Prevalence of pseudobulbar affect symptoms and clinical correlates in nursing home residents

Abstract

ObjectivePseudobulbar affect (PBA) is a neurological disorder of emotional expression, characterized by uncontrollable episodes of crying or laughing in patients with certain neurological disorders affecting the brain. The purposes of this study were to estimate the prevalence of PBA in US nursing home residents and examine the relationship between PBA symptoms and other clinical correlates, including the use of psychopharmacological medications.MethodsA retrospective study was conducted between 2013 and 2014 with a convenience sample of residents from nine Michigan nursing homes. Chronic‐care residents were included in the “predisposed population” if they had a neurological disorder affecting the brain and no evidence of psychosis, delirium, or disruptive behavior (per chart review). Residents were screened for PBA symptoms by a geropsychologist using the Center for Neurologic Study‐Lability Scale (CNS‐LS). Additional clinical information was collected using a diagnostic evaluation checklist and the most recent Minimum Data Set 3.0 assessment.ResultsOf 811 residents screened, complete data were available for 804, and 412 (51%) met the criteria for the “predisposed population.” PBA symptom prevalence, based on having a CNS‐LS score ≥13, was 17.5% in the predisposed population and 9.0% among all nursing home residents. Those with PBA symptoms were more likely to have a documented mood disorder and be using a psychopharmacological medication, including antipsychotics, than those without PBA symptoms.ConclusionsPseudobulbar affect symptoms were present in 17.5% of nursing home residents with neurological conditions, and 9.0% of residents overall. Increasing awareness and improving diagnostic accuracy of PBA may help optimize treatment. © 2015 The Authors. International Journal of Geriatric Psychiatry Published by John Wiley & Sons Ltd.

Early Clinical Manifestations of Temporal Bone Paragangliomas: Two Case Reports

“…However, it should be noted that such clinical symptoms have pseudobulbar syndrome as a manifestation of various neurological disorders against the background of vascular diseases with the formation of multiple lesions in the cerebral hemispheres. It is known to occur as a result of bilateral damage to the supranuclear innervation of the bulbar motor neuron at different levels, more often in the inner capsule and the pons 19 . It is possible to develop pseudobulbar affect or pseudobulbar syndrome when unilaterally excluding blood flow in the large cerebral artery (cerebral atherosclerosis), which also reduces blood flow in the opposite hemisphere (steal syndrome or steal phenomenon) and develops chronic brain hypoxia.…”

Daily crying prevalence and associated factors in older adult persons living in nursing homes: findings from a regional study

“…Jutkowitz et al ., ) have been widely studied. According to our study, which represents a specific research line inside a larger regional study (PENSA, Palese et al ., ), around one resident out of six of those living in NHs reported at least one episode of crying on a daily basis in the last month; however, given the lack of available studies in the field (Zarowitz and O'Shea, ; Foley et al ., ), limited comparison is possible. Moreover, we have adopted a pragmatic approach (Gaglio et al ., ), including episodes as documented by RNs without any distinction between pathological and non‐pathological crying.…”

“…In addition, those residents suffering from communication problems were more likely to cry on a daily basis. Underlying neurological diseases such as stroke and the consequent aphasia (Foley et al ., ), as well as the increased sense of loneliness experienced by non‐communicating residents, may all increase the occurrence of crying in the attempt to attract attention from health‐care professionals and/or from family (Hasson, ; Gračanin et al ., ). Furthermore, consistent with previous evidence (Vingerhoets et al ., ), those residents suffering from pain, night restlessness and clinical instability reported a higher likelihood of daily crying, thus suggesting that compromised physical conditions may reduce the threshold of crying (Vingerhoets et al ., ) and that crying may be a manifestation of underlying clinical needs.…”

“…To the best of our knowledge, the phenomenon of crying has been widely studied in healthy adults (Vingerhoets et al ., ; Gračanin et al ., ) and in adults affected by depression (Vingerhoets et al ., ) and mood disorders (Rottenberg et al ., , b); however, little research has been conducted to date with older adult people living in nursing homes (NHs; Foley et al ., ). Moreover, those studies on crying conducted in NHs (Foley et al ., ) have been focused on pathological crying and correlated clinical conditions, such as mood and/or behavioural disorders, and the use of antipsychotics, anxiolytics and antidepressants. However, other different factors may affect the occurrence of crying in older adult people living in NHs, where the individual is required to adapt to a new context, to live according to different rules and routines rather than at home, and where limited contact with family and increased loneliness may occur (Olsen et al ., ).…”

Pseudobulbar Affect Presenting as Hypomania

“…It is especially common in patients with Parkinson's disease, multiple sclerosis, and stroke. PBA symptoms were present in about 17.5% of the nursing home residents with neurological condition [1]. As PBA often involves uncontrollable crying, it may be confused with depression.…”