In your residents with neurologic conditions or brain injury, it’s important to evaluate them carefully to see if they have pseudobulbar affect (PBA).
Symptoms to look for are frequent, sudden, uncontrollable outbursts of laughing and/or crying in residents with underlying neurologic conditions or brain injury, including but not limited to stroke, dementia, traumatic brain injury (TBI), Parkinson's disease (PD), amyotrophic lateral sclerosis (ALS), or multiple sclerosis (MS).1,2
PBA symptoms may be noted as emotional lability. Your staff may report that the resident seems sad or depressed, but when asked for details, they describe what might be the incongruent or exaggerated laughing and/or crying outbursts of PBA.1
Do their episodes seem exaggerated or disproportionate in relation to their mood?
She cries frequently and can’t explain why.
He says he doesn’t even feel sad while he’s crying.
The laughing and crying outbursts are so intense but they come and go quickly.
If nurses and other staff members report that their residents’ laughing and/or crying are exaggerated or incongruent with their underlying emotional state, it may be time to evaluate for PBA.
Look for some of these terms on resident charts that may describe symptoms of PBA3
- Sudden outbursts of laughing and/or crying
- Exaggerated response
- Emotional lability
- Mood incongruence
- Incongruent emotions
PBA symptoms are prevalent in residents with various underlying neurologic conditions
In a retrospective study of long-term care residents, a Center for Neurologic Study-Labilty Scale (CNS-LS) score ≥13 suggesting the presence of PBA symptoms was reported in 17.5% (72/412) of residents with a neurologic disorder that could be associated with PBA.4,a
aAs determined by a score of ≥13 on the Center for Neurologic Study-Lability Scale (CNS-LS).