RSS Feed Print
Pseudobulbar affect and AD
llee08032
Posted: Saturday, October 29, 2016 10:20 AM
Joined: 5/20/2014
Posts: 4408


Pseudobulbar affect (PBA) can be challenging to differentiate from the symptoms of various neurological diseases with which it is associated. In patients with Alzheimer’s disease (AD) and dementia such a diagnosis can be particularly difficult as illustrated by a case of an elderly male with sudden tearful outbursts, which is reported and discussed here. PBA attacks are often incorrectly attributed to emotion or distress in response to memory loss or a result of depression or dementia. PBA is common, affecting between 10–40 % of people with AD but is frequently not detected or is misdiagnosed. Multiple authors have published clinical criteria for identifying PBA; in sum, it is described as a condition affecting the brain with episodes of laughing or crying that are sudden and unpredictable, occur without warning and are excessive, exaggerated, or not appropriate to the stimuli and are involuntary and difficult to control. Differentiating PBA from depression and other behavioral disturbances in AD and dementia is helpful to patients by identifying a specific cause of their symptoms and enabling appropriate management. Various different approaches have been taken in the treatment of PBA. A combination of dextromethorphan and quinidine hasbeen shown in well-controlled trials and in clinical use to control the symptoms of PBA associated with several neurological diseases including AD and to reduce the burden on patients and their caregivers.
llee08032
Posted: Saturday, October 29, 2016 10:28 AM
Joined: 5/20/2014
Posts: 4408


I cannot post the link to the above abstract. 

Over the last 5 or more years I have 10 or more episodes of uncontrolled crying. Very unpleasant and lasted for almost an hour or more on some occasions! It can also happen with uncontrolled laughter. PBA is oftentimes mistaken for depression. I'll try to write more about my experience with PBA tomorrow.


llee08032
Posted: Sunday, October 30, 2016 9:23 AM
Joined: 5/20/2014
Posts: 4408


It's important for caregivers and loved ones to be sensitive and understanding of the PWD's experience of pseudobulbar affect.  Being unable to stop crying can be an embarrassing and shameful experience for the PWD who more than likely has no control in stopping the crying once it begins. This is especially true of PWD whose parents reacted negatively in response to their crying as a child or a PWD who holds the belief that crying is a sign of weakness. I was shamed and punished as child for crying so I am aware of how the episodes of crying bring up those old feelings of shame. The feelings are so intense for me that I make every effort I can to go somewhere where I can be alone. 

PBA episodes are sudden and unpredictable and do not necessesarily reflect how the person feels inside. The worst episode I had was especially embarrassing during a meeting at work. I tried and tried to make myself stop crying to no avail and had to walk out of the meeting. I cried all the way back in the car to my office and in my office behind the closed door for what seemed like over an hour. I emailed my supervisor and told her I had to leave the meeting because I was ill which was not far from the truth. During the episode I remember trying to shut down my feelings and divert my thinking to something pleasant which did not work.


llee08032
Posted: Sunday, October 30, 2016 9:34 AM
Joined: 5/20/2014
Posts: 4408


A Flood of Emotions: Treating the uncontrollable crying and laughing of pseudobulbar affect.

PBA is not a disease in and of itself but the result of brain changes from other neurologic diseases, such as amyotrophic lateral sclerosis (ALS, or Lou Gehrig's disease), multiple sclerosis (MS), Alzheimer's disease, stroke, traumatic brain injury, and Parkinson's disease. Symptoms include inappropriate, uncontrollable crying and, less often, laughing. People with PBA may also express inappropriate anger and frustration.

Researchers don't know exactly what causes PBA, but they suspect it's related to some disconnect between the brain stem—the oldest part of the brain, where our emotions originate—and the frontotemporal lobes, the part of the brain that determines how we express those emotions. Current theories also link the condition to abnormalities related to the neurotransmitter glutamate, which plays a role in how brain cells communicate, says neurologist Robert Miller, M.D., of California Pacific Medical Center in Sacramento, CA, and an AAN Fellow.


llee08032
Posted: Sunday, October 30, 2016 9:53 AM
Joined: 5/20/2014
Posts: 4408


Below are some tips for living with PBA. I would think some of these tips are more applicable for PWD in the earlier stages. I do try to keep my emotions in check and feel like I have some control in preventing an episode. However, once an episode begins I feel I have no control in stopping crying. I try especially hard not to let others upset me because it can trigger an episode. 


Tips for Living with PBA

Keep an episode diary to help you and your doctor to understand what may trigger your episodes.
Click here to print out a convenient diary form.

Be open about it. Let people know that you cannot always control your crying or laughing because of a neurologic condition. This can help ensure that people are not surprised, confused or insulted.

Distract yourself. If you feel an episode coming on, try to focus on something unrelated.

Breathe. Take slow deep breaths until you are in control.

Relax. Release the tension in your forehead, shoulders, and other muscle groups that tense up during a PBA episode.

Change your body positions. Note the posture you take when having an episode. When you think you are about to cry or laugh, change your position. 

These tips are general coping techniques and are not substitutes for medical advice. Talk with your doctor about additional ways to cope with your PBA episodes and whether a treatment plan may be appropriate.

What can you do to help a loved one with PBA?

Relate. If someone you love has PBA, he or she may be embarrassed by his or her outbursts and reluctant to talk about his or her condition. You can help by letting that person know you understand that his or her episodes are involuntary and are not something they can control.

Remind. You can also remind your loved one that PBA is a neurologic condition, not a mental state, and can occur when certain underlying neurologic diseases or injuries damage the areas of the brain that control normal expression of emotions. This damage can disrupt brain signaling, causing a ‘short circuit’, triggering his or her episodes of involuntary crying or laughing.

Reassure. Finally, you can reassure your loved one that he or she is not alone. Nearly 2 million people suffer from the symptoms of PBA. They are looking for answers about this condition and ways to cope with it. And many of these PBA patients have loved ones who, like you, want to let them know that PBA does not change the way you feel about them.


The_Sun_Still_Rises
Posted: Monday, October 31, 2016 8:22 AM
Joined: 7/24/2015
Posts: 3020


That is some really good information.  Thanks Llee. 
BlueSkies
Posted: Monday, October 31, 2016 1:26 PM
Joined: 2/24/2016
Posts: 1096


Yes, thanks llee.  Awesome information to know.  The tips are good for all of us as emotions are usually not as stable as use to be.  I use the breathing and distraction for anxiety and frustration also.
feudman
Posted: Friday, November 4, 2016 8:13 PM
Joined: 6/5/2014
Posts: 1591


My FTD wife also has PBA . I long suspected this and it was confirmed by her neurologist. However, she has the laughing, never crying. He said he only treats the crying with Neudexta. I am concerned if left untreated it may be difficult to place her. It has gotten worse over the years. There have been threads about it if you search "PBA."
JTAC
Posted: Saturday, November 5, 2016 9:26 AM
Joined: 11/4/2016
Posts: 4


Been there done that. I started having symptoms (PBA) related to a major TBI w/seizure DO long before my memory became an issue. I ran heavy construction crews and it would hit me occasionally while driving to projects, I would turn away from my driver and say "pull it over NOW" get out and just walk away. On one occasion there was a phone booth near by and I called my father and said I don't know what the heck is happening but I can't stop crying. Minutes later is passed. It would be years later when I started a medication that stopped 98% of it in its tracks. Scary and embarrassing stuff.

 

 



llee08032
Posted: Sunday, November 6, 2016 6:56 AM
Joined: 5/20/2014
Posts: 4408


Welcome to the board Jtac. PBA is scary and embarrassing. I can see how persons aware  that they are experiencing PBA may want to isolate themselves from others. Would you mind sharing what medication is working for you?
alz+
Posted: Sunday, November 6, 2016 8:19 AM
Joined: 9/12/2013
Posts: 3608


L lee - thank you for this!

how to tell difference between panic attacks and this?

maybe what works for this would help me calm down today - having full blown physical meltdowns and going to church in this condition.

i want to be under some kind of heavy pressure - which is what my dog did when i got this way. she would come close and press her 95 pounds into my chest which did work.

this is heartbreaking to read - so glad you posted all this. 


llee08032
Posted: Monday, November 7, 2016 7:58 AM
Joined: 5/20/2014
Posts: 4408


Alz,

Diesel was a good hugger. I think that's how dogs hug us when they press against us. he would press against me and nuzzle his head between my neck and shoulder. 


JTAC
Posted: Monday, November 7, 2016 6:08 PM
Joined: 11/4/2016
Posts: 4


I had great results with Nuedexta. It was hard to get and my doc let me use samples for a few months until it was approved. Within a week the results were dramatic.