HONOLULU—More than one-third of patients with stroke may have pseudobulbar affect (PBA), according to research presented at the 2013 International Stroke Conference. Compared with patients with stroke, patients with stroke and pseudobulbar affect may be more likely to report that their neurologic condition influences their quality of life and more likely to take a tricyclic antidepressant.
The Prevalence of Pseudobulbar Affect in Patients With Six Neurologic Conditions
Jonathan Fellus, MD, Director of Brain Injury Services at the Kessler Institute for Rehabilitation in Saddle Brook, New Jersey, and colleagues created the Pseudobulbar Affect Registry Series (PRISM) to gauge the prevalence of pseudobulbar affect symptoms in six neurologic conditions in a clinical practice setting. The investigators solicited the participation of American physicians who treat patients with neurologic conditions commonly associated with pseudobulbar affect. Facilities enrolled in the registry online and registered with an institutional review board.
The review board recruited 20 or more consenting patients with Alzheimer’s disease, amyotrophic lateral sclerosis, multiple sclerosis, Parkinson’s disease, stroke, or traumatic brain injury at each study site. Patients or their caregivers completed the Center for Neurologic Study–Lability Scale (CNS–LS) to screen for pseudobulbar affect symptoms, which were defined as a score of 13 or higher. Using an 11-point scale, patients also indicated the extent to which their neurologic condition affected their qualify of life. Higher numbers represented greater impact on quality of life.
Pseudobulbar Affect and Antidepressant Use
At the time that study enrollment ended, the PRISM registry series included 757 patients with stroke. The mean age of these patients was 68, and nearly 54% were women. The mean CNS–LS score of patients with stroke was 12.0, and approximately 38% of those with stroke had pseudobulbar affect symptoms. About 9% of patients with stroke had a CNS–LS score of 21 or higher, which was the mean score of patients who sought treatment in recent clinical trials of therapies for pseudobulbar affect.
Patients with stroke and pseudobulbar affect said that their neurologic condition had a greater influence on their quality of life, compared with patients with stroke without pseudobulbar affect. The mean quality-of-life score was 6.7 for patients with pseudobulbar affect, compared with 4.5 for patients without pseudobulbar affect. Higher CNS–LS scores correlated with greater influence of the neurologic condition on quality of life.
About 20% of patients with stroke who had CNS–LS scores of 13 or greater were receiving tricyclic antidepressants, and approximately 8% of patients with stroke and CNS–LS scores lower than 13 were taking these drugs. In addition, 38.5% of patients with stroke and CNS–LS scores of 13 or greater were taking other antidepressants, compared with 26.5% of patients with stroke and CNS–LS scores lower than 13.
“PRISM is currently the largest clinic-based study to assess pseudobulbar affect symptom prevalence,” said Dr. Fellus. “These data underscore a need for greater recognition and diagnosis of pseudobulbar affect in patients with stroke and other at-risk populations.”
—Erik Greb
Senior Associate Editor
Suggested Reading
Balakrishnan P, Rosen H. The causes and treatment of pseudobulbar affect in ischemic stroke. Curr Treat Options Cardiovasc Med. 2008;10(3):216-222.
Colamonico J, Formella A, Bradley W. Pseudobulbar affect: burden of illness in the USA. Adv Ther. 2012;29(9):775-798.