Pseudobulbar Affect Among Patients With Dementia

TL;DR

This study explores pseudobulbar affect, a mood disorder involving uncontrolled crying or laughter, in patients with dementia, highlighting its under-researched nature and common comorbidities.

Contribution

The study identifies and describes a cohort of dementia patients with pseudobulbar affect using the TriNetX database, laying groundwork for future research.

Findings

Seventy-three percent of the cohort had postconcussion syndrome.

Many patients had comorbid psychiatric disorders like anxiety and depression.

Abstract

Objective: Dementia is a neurocognitive disorder characterized by memory loss and deficits in multiple cognitive domains, caused by damage to or loss of neurons in the brain, which impairs one’s abilities and capabilities for independent daily living. The etiologies of dementia are diverse, including vascular, infectious, traumatic, and neurodegenerative causes. The most common types of dementia include Alzheimer’s dementia, vascular dementia, Lewy body dementia, and frontotemporal dementia. Patients with dementia frequently develop cognitive, psycho-behavioral, emotional, and mood symptoms. One largely unstudied mood symptom seen in dementia patients is pseudobulbar affect (PBA). PBA is a state of emotional incontinence characterized by episodes of uncontrolled crying or laughter that are inconsistent with the social context or the patient’s emotional state. Although many neurological disorders may present with PBA, only a small fraction of the literature focuses on PBA in dementia patients. In the present study, we used the TriNetX database to identify a cohort of patients with both PBA and dementia. We describe this cohort to provide a foundation for further research on this patient population.

Results: Seventy-three percent (n=182) of the cohort had postconcussion syndrome, 18% (n=44) had overt dementia, 49% (n=121) had mild cognitive impairment, and 42% (n=105) had some form of amnesia. Many patients had comorbid psychiatric disorders, including anxiety and depressive disorders.

Conclusions: The multitude of comorbid mood disorders and symptoms can complicate the clinical management of dementia patients, adding to their distress and that of their caregivers. Understanding these symptoms is essential for providing an accurate diagnosis and effective management of PBA in dementia.

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