Pseudobulbar Affect (PBA) is a neurological disorder that causes uncontrollable bouts

of emotion such as laughing and crying.  PBA can affect people at any age, but generally

accompanies another neurological disease such as Multiple Sclerosis or Alzheimer's,

according to  This website is dedicated to raising awareness about this

little-known and misunderstood disorder.


In people with Alzheimer’s disease (AD) and dementia such a diagnosis can be

particularly difficult.  PBA is common, affecting between 10–40 % of people with AD but

is frequently not detected or is misdiagnosed.  According to figures from The National

Stroke Association, 20% of stroke survivors will experience PBA in the year following

their stroke.


Differentiating PBA from depression and other behavioral disturbances in AD and

dementia is helpful to identify a specific cause of their symptoms and assist with

appropriate management.  A person can have both PBA and depression, but they

are two separate diagnoses.





• Emotional outbursts that are sudden and uncontrollable.

• Outbursts can include laughing, crying, and can last as long as a few minutes, or be as

  short as a few seconds.  According to the American Stroke Association, these episodes

  can strike a person up to 100 times a day.

• Besides being out of the control of the person experiencing them, the emotional spells

  caused by PBA may not reflect the actual feelings of that individual.  A person may cry

  in response to a joke or have a laughing fit during a sad time.

• Outbursts may also be overly exaggerated, for example a person may display a bout of

  boisterous laughter in response to a neutral or mildly humorous situation.





PBA is thought to be triggered by a traumatic injury, or a neurological disease that affects

the parts of the brain that deal with the processing and expression of emotions.  People

with PBA suffer from an injury-induced, "short-circuiting" of the signals that govern their



Some health problems that can give rise to PBA include:


• A stroke

• Multiple Sclerosis

• Alzheimer's disease

• Parkinson's disease

• Brain trauma

• Lou Gehrig's disease (ALS)





PBA is a separate neurological disorder that can be diagnosed and treated independently

of other health related diagnoses.  Diagnosing PBA can often be challenging as the

symptoms of this disease closely mirror those of depression and other mood disorders.


Current diagnostic methods for PBA are relatively sparse.  There are essentially the two

tests a physician may utilize to identify if person has PBA:


• The Pathological Laughter and Crying Scale

• The Center for Neurologic Study-Lability Scale.


These tests are designed to help a physician determine how often and severe PBA

outbursts are in a person and what their primary triggers are.


If you feel that you're caring for someone who may have undiagnosed PBA, discuss the

symptoms with their doctor.



Supporting a Loved One with PBA


PBA can have an enormous impact on a person's social life.  Emotional occurrences

caused by the disease can be distressing and can interfere with interpersonal



For caregivers of people with PBA, it can be difficult trying to deal with a person who

feels isolated and alone because of their disease. offers a tips for caregivers to help them interact positively with their

loved ones:


1. Let them know that you support them and they are not alone. Reassure them that

    many people suffer from the symptoms of PBA.

2. Remind them that their outbursts are caused by a physical disease, not a mental


3. Indicate your willingness to listen to their frustrations and concerns.

4. Keep an "episode diary." By recording PBA episodes, you can ensure better

    communication with your doctor and help him or her make an accurate diagnosis.

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