Male patient laughing due to PseudoBulbar Affect (PBA)

Talk to your doctor about managing PBA

Unpredictable episodes of sudden, frequent, uncontrollable crying and/or laughter can be a challenge. But you can begin to manage PseudoBulbar Affect (PBA) by taking these steps.

Learn about a PBA treatment option

Talking to your doctor about PBA

  • Take a short PBA quiz and show the results to your doctor
  • Use this list to guide your conversation

Tell your doctor if this sounds like you or someone you care for:

  • Sometimes feels fine one minute, then suddenly cries over the smallest things or for no reason
  • Laughs at very inappropriate times
  • Experiences added stress or frustration because of crying and/or laughing episodes
  • Avoids spending time in public or with family and friends because of uncontrollable crying and/or laughing episodes
  • Concerned that these episodes could be mistaken for depression or another disorder

Ask your doctor these questions:

  • Could my crying or laughing be a sign of PBA?
  • What should I know about PBA with my neurologic condition (Stroke, Dementia, MS, TBI, Parkinson’s disease, or ALS [Lou Gehrig’s disease])?
  • How is PBA different from depression?
  • What can I do to manage PBA?

Do these things at your next appointment:

  • Ask questions. Don’t worry about asking “the right questions,” just open up. Your doctor wants to help you understand your condition.
  • Get specific. Because PBA is sometimes mistaken for other conditions, make sure to describe your symptoms. How often do they happen? How long do they last? How do you feel while they’re happening? Details matter.
  • Write your questions down beforehand. It's also good to take notes during your appointment. If you prefer, keep notes in your smartphone so you always have them handy.
  • Go beyond symptoms. Help your doctor understand how your symptoms impact your daily life. What has changed in your life because of this condition?
  • Bring a friend or caregiver along. They can help you remember what you learn from the doctor—and help you remember what to ask.

Getting an accurate PBA diagnosis is key

Because PBA always happens with certain neurologic conditions or brain injury, its symptoms are often misunderstood. Sudden, frequent, uncontrollable crying or laughing from PBA can be mistaken for other states or conditions, such as:

Depression
A mood disorder that causes persistent feelings of sadness. Learn more about PBA and depression here.
Bipolar Disorder
A disorder associated with mood swings
Euphoria
Excessive laughter sometimes associated with conditions like multiple sclerosis (MS)
PTSD
(post-traumatic stress disorder) – A disorder that follows a traumatic event, sometimes associated with conditions like traumatic brain injury (TBI)
Pain
A feeling sometimes communicated through crying, especially in people with Alzheimer’s disease

It is possible to have any of these symptoms while having PBA. Each condition should be diagnosed and managed by a doctor.

Only your doctor can diagnose PBA. That's why it's important to give a full picture of your laughing and/or crying episodes —including how often they occur and their impact.

Caregiver comforting loved one with PBA

Supporting someone with PBA

If you know or care for someone with PBA, you may be wondering how you can help.

Show them you understand

People with PBA often say they feel embarrassed. They may not want to talk about their condition. Let them know you understand that:

  • PBA episodes are not something they can control
  • They’re not alone: about 7 million people in the US with neurologic conditions or traumatic brain injury have symptoms that may suggest PBA. It is thought that almost 2 million people in the US have PBA*
  • PBA is not their fault

*When considering patients with any of 6 common neurologic conditions associated with PBA, it is estimated that 37%, or an estimated 7.1 million Americans, have symptoms suggestive of PBA as defined by a CNS-LS (Center for Neurologic Study-Lability Scale) score ≥13 and 9.4% of patients, or an estimated 1.8 million Americans, with CNS-LS scores ≥21. The presence of PBA symptoms was defined as a CNS-LS score ≥13 and a more restrictive definition was also evaluated using CNS-LS ≥21. The CNS-LS was validated as a PBA screening tool in ALS and MS populations. A CNS-LS score ≥13 merits further diagnostic assessment.

It’s OK if you don’t always feel OK

Caregivers of people with PBA experience a wide variety of feelings:

  • They often feel confused or helpless, wondering where the crying or laughing is coming from
  • Some feel guilty about not knowing how to help
  • They may feel frustrated about the symptoms of PBA
  • Many also feel sad at seeing their loved one struggle with PBA

Feelings like these are normal and understandable. Whether you’re someone’s main caregiver or you provide occasional support, remember that PBA affects everyone—not just the person who has it.

Remember to take care of yourself

Sometimes it’s easy to put all the focus on the person you’re caring for—and forget to care for yourself. Make sure to establish healthy habits of your own, such as:

  • Accept help from others. People want to help. When they offer, be ready with a short list of simple tasks they can do.
  • Get some exercise. It can help lower stress, improve sleep, and increase energy.
  • Try yoga or meditation. Using a smartphone app can be an easy way to get started.

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WHAT'S NEXT:

Get a free kit to help you discuss your PBA symptoms

Use this guide to explain how PBA affects you, and get the help you need.