How are you identifying PBA in your patients with stroke, dementia, or TBI?

Patients with stroke, dementia, or TBI can experience mood swings or other behavioral changes.1-3 They may report that they feel sad or depressed, but when asked for details, go on to describe what might be the incongruent or exaggerated crying and/or laughing outbursts of PBA.4

PBA simpthoms are often mischaracterized

 

Why don’t you see PBA in your clinic?

Watch video

DR FISHER DISCUSSES WHY YOU MAY NOT SEE PBA IN YOUR PRACTICE <span class="timecode">(0:36)</span>

Consider PBA

Probe further: Do your mood swings match how you feel?
If patients or their caregivers report that their crying and/or laughing episodes are exaggerated or incongruent with their underlying emotional state, they may have PBA.5

 

PATIENTS OR CAREGIVERS MAY HAVE THEIR OWN TERMS FOR SYMPTOMS THAT COULD HELP IDENTIFY PBAa,4

Crying jags or bouts
Overreacting
Random
Laughing spells or fits

aVarious terms have been used to describe PBA but these are not necessarily synonymous or interchangeable.

The importance of screening for PBA

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SEE A DISCUSSION ON THE IMPORTANCE OF SCREENING FOR PBA <span class="timecode">(1:59)</span>

PBA vs depression

PBA is often mischaracterized as depression—and may be comorbid2,5,6

Comorbidity with depression may complicate diagnosis

DIFFERENTIATING PBA FROM DEPRESSION WHEN CRYING IS PRESENTa,1,2,5,7,8

Differentiating PBA from depression when crying is present

 

  • In a Harris online poll (N=399), approximately 75% of patients with PBA symptoms (CNS-LS ≥13) showed at least moderate depression symptoms9
  • In PRISM II (N=367), 57.5% of patients with PBA secondary to stroke, dementia, or TBI were diagnosed with comorbid depression10
Study Description
 

PRISM ll was a 90-day, open-label (uncontrolled), US trial in adult patients with dementia, stroke, or TBI. All patients had a clinical diagnosis of PBA and a CNS-LS score ≥13 at baseline. Patients received 1 capsule of NUEDEXTA QD during Week 1 and were titrated to 1 capsule Q12H for Weeks 2 through 12. The primary endpoint was change from baseline in CNS-LS score. Effectiveness population: Dementia: Baseline n=108, Day 30 n=108, Day 90 n=102. Stroke: Baseline n=103, Day 30 n=103, Day 90 n=92. TBI: Baseline n=87, Day 30 n=86, Day 90 n=67. Overall: Baseline n=298, Day 30 n=297, Day 90 n=261.10

aFormal diagnosis of PBA or depression can only be made by a qualified healthcare practitioner (HCP). These are not all of the diagnostic features of depression. PBA occurs in the context of a neurologic disease/injury affecting the brain and is not explained by other causes such as medication use.

bTearfulness/crying is not a DSM-5 criterion for depression diagnosis.6

PBA vs depression

Watch video

WATCH NURSE PRACTITIONER, CATHY YAGGI CHARACTERIZE PBA VS DEPRESSION <span class="timecode">(0:33)</span>