Pseudobulbar Affect Symptoms in Nursing Home Patients with Neurocognitive Disorders

Abstract

Background: Symptoms of pseudobulbar affect (PBA) often are misinterpreted as those of a mood disorder. Symptoms seen in patients with PBA can be influenced by a mood disorder and vice versa. Our aim in this study was to determine the occurrence rate of PBA symptoms and comorbid depressive symptoms in a cohort of nursing home patients with different subtypes of neurocognitive disorders (NCD)/dementia. Methods: Eighty patients were screened and 61 met the inclusion criteria. These individuals were divided into 5 groups according to NCD subtypes: Alzheimer's disease, vascular, HIV, unspecified, or combined types. The Center for Neurologic Study–Lability Scale (CNS-LS) and the Geriatric Depression Scale–Short Form (GDS-SF) were used to screen for PBA and depressive symptoms, respectively. The Mini-Mental Status Exam (MMSE) was used to determine patients' baseline functioning. Fifty-nine patients successfully completed the CNS-LS and 42 completed the GDS. Results: Forty-four percent of individuals screened positive for PBA symptoms. Depressive symptoms were found among 23% of these patients. Not only were PBA-symptoms positive patients common among this nursing home residents, the PBA-symptoms positive patients were found to cluster mostly among those with NCD due to HIV (66.0%). PBA symptom-positive patients often received psychotropics. Conclusion: Better awareness, screening tools, and treatment approaches for patients with NCD expressing PBA-symptoms—especially those with NCD due to HIV Infection—are needed.