Pseudobulbar affect after stroke: a narrative review

Background: Pseudobulbar affect (PBA) is a neuropsychological condition of emotional lability and affective dysregulation associated with a variety of neurological conditions such as stroke, traumatic brain disease, and neurodegenerative disease. The true prevalence and medico-social burden of PBA associated with stroke is unclear. Often confused with post-stroke mood disorders, PBA is under-recognized and under-treated. Objective: To provide a comprehensive narrative synthesis of published literature on the topic of PBA. Methods: Literature review was performed by searching the key words "pseudobulbar atrophy", "emotional incontinence," and "stroke" in PubMed. Only manuscripts published in English were appraised and relevant content was extracted, synthesized, and summarized. Results: A narrative overview was performed on the following topics: epidemiology, pathophysiology, clinical features of differential diagnosis, impact on public health, and therapeutic options. Conclusion: PBA remains an under-treated condition with significant psychosocial burden on both effected stroke survivors and their families. Advances have been made in developing consensus-based clinical diagnostic criteria for PBA. Early identification and prompt initiation of therapeutic measures are required in these stroke patients. Further research is needed to develop better PBA diagnostic criteria and more cost-effective therapeutic treatment options.