Abstract
Introduction
Pseudobulbar affect (PBA) is characterized by involuntary and uncontrollable laughing and/or crying episodes, occurring secondary to neurological disease or injury. The impact of PBA on social and occupational function, health status, quality of life (QOL), and quality of relationships (QOR) is not well studied.
Methods
This US survey conducted by Harris Interactive compared health status and daily function of patients with and without PBA. Eligible respondents were Harris Panel Online registrants previously diagnosed with stroke, multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, traumatic brain injury, or amyotrophic lateral sclerosis, or primary, nonpaid caregivers for such patients who were too debilitated to participate. PBA was identified by a Center for Neurologic Study lability scale score of 13 or greater. Measures included the 36-item short form health survey (SF-36), the work productivity and impairment (WPAI) questionnaire, visual analog scales (VAS) for impact of PBA symptoms on QOL and QOR, and customized questions related to burden and impact of involuntary laughing/crying episodes on patients’ lives. Survey responses were weighted to adjust for the relative proportion of the primary neurological conditions in the overall population and between group differences in patient age and gender. PBA and non-PBA group responses were compared using two-tailed t tests adjusted for severity of the primary neurological conditions.
Results
The 1,052 respondents included 399 PBA group participants and 653 controls. The PBA group showed significantly worse scores versus non-PBA controls on component and summary SF-36 scores (P < 0.05 for all), VAS scores (P < 0.05 for both), and WPAI scores (P < 0.05). Among PBA group respondents, PBA contributed a great deal to or was the main cause of patients becoming housebound for 24% and being moved to supervised living placement for 9% of respondents.
Conclusion
PBA is associated with considerable burden incremental to that of the underlying neurological conditions, affecting QOL, QOR, health status, and social and occupational functioning.
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References
Dark FL, McGrath JJ, Ron MA. Pathological laughing and crying. Aust NZ J Psychiatry. 1996;30:472–479.
Schiffer R, Pope LE. Review of pseudobulbar affect including a novel and potential therapy. J Neuropsychiatry Clin Neurosci. 2005;17:447–454.
Wortzel HS, Oster TJ, Anderson CA, Arciniegas DB. Pathological laughing and crying: epidemiology, pathophysiology and treatment. CNS Drugs. 2008;22:531–545.
Arciniegas DB, Topkoff J. The neuropsychiatry of pathologic affect: an approach to evaluation and treatment. Semin Clin Neuropsychiatry. 2000;5:290–306.
Work S, Colamonico JA, Bradley WG, Kaye RE. Pseudobulbar affect: an under-recognized and undertreated neurological disorder. Adv Ther. 2011;28:586–601.
Wilson SAK. Some problems in neurology. II: pathological laughing and crying. J Neurol Psychopathol. 1924;4:299–333.
Davison C, Kelman H. Pathologic laughing and crying. Arch Neurol Psychiatry. 1939;42:595–643.
Calvert T, Knapp P, House A. Psychological associations with emotionalism after stroke. J Neurol Neurosurg Psychiatry. 1998;65:928–929.
Tateno A, Jorge RE, Robinson RG. Pathological laughing and crying following traumatic brain injury. J Neuropsychiatry Clin Neurosci. 2004;16:426–434.
Siddiqui MS, Fernandez HH, Garvan CW, et al. Inappropriate crying and laughing in Parkinson disease and movement disorders. World J Biol Psychiatry. 2009;10:234–240.
Strowd RE, Cartwright MS, Okun MS, Haq I, Siddiqui MS. Pseudobulbar affect: prevalence and quality of life impact in movement disorders. J Neurol. 2010;257:1382–1387.
Tang WK, Chen Y, Lam WW, et al. Emotional incontinence and executive function in ischemic stroke: a case-controlled study. J Int Neuropsychol Soc. 2009;15:62–68.
Choi-Kwon S, Kim JS. Poststroke emotional incontinence and decreased sexual activity. Cerebrovasc Dis. 2002;13:31–37.
Petracca GM, Jorge RE, Ación L, Weintraub D, Robinson RG. Frequency and correlates of involuntary emotional expression disorder in Parkinson’s disease. J Neuropsych Clin Neurosci. 2009;21:406–412.
Moore SR, Gresham LS, Bromberg MB, Kasarkis EJ, Smith RA. A self-report measure of affective lability. J Neurol Neurosurg Psychiatry. 1997;63:89–93.
Smith RA, Berg JE, Pope LE, Callahan JD, Wynn D, Thisted RA. Validation of the CNS emotional lability scale for pseudobulbar affect (pathological laughing and crying) in multiple sclerosis patients. Mult Scler. 2004;10:1–7.
Brooks BR, Thisted RA, Appel SH, et al; AVP-923 ALS Study Group. Treatment of pseudobulbar affect in ALS with dextromethorphan/quinidine: a randomized trial. Neurology. 2004;63:1364–1370.
Panitch HS, Thisted RA, Smith RA, et al; Pseudobulbar Affect in Multiple Sclerosis Study Group. Randomized, controlled trial of dextromethorphan/ quinidine for pseudobulbar affect in multiple sclerosis. Ann Neurol. 2006;59:780–787.
Pioro EP, Brooks BR, Cummings J, et al; Safety, Tolerability, and Efficacy Results Trial of AVP-923 in PBA Investigators. Dextromethorphan plus ultra low-dose quinidine reduces pseudobulbar affect. Ann Neurol. 2010;68:693–702.
Faul M, Xu L, Wald MM, Coronado VG. Traumatic brain injury in the United States: emergency department visits, hospitalizations and deaths 2002–2006. Overview, page 13. Atlanta: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010. Available at: http://www.cdc.gov/traumaticbraininjury/pdf/blue_book.pdf Accessed Aug 8 2012.
Ware JE Jr., Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473–483.
Reilly MC, Zbrozek AS, Dukes EM. The validity and reproducibility of a work productivity and activity impairment instrument. Pharmacoeconomics. 1993;4:353–365.
Vitaliano PP, Russo J, Young HM, Becker J, Maiuro RD. The screen for caregiver burden. Gerontologist. 1991;31:76–83.
Andresen EM, Malmgren JA, Carter WB, Patrick DL. Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). Am J Prev Med. 1994;10:77–84.
Cedarbaum JM, Stambler N. Performance of the amyotrophic lateral sclerosis functional rating scale (ALSFRS) in multicenter clinical trials. J Neurol Sci. 1997;152:S1–S9.
Schwab RS, England AC. Projection technique for evaluating surgery in Parkinson’s disease. In: Gillingham FJ, Donaldson IML, eds. Third Symposium on Parkinson’s Disease; May 20–22 1969, Edinburgh, UK.
Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9:179–186.
Guajardo V, Souza BP, Henriques SG, et al. Loss of interest, depressed mood and impact on the quality of life: cross sectional survey. BMC Pub Health. 2011;11:826.
House A, Dennis M, Molyneux A, Warlow C, Hawton K. Emotionalism after stroke. BMJ. 1989;298:991–994.
Jenkinson C, Peto V, Fitzpatrick R, Greenhall R, Hyman N. Self-reported functioning and well-being in patients with Parkinson’s disease: comparison of the short-form Health Survey (SF-36) and the Parkinson’s Disease Questionnaire (PDQ-39). Age Ageing. 1995;24:505–509.
Hagell P, Nygren C. The 39 item Parkinson’s disease questionnaire (PDQ-39) revisited: implications for evidence based medicine. J Neurol Neurosurg Psychiatry. 2007;78:1191–1198.
Feinstein A, Feinstein K, Gray T, O’Connor P. Prevalence and neurobehavioral correlates of pathological laughing and crying in multiple sclerosis. Arch Neurol. 1997;54:1116–1121.
Feinstein A, O’Connor P, Gray T, Feinstein K. Pathological laughing and crying in multiple sclerosis: a preliminary report suggesting a role for the prefrontal cortex. Mult Scler. 1999;5:69–73.
McCullagh S, Moore M, Gawel M, Feinstein A. Pathological laughing and crying in amyotrophic lateral sclerosis: an association with prefrontal cognitive dysfunction. J Neurol Sci. 1999;169:43–48.
Edgley K, Sullivan MJ, Dehoux E. A survey of multiple sclerosis: part 2. Determinants of employment status. Can J Rehabil. 1991;4:127–132.
Julian LJ, Vella L, Vollmer T, Hadjimichael O, Mohr DC. Employment in multiple sclerosis: exiting and reentering the work force. J Neurol. 2008;255:1354–1360.
Morrow SA, Drake A, Zivadinov R, Munschauer F, Weinstock-Guttman B, Benedict RH. Predicting loss of employment over three years in multiple sclerosis: clinically meaningful cognitive decline. Clin Neuropsychol. 2010;24:1131–1145.
Ownsworth T, Shum D. Relationship between executive functions and productivity outcomes following stroke. Disabil Rehabil. 2008;30:531–540.
Lantz MS. Pathologic laughing and crying in multiple sclerosis. Clin Geriatr. 2005;13:14–17.
Starr LB, Robinson RG, Price TR. Reliability, validity, and clinical utility of the social functioning exam in the assessment of stroke patients. Exp Aging Res. 1983;9:101–106.
Phuong L, Garg S, Duda JE, Stern MB, Weintraub D. Involuntary emotional expression disorder (IEED) in Parkinson’s disease. Parkinsonism Relat Disord. 2009;15:511–515.
Cummings JL, Arciniegas DB, Brooks BR, et al. Defining and diagnosing involuntary emotional expression disorder. CNS Spectrums. 2006;11:1–7.
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Colamonico, J., Formella, A. & Bradley, W. Pseudobulbar Affect: Burden of Illness in the USA. Adv Therapy 29, 775–798 (2012). https://doi.org/10.1007/s12325-012-0043-7
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DOI: https://doi.org/10.1007/s12325-012-0043-7