Pseudobulbar Affect: Burden of Illness in the USA

PRISM: A Novel Research Tool to Assess the Prevalence of Pseudobulbar Affect Symptoms Across Neurological Conditions

“…A more restrictive definition was also evaluated using a CNS-LS $21. This score is consistent with mean CNS-LS scores of PBA patients who participated in recent clinical trials [7] and has been used in other prevalence surveys to identify a subset of patients likely to have more frequent and severe PBA symptoms [7,8]. The CNS-LS is the first self-report measure of PBA symptoms to be established and validated; it consists of subscales for laughter (4 items) and for crying (3 items), with each item scored on a 5-point scale (1 = applies never; 5 = applies most of the time) for a total score ranging from 7 (no symptoms) to 35 (maximum) [32,49].…”

“…The finding that patients with a CNS-LS $13 rated their neurological condition as having a greater negative impact on their QOL is interesting and parallels the findings from a burden of illness (BOI) study conducted as a follow-on to the online HPOL prevalence study discussed above [7,8]. In the BOI study, respondents with a CNS-LS $13 had worse scores for the impact of laughing/crying episodes on QOL and quality of relationships, and had worse scores on all 8 domains and both the mental and physical component summary scores of the 36-item short-form health survey (SF-36), a well-validated measure of general health and well-being [58], compared with respondents with a CNS-LS ,13 [8].…”

“…In the BOI study, respondents with a CNS-LS $13 had worse scores for the impact of laughing/crying episodes on QOL and quality of relationships, and had worse scores on all 8 domains and both the mental and physical component summary scores of the 36-item short-form health survey (SF-36), a well-validated measure of general health and well-being [58], compared with respondents with a CNS-LS ,13 [8]. The BOI study also found that among survey respondents with CNS-LS $13 and involuntary episodes of laughing/crying, these episodes contributed a great deal to or were the main reason for becoming housebound for 24% of these patients, and for being moved to supervised living placement for 9% of these patients.…”

“…PBA occurs secondary to multiple neurological diseases or injury, including stroke, amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), traumatic brain injury (TBI), Alzheimer's disease (AD), and Parkinson's disease (PD), among others [3,7]. Because of their disruptive and often embarrassing nature, PBA episodes may have socially and occupationally disabling consequences, which are superimposed on the burden of the primary neurological disorder [2,3,8]. The pathophysiology of PBA is thought to involve injury to the neurological pathways that regulate affect [5,9,10].…”

“…When PBA symptoms are evaluated, they may be mischaracterized as a mood disorder such as depression, although PBA is clinically distinct from mood disorders in terms of duration, character, and context [3,[16][17][18]. Furthermore, the two conditions may both be comorbid, as recent studies show a meaningful incidence of depression or depressive symptoms in patients with PBA [8,[18][19][20][21][22][23][24][25].…”