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Pseudobulbar Affect is a condition typically seen in brain damage where patients experience unexpected fits of laughter or crying in situations that would not normally cause these emotions. There is a link with this condition and Alzheimer's Disease.

Alzheimer's Disease is a condition associated with a multitude of changes that you can expect to occur over a longer period of time. Symptoms can manifest even a decade prior to patients ultimately being diagnosed with the disease. Although Alzheimer's and dementia are typically linked with symptoms like memory loss and forgetfulness, another lesser known component of this disease's cascade of symptoms is known as the pseudobulbar affect. In this article, we will focus on what this condition entails and what type of symptoms you may notice with this disease.

What is the Pseudobulbar Affect?

The pseudobulbar affect, PBA, is also called emotional incontinence and is associated with rapid and unexpected changes in emotions. It features rapidly changing periods of laughing or crying unexpectedly and not related to the tone of the conversation. These periods can last for several minutes and can become quite distressing for a patient when they are unable to stop these sensations.

The key thing to remember with this condition is that it is not due to an underlying psychiatric problem but linked to brain damage often found in conditions like Alzheimer's Disease, dementia, strokes or ALS. The destruction of the frontal lobe of the brain where emotions and behaviors are localized is responsible for the manifestation of this condition.

It is considered to be a disinhibition syndrome in which pathways involving serotonin and glutamine are affected. This imbalance in chemicals makes it hard for patients to regulate their emotions and can cause these unexpected fits. It is hard to diagnose, however, and patients can go years with an improper diagnosis and be treated as if they were suffering from a mood disorder.

It is believed that roughly 10 percent of patients with long-standing neurological dysfunction are at risk of having PBA. Those patients with PBA also have an increased risk of other psychological problems such as depression and anxiety. There are some key differences between PBA and depression that you must keep in mind, however.

One of the most striking differences between the two conditions would be the duration of symptoms.

  • Depression can last for weeks to months in individuals while PBA typically manifests from seconds to minutes.
  • Depression is also a disease in which patients do have some control over their symptoms, while PBA is a condition where symptoms are almost completely involuntary.
  • The last and most significant difference between these two conditions would be the secondary symptoms associated with each condition. In depression, patients will have a mood congruency with their state of mind. They will be lethargic, have an unwillingness to do even simple chores and easily fatigued. With PBA, the patient's state of mind and energy levels will be normal and return back to the previous state once these flare-ups in personality subside. 

The exact mechanism of what is causing these sudden shifts in emotion is unknown but scientists tend to agree on two major theories that attempt to explain the origins.

  • In one theory, it is believed that damage to specific tracts in the brain known as the corticobulbar tract causes symptoms. This is a tract that plays a key role in the activation or suppression of emotions. When damaged, it is believed that patients will be disinhibited and as a result, minor shifts in emotion can lead to significant bouts of laughing or crying almost unexpectedly.
  • The other theory suggests that damage in the prefrontal cortex leads to these mood fluctuations. This can best be explained by the accumulation of plaques in the prefrontal cortex that lead to other behavioral changes seen in Alzheimer's Disease. 

Treatment options for Psuedobulbar Affect 

When it comes to treating this condition, one of the most important aspects to therapy would be family education. It is very likely that sudden crying fits or laugh attacks in patients while with family members at public locations can be quite embarrassing and surprising.

It is important for family members of loved ones affected with the disease to be aware that these emotional changes are entirely involuntary and the patient is just as helpless as you are in curbing these emotions on their own.

A simple understanding of the condition can circumvent a substantial amount of anxiety and stress because of these emotions. With this understanding, you may be able to ask for more private rooms in restaurants or avoid trips to venues where being quiet is necessary such as in a movie theater to help avoid potential situations. 

Family education may be helpful to inform about the condition but there are also some medications on the market that have been used to help manage the condition. In the last decade, a combination pill of dextromethorphan/quinidine has received FDA approval for treating the disease. Dextromethorphan may be a drug you have come across before if you take cough suppressants. It is the active ingredient in these medications to help suppress the cough reflex in patients. Quinidine is typically used as a treatment for malaria. This atypical combination was actually found to significantly reduce the frequency of emotional instability in patients who took two pills daily compared to placebo groups. 

When asked about their perceived health status, patients who were part of this study also felt that higher doses of this drug combination lead to a better quality of life. The most significant benefits were better mental health and social role functioning. This can be quite beneficial for patients who are dealing with a debilitating disease. When they lose their independence and become more and more reliant on others to fulfill simple daily living tasks, depression will likely ensue. 

Traditionally, it is also common for doctors to prescribe a serotonin-selective reuptake inhibitor, or SSRI, to help patients cope with their PBA. These are drugs that are typically used to help treat depression. Even if we have already covered some of the chief differences between PBA and depression above, you can see that there is still some overlap in the symptoms that patients may experience with each condition. Having a potent SSRI to help restore the balance of serotonin in the brain can help stabilize patients' moods and help manage the helplessness likely felt during these sudden outbursts of emotions. 

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