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Pseudobulbar affect (PBA) and Parkinson's

Pseudobulbar affect (PBA) is a neurological condition that can cause a person to have frequent but short uncontrollable outbursts of crying, laughing, or frustration. These outbursts are typically contradictory to the person's emotional state. PBA is not life-threatening, but it can significantly impact one's mental and emotional health. Bursting into tears or fits of laughter can make people feel embarrassed and sometimes lead to social isolation, anxiety, and depression. PBA can also be referred to as "emotional incontinence." PBA is often misdiagnosed for mood disorders such as depression, bipolar disorder, generalized anxiety disorder, schizophrenia, or a personality disorder. However, PBA is not a mood disorder. Let's learn more.

Even though PBA isn’t physically dangerous, it can significantly impact your relationships with friends and family and your quality of life. PBA can interfere with your social life and your work life. Some people may begin to avoid social encounters leading to isolation. This isolation can lead to depression, acceleration of cognitive decline, decreased quality of life, and an exacerbate PD symptoms.

Signs of PBA

Laughing when you are angry.

Bursting into tears when someone tells a funny story.

Laugh hysterically for several minutes at something others may find only slightly humorous.

Having no control over your laughing and crying.

Frustration or anger in situations that are out of proportion to the trigger.

Crying is the most common sign.

PBA Causes  

PBA is most common in people with a traumatic brain injury or those who are living with a neurological condition such as Parkinson’s, Alzheimer’s, multiple sclerosis (MS), stroke, or amyotrophic lateral sclerosis (ALS). Currently, researchers believe that PBA is caused by an injury to the pathways in the brain that regulate our emotional expression and behavioral function (the prefrontal cortex). More specifically, researchers believe that the cortico-ponto-cerebellar circuitry is impacted. This includes pathways to the brainstem and cerebellum.


Talk with your loved ones if you are experiencing symptoms. If you are a family or friend reading this, talk to the person experiencing it. This can greatly help reduce any feelings of embarrassment.

Calming exercises like yoga, deep breathing, meditation, and mindfulness practices can help calm your emotions.

Creative therapies such as art, music, or dance can also help calm emotions.

Some suggest that changing your posture as soon as you feel an episode coming on may stop it from taking place.

Dextromethorphan hydrobromide/quinidine sulfate (branded under Nuedexta) is the only medication that is approved by the FDA. However, it can negatively interact with some PD medications like selegiline. Other medications like antidepressants, antipsychotics, or anticonvulsants, are often prescribed to treat PBA.

Keep up with your social life. Staying connected with people you care about is very important for mental health. Isolating yourself out of fear of embarrassment may lead to depression or other emotional changes.


If you are experiencing symptoms of PBA, talk with your neurologist to determine which treatments are best for you.



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