Pseudobulbar Affect in Parkinson’s Disease

Pseudobulbar affect (PBA) is a condition characterized by frequent, uncontrollable outbursts of crying or laughing that do not match how the person actually feels. It can affect people with Parkinson’s disease as well as those with brain injury or other neurologic conditions. Crying appears to be a more common sign of PBA than laughing.

The sudden outbursts seen in PBA may be frequent and occur at any time with the affected person’s mood appearing normal between episodes. The condition often is mistaken for depression or bipolar disorder because of the intense emotions experienced. However, PBA episodes tend to be short in duration, while depression causes a persistent feeling of sadness. People with PBA often lack certain features of depression, such as sleep disturbances or a loss of appetite. But depression also is common among those who have pseudobulbar affect.

What causes PBA?

PBA happens when a nervous system disorder, such as Parkinson’s, affects the areas of the brain that control the expression of emotion, such as the prefrontal cortex. There also may be alterations in chemicals in the brain that contribute to the development of the condition. These alterations may disrupt brain signaling, triggering episodes the person affected cannot control.

How common is PBA in people with Parkinson’s?

A survey of 449 Parkinson’s patients (or their caregivers) showed that 3.6 percent had PBA. This means that as many as 35,000 Parkinson’s patients in the U.S. may have PBA. According to another source, this percentage could be as high as 24 percent of Parkinson’s disease patients.

It is speculated that many cases go unreported and undiagnosed due to a lack of awareness about the condition.

Managing PBA episodes

Lifestyle strategies may help manage PBA. These include keeping a diary to track what triggers the episodes and sharing it with a doctor. Also, when a person feels an episode approaching, he may try to focus on something unrelated and adjust his posture. Taking slow, deep breaths during an episode until they are in control also may help, and so can relaxing the forehead, shoulders, and body.

Diagnosis and treatment

People with Parkinson’s already may be treated by a doctor who can diagnose PBA. Helpful specialists include neuropsychologists, neurologists, and psychiatrists.

Although the condition is not curable, it is treatable. There are various treatment options with differing side effects and limitations on their use (counterindications). Physicians must be familiar with these when choosing the best therapy for an individual, particularly for elderly patients and those who also have other diseases and take medication.

The only treatment currently approved by the U.S. Food and Drug Administration (FDA) for the treatment of PBA is Nuedexta.


ALS News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of ALS News Today, or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to ALS.

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