Editor’s Note: Dr. Andrew Stalker is a Board-Certified Neurologist who has diagnosed and treated people with the condition called PseudoBulbar Affect (PBA). In this guest post, Dr. Stalker recounts his time with patient Doug Parsons and his family, who are featured in The PBA Film Project (working title).
I first met Doug Parsons about 10 years ago when he came to me as a patient. At that time, he communicated that something didn’t seem right: he was experiencing difficulty conveying his thoughts and emotions. After some investigation, we determined that he had Frontotemporal Dementia (FTD).
While most people are familiar with Alzheimer’s disease, many people don’t know about FTD, which is a relatively more common form of dementia in people younger than age 65, accounting for up to 20-50% of dementia cases . FTD is like Alzheimer’s disease, but different in key ways. When people have Alzheimer’s disease, they can talk but often don’t understand what’s happening or can’t remember what’s going on. Doug, on the other hand, understands what’s going on but is unable to communicate by talking. His FTD has progressed so much that it has led to a loss of speech as well as impaired motor skills, confining him to a wheelchair.
But much earlier on, before it progressed to that point, Doug developed PseudoBulbar Affect (PBA).
An estimated two million Americans suffer from PBA. It’s a neurologic condition characterized by uncontrollable laughing and/or crying outbursts that are often contrary or exaggerated to how a person is really feeling on the inside. People with PBA can find themselves involuntarily laughing or crying when they don’t mean to or out of context to a situation.
PBA is a secondary condition that is linked to FTD but it can arise out of a variety of other neurologic conditions such as traumatic brain injury (TBI), multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), Parkinson’s disease, stroke, and Alzheimer’s disease.
I remember that Doug initially started to show very mild symptoms of PBA. It wasn’t present all the time, but when you would talk to Doug, he would occasionally have a spontaneous laugh or cry that was out of context.
Over time his symptoms became more pronounced. It got to the point where every interaction with Doug would include an involuntary and uncontrollable laugh-turn-to-cry outburst. It was very disruptive and very hard for him and his entire family.
Many people with PBA describe the symptoms as disruptive, but also embarrassing. They can feel anxious about having these uncontrollable outbursts in social situations. As a result, they might restrict themselves from going out and being around people that may not understand what’s happening when their PBA symptoms occur. It can therefore be an isolating condition.
The good news is that PBA is treatable. If you or someone you care for have an underlying neurologic condition or brain injury and are experiencing uncontrollable outbursts of crying and/or laughing, take this short assessment and share the results with your doctor.
Dr. Andrew Stalker
Northeastern Ohio College of Medicine