated. In the current study, a validated self-administered screening instrument, the Center for Neurologic Study-Lability Scale (CNS-LS), was used to study the prevalence of PBA, its association with mood symptoms, and the quality of life impact. Two hundred sixty-nine patients met inclusion criteria (consent, age > 18 years, formal diagnosis, and completion of the CNS-LS). The CNS-LS was used to assess PBA at a cutoff score of 17 (utilized from multiple sclerosis studies). The Beck Depression Inventory (BDI) scale and Parkinson’s disease questionnaire (PDQ-39) were used to assess depressive symptoms and quality of life. Logistic regression analysis was used to predict associations with PBA. PBA was prevalent in 7.1% (n = 19) of movement disorder patients. No significant difference in prevalence was observed by patient diagnosis: 7.1% (12/168) in Parkinson’s disease (PD), 11.4% (4/35) in essential tremor, 0% (0/13) in dystonia, 0% (0/16) in psychogenic movement disorders, and 10.7% (3/28) in patients with other movement disorders. Patients with PBA had higher BDI depression scores (p < 0.0001) and lower PDQ-39 emotional well-being subscores (p < 0.0001). Patients taking antidepressant medications had significantly higher rates of PBA (p = 0.0008). The prevalence of PBA symptoms was 7.1% in PD and all movement disorders patients. Patients with PBA tend to have more depressive symptoms and poorer quality of life.

Keywords

Movement disorders Pseudobulbar affect Parkinson’s disease Depression Emotional incontinence Involuntary emotional expression disorder Emotional lability Pathologic or incontrollable laughter and crying 

Abbreviations

PBA

Pseudobulbar affect

CNS-LS

Center for Neurologic Study-Lability Scale

PD

Parkinson’s disease

ET

Essential tremor

BDI

Beck Depression Inventory scale

PDQ-39

39-question Parkinson’s disease questionnaire

MS

Multiple sclerosis

ALS

Amyotrophic lateral sclerosis

DBS

Deep brain stimulation

ROC

Receiver operated characteristic

Notes

Conflict of interest statement

None.

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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Roy E. Strowd
    • 1
    Email author
  • Michael S. Cartwright
    • 1
  • Michael S. Okun
    • 2
  • Ihtsham Haq
    • 2
  • Mustafa S. Siddiqui
    • 1
  1. 1.Department of Neurology, Medical Center BlvdWake Forest University School of MedicineWinston-SalemUSA
  2. 2.Department of NeurologyUniversity of FloridaGainesvilleUSA

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