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The Fearless Caregiver 


Gary Barg - Editor-in-chiefOn Being A Family Caregiver CEO:
Understanding Unpredictable Crying or
Laughing Outbursts

I’ve often said that being a family caregiver is similar to being the CEO of an organization called Caring for my Loved One, Inc.  Yet, upon reflection, the caregiver’s role is so much more multifaceted than any traditional CEO would be called upon to play. As well as manager of all services affecting our loved ones, as a family caregiver, we must also be a moral supporter, task manager and even a dedicated observer. However, it’s the role as the observer that is often the most vital one to play.

Trying to discern what is to be expected within a disease or condition is a difficult position, such is the case with a condition known as pseudobulbar affect or PBA. Charles Darwin first documented the condition in medical literature over 130 years ago; however, there is still little awareness of PBA.  Due to its symptoms—seemingly out-of-the-blue, involuntary outbursts of crying or laughing—PBA is frequently mistaken for depression.  However, PBA is a distinct neurologic condition. Unlike depression, PBA episodes are sudden, brief and unpredictable. Many people who suffer from PBA describe their episodes as uncontrollable, exaggerated or different from their true feelings.

As you may recall from one of our April newsletters, PBA is a distinct medical condition that occurs in people with an underlying neurologic condition or injury such as:

  • Alzheimer’s disease or other dementias
  • Stroke
  • Traumatic brain injury (TBI)
  • Parkinson’s disease
  • Multiple sclerosis (MS)
  • Lou Gehrig’s disease (ALS)

People who suffer from PBA may find it challenging.  PBA episodes can sometimes cause embarrassment, particularly in public settings.  Sometimes these crying or laughing episodes can be so disruptive for people that they can interfere with their routine activities or cause them to avoid social situations. If someone you love has PBA, he or she may be embarrassed by his or her crying or laughing outbursts and reluctant to talk about their condition. You can help by letting your loved one know you understand these episodes are involuntary and not something they can control. You can also remind your loved one that PBA is a neurologic condition.  Neurologic diseases or injuries can damage the areas of the brain that control normal expression of emotions.  This damage can disrupt brain signaling, causing a ‘short circuit,’ triggering episodes of uncontrollable crying of laughing.

Finally, you can reassure your loved one that he or she is not alone.  Nearly two million Americans with underlying neurologic diseases or brain injuries are thought to suffer from PBA.  And many of these folks living with PBA have loved ones who, just like you, want to let them know that PBA does not change the way you feel about them. Asking the right questions and having this information will help you talk to your loved one’s doctor to ensure he or she gets the care they need.


  Gary Barg
Today's Caregiver magazine
Wednesday June 27, 2012


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