Pseudobulbar affect may be an early marker of Alzheimer’s disease

Pseudobulbar affect, or PBA, is a neurological syndrome characterized by frequent, uncontrollable, mood incongruent episodes of laughing or crying that are unprovoked or disproportionate to the context. While the exact cause of PBA remains unknown, PBA is common in those with Alzheimer's disease and other dementias.

“We wanted to investigate the association between PBA symptoms, clinical diagnosis, cognitive testing and self-reported mood in older adults seeking evaluation for dementia,” said corresponding author Dr. Maureen O'Connor, director of Neuropsychology at VA Bedford Healthcare System and assistant professor of neurology at BU Chobanian & Avedisian SOM. 

The study examined associations between neuropsychological tests, patient and clinician rating scales, and the Center for Neurological Study-Lability Scale among 311 patients with suspected Alzheimer's or other neurocognitive diagnoses. The research team then examined differences in test performance between patients with and without suspected PBA.

The research found that participating patients with suspected PBA and Alzheimer's diagnosis had better memory recall and recognition than those without suspected PBA, suggesting that impaired emotional regulation may be an early sign of Alzheimer's disease in patients with less prominent memory decline. 

“We hope that better understanding PBA in neurodegenerative diseases, including prevalence and comorbidity with psychiatric conditions, could help with early identification and treatment,” said co-author Dr. Brandon Frank, neuropsychologist at VA Boston Healthcare System and assistant professor of neurology at BU Chobanian & Avedisian SOM. “Medical education and training specific to PBA should be a priority for clinicians working with older adults, to help reduce the burden of advocacy currently placed on patients and their families.”

The study is available in the International Journal of Geriatric Psychiatry through Wiley Online Library at https://onlinelibrary.wiley.com/doi/10.1002/gps.70002

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