Pseudobulbar Affect Linked to Mood Symptoms in Parkinsonian Syndromes

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PBA(+) individuals experienced greater levels of anxious and depressive symptoms, as well as decreased mental health quality of life, as compared with PBA(-) individuals.
PBA(+) individuals experienced greater levels of anxious and depressive symptoms, as well as decreased mental health quality of life, as compared with PBA(-) individuals.

According to the results of an exploratory, cross-sectional study published in the Journal of Neuropsychiatry and Clinical Neuroscience, pseudobulbar affect (PBA), a syndrome characterized by episodes of inappropriate laughing or crying, may be associated with increased anxiety and depression, as well as with lower mental health status. PBA is common in those with amyotrophic lateral sclerosis (ALS). PBA has been observed increasingly in people with parkinsonism syndromes and is more frequently associated with mood disturbances in these patients. 

The clinical sample was comprised of 108 patients (Parkinson disease, n=53; atypical parkinsonism [aP], n=29; ALS, n=26). To assess cognitive and psychiatric symptoms, each patient was required to complete a cognitive screening, as well as a series of self-report questionnaires, including the Center for Neurological Study-Lability Scale for pseudobulbar affect; the Beck Depression Inventory, 2nd edition; the State-Trait Anxiety Inventory (STAI, trait only); the Apathy Evaluation Scale; the 36-Item Short Form Survey; and the Montreal Cognitive Assessment.   

Individuals with pseudobulbar affect (PBA+) comprised 37.9% of patients with aP (n=11), 20.8% of people with Parkinson disease (n=11), and 34.6% of patients with ALS (n=9). The proportions of PBA+ individuals per patient group were not significantly different (P =.193).  

Significant main effects of clinical group (PBA+ vs PBA-) were evidenced in the STAI (F = 8.06, P =.005), Beck Depression Inventory, 2nd edition (F = 3.50, P =.06), and 36-Item Short Form Survey mental health component (F = 6.18, P =.02.) scores. Individuals who were PBA+ experienced greater levels of anxious and depressive symptoms and decreased mental health quality of life compared with those who were PBA-. 

Mood-related symptoms correlated with PBA+ status in Parkinson disease (BDI r = 0.35; STAI, r = 0.46; both P <.05) and aP (STAI, r = 0.46; P <.05), but not in ALS (BDI, r = 0.12; STAI, r = 0.27; both P >.05). 

“This pilot study is the first to systematically identify the neuropsychiatric correlates of PBA symptoms between different neurological disorders,” according to the authors. However, they recommend that “[f]uture research should include larger cohorts and a more thorough neuropsychological evaluation (including structured interviews) to establish formal diagnoses.”

Disclosures: Several authors declare affiliations with the pharmaceutical industry. 

Reference

Patel N, Combs H, York M, Phan C, Jimenez-Shahed J. Pseudobulbar affect correlates with mood symptoms in parkinsonian disorders but not amyotrophic lateral sclerosis [published online March 5, 2018]. J Neuropsychiatry Clin Neurosci. doi:10.1176/appi.neuropsych.17070131

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