title: PRISM: a novel research tool to assess the prevalence of pseudobulbar affect symptoms across neurological conditions.
abstract: BACKGROUND
  Pseudobulbar affect (PBA) is a neurological condition characterized by involuntary, sudden, and frequent episodes of laughing and/or crying, which can be socially disabling. Although PBA occurs secondary to many neurological conditions, with an estimated United States (US) prevalence of up to 2 million persons, it is thought to be under-recognized and undertreated. The PBA Registry Series (PRISM) was established to provide additional PBA symptom prevalence data in a large, representative US sample of patients with neurological conditions known to be associated with PBA.
  
  
  METHODS
  Participating clinicians were asked to enroll ≥20 consenting patients with any of 6 conditions: Alzheimer's disease (AD), amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), Parkinson's disease (PD), stroke, or traumatic brain injury (TBI). Patients (or their caregivers) completed the Center for Neurologic Study-Lability Scale (CNS-LS) and an 11-point scale measuring impact of the neurological condition on the patient's quality of life (QOL). Presence of PBA symptoms was defined as a CNS-LS score ≥13. Demographic data and current use of antidepressant or antipsychotic medications were also recorded.
  
  
  RESULTS
  PRISM enrolled 5290 patients. More than one third of patients (n = 1944; 36.7%) had a CNS-LS score ≥13, suggesting PBA symptoms. The mean (SD) score measuring impact of neurological condition on QOL was significantly higher (worse) in patients with CNS-LS ≥13 vs <13 (6.7 [2.5] vs. 4.7 [3.1], respectively; P<0.0001 two-sample t-test). A greater percentage of patients with CNS-LS ≥13 versus <13 were using antidepressant/antipsychotic medications (53.0% vs 35.4%, respectively; P<0.0001, chi-square test).
  
  
  CONCLUSIONS
  Data from PRISM, the largest clinic-based study to assess PBA symptom prevalence, showed that PBA symptoms were common among patients with diverse neurological conditions. Higher CNS-LS scores were associated with impaired QOL and greater use of antipsychotic/antidepressant medications. These data underscore a need for greater awareness, recognition, and diagnosis of PBA.
authors.affiliation: Carolinas Medical Center, University of North Carolina School of Medicine-Charlotte Campus, Charlotte, North Carolina, USA.
authors.forename: Benjamin Rix
authors.initials: BR
authors.lastname: Brooks
authors.forename: David
authors.initials: D
authors.lastname: Crumpacker
authors.forename: Jonathan
authors.initials: J
authors.lastname: Fellus
authors.forename: Daniel
authors.initials: D
authors.lastname: Kantor
authors.forename: Randall E
authors.initials: RE
authors.lastname: Kaye
mesh_terms: D000368:Aged; D014150:Antipsychotic Agents / Q000627:therapeutic use; D003448:Crying; D005260:Female; D006801:Humans; D007845:Laughter; D008297:Male; D009422:Nervous System Diseases / Q000145:classification / Q000188:drug therapy / Q000503:physiopathology*; D020828:Pseudobulbar Palsy / Q000503:physiopathology*; D011788:Quality of Life
chemical_list: D014150:Antipsychotic Agents