Pseudobulbar affect (PBA) is a specific condition, distinct from other types of emotional
lability that may occur in patients with neurological disease or injury1

PBA can occur as a consequence of other neurologic disorders, and is characterized by involuntary, sudden, and frequent episodes of laughing and/or crying.1 It involves a disconnect between affect (expression of emotion) and mood (underlying emotional state).2,3

In relation to mood, PBA episodes may be incongruent, or commonly, exaggerated4-9
Exaggerated

 

Exaggerated
Excessive or disproportionate in relation to mood or stimulus4
and/or
Incongruent

 

Incongruent
Inconsistent with or opposite to a person’s mood4
  • Crying or laughing that is incongruent with how a patient feels can be a distinguishing feature of PBA, yet it characterizes only one aspect of the disease4,5
  • Medical literature indicates that a mood-congruent but exaggerated response, typically one of crying, is common among patients with PBA6-9

Brain lesions that result from various neurologic diseases or injuries may disrupt the neural networks that regulate emotional expression2

NEURAL DAMAGE AFFECTS CONTROL OVER EMOTIONAL EXPRESSION2

People with PBA have a disconnect between affect (expression of emotion) and mood (inner feelings)

 

  • Pathways along the cerebral cortex, pons and other areas of the brainstem, and cerebellum (also known as the cortico-pontine-cerebellar [CPC] network) may play an important role in PBA2,3
  • One of the major neurotransmitters involved in PBA is glutamate. Glutamate receptors, including NMDA, exist in this CPC neural network in the brain2,3,10
 
Disruption of normal glutamate signaling along the damaged pathways may contribute to PBA episodes2
Uncovering PBA

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WATCH NURSE PRACTITIONER, CATHY YAGGI, HELP UNCOVER PBA (0:36)

Uncovering PBA and associated crying

Typically, crying is thought of as the physical response of shedding tears, showing sadness, or distress. However, in PBA, the episodes of crying may appear differently, as described below.

Crying in PBA may be indistinguishable from normal crying, however it can also have a more stereotyped appearance which includes:5-7

Tears11,12

Tears may or may not be present when crying

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and/or

Noiseless4,12,13

May be silent or quiet when crying

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and/or

Noisy12,14

May be loud with increasing volume when crying

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and/or

Grimacing4,5,11

Facial features may or may not be contorted when crying

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and/or

In addition, these episodes can be4:

  • Sudden and brief (lasting seconds or minutes)
  • Stronger and more intense than normal reactions
  • Disruptive
Symptoms and impact of PBA

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LEARN MORE ABOUT SYMPTOMS AND IMPACT OF PBA (0:49)