Memantine may affect pseudobulbar affect in patients with Alzheimer's disease

Pseudobulbar affect: clinical associations, social impact and quality of life implications - Lessons from PLS

BACKGROUND

Pseudobulbar affect (PBA) is a well-recognised and troublesome clinical phenomenon in a range of neuroinflammatory, neoplastic, neurovascular and neurodegenerative conditions. It is often under-recognised in the community, frequently mistaken for psychiatric manifestations, appropriate pharmacological treatment is often delayed, and may result in a sense of embarrassment or lead to social isolation. Despite its considerable quality of life (QoL) implications and the challenges associated with its effective management, it is notoriously understudied.

METHODS

As the incidence of PBA is lower in non-motor neuron disease patient cohorts, and the social and QoL impact of PBA is not sufficiently recognised, a purpose-designed study was conducted in a Primary Lateral Sclerosis (PLS) cohort to assess the clinical correlates and social impact of PBA.

RESULTS

PBA was very strongly associated with pseudo-bulbar motor dysfunction. Dysphagia (OR 14, P = .005) and the presence of abnormal jaw jerk (OR 19.8, P < 0.001) greatly increased odds of PBA. There was no significant difference in the cognitive or behavioural profiles between those with PBA and those without it. Poorly controlled laughing (85%) was more prevalent than crying (69%) among PLS patients with PBA. No individual experienced PBA symptoms prior to the motor manifestations of PLS. Most patients were unaware that PBA was common in their neurological condition. The mean PBA Impact score was 5 (range 1-17) and correlated with CNS-LS crying subscores (r = .693, p = .006).

DISCUSSION

The severity of pseudobulbar affect correlates with motor manifestations of pseudobulbar palsy, a link supporting emerging imaging studies regarding bilateral corticobulbar tract degeneration as in important aetiological factor. The social and quality of life ramifications of pseudobulbar affect can be readily demonstrated by purpose-designed questionnaires.

CONCLUSIONS

Despite sporadic reports, the clinical, social, caregiver burden and quality of life implications of pseudobulbar affect remain poorly characterised. The comprehensive evaluation of the clinical correlates of PBA helps to elucidate the underlying pathophysiology. Ultimately, the comprehensive assessment of both the aetiology and social impact of PBA helps to raise awareness of this entity, reduce misdiagnoses, enhance the early recognition of this phenomenon and encourage proactive pharmacological intervention.

Treatment of disorders of emotional comprehension, expression, and emotional semantics

Neurological disease can impair emotional communication by several means: damaging the networks important in understanding the meaning of emotional stimuli (emotional semantics); damaging networks important in the perceptual recognition and production of emotional stimuli, and damaging the connections between networks supporting emotional semantics and recognition/production networks. Disorders of emotional expression, comprehension, and emotional semantics may improve with pharmacological or behavioral treatments. Pharmacological treatments can be used to redress naturally occurring or disease-related alterations in the computational properties of target neural systems. No drug treatment can replace a loss of cerebral knowledge related to the pathological loss of neural connectivity. Behavioral treatments that benefit either comprehension or expression of specific emotions may be of value if these emotions are particularly important in enabling human social interaction. However, behavioral treatments that achieve generalization, that is, improve performance with untrained exemplars and in daily life, are much to be preferred, even as they pose the greatest methodological challenges. This chapter will discuss possible mechanisms of generalization and then review what is known about the treatment of expressive and receptive affective aprosodia, deficits in recognition of facial emotions, and pseudobulbar affect. The final section of the chapter is devoted to a discussion of three disorders of emotional semantics, apathy, alexithymia, and impaired empathy.

Pathological Crying and Laughing in Motor Neuron Disease: Pathobiology, Screening, Intervention

Pathological crying and laughing (PCL) has significant quality-of-life implications in amyotrophic lateral sclerosis (ALS); it can provoke restrictive life-style modifications and lead to social isolation. Despite its high prevalence and quality of life implications, it remains surprisingly understudied. Divergent pathophysiological models have been proposed, centered on corticobulbar tract degeneration, prefrontal cortex pathology, sensory deafferentation, and impaired cerebellar gate-control mechanisms. Quantitative MRI techniques and symptom-specific clinical instruments offer unprecedented opportunities to elucidate the anatomical underpinnings of PCL pathogenesis. Emerging neuroimaging studies of ALS support the role of cortico-pontine-cerebellar network dysfunction in context-inappropriate emotional responses. The characterization of PCL-associated pathophysiological processes is indispensable for the development of effective pharmacological therapies.

Candidate SNP markers of aggressiveness-related complications and comorbidities of genetic diseases are predicted by a significant change in the affinity of TATA-binding protein for human gene promoters

BACKGROUND

Aggressiveness in humans is a hereditary behavioral trait that mobilizes all systems of the body-first of all, the nervous and endocrine systems, and then the respiratory, vascular, muscular, and others-e.g., for the defense of oneself, children, family, shelter, territory, and other possessions as well as personal interests. The level of aggressiveness of a person determines many other characteristics of quality of life and lifespan, acting as a stress factor. Aggressive behavior depends on many parameters such as age, gender, diseases and treatment, diet, and environmental conditions. Among them, genetic factors are believed to be the main parameters that are well-studied at the factual level, but in actuality, genome-wide studies of aggressive behavior appeared relatively recently. One of the biggest projects of the modern science-1000 Genomes-involves identification of single nucleotide polymorphisms (SNPs), i.e., differences of individual genomes from the reference genome. SNPs can be associated with hereditary diseases, their complications, comorbidities, and responses to stress or a drug. Clinical comparisons between cohorts of patients and healthy volunteers (as a control) allow for identifying SNPs whose allele frequencies significantly separate them from one another as markers of the above conditions. Computer-based preliminary analysis of millions of SNPs detected by the 1000 Genomes project can accelerate clinical search for SNP markers due to preliminary whole-genome search for the most meaningful candidate SNP markers and discarding of neutral and poorly substantiated SNPs.

RESULTS

Here, we combine two computer-based search methods for SNPs (that alter gene expression) {i} Web service SNP_TATA_Comparator (DNA sequence analysis) and {ii} PubMed-based manual search for articles on aggressiveness using heuristic keywords. Near the known binding sites for TATA-binding protein (TBP) in human gene promoters, we found aggressiveness-related candidate SNP markers, including rs1143627 (associated with higher aggressiveness in patients undergoing cytokine immunotherapy), rs544850971 (higher aggressiveness in old women taking lipid-lowering medication), and rs10895068 (childhood aggressiveness-related obesity in adolescence with cardiovascular complications in adulthood).

CONCLUSIONS

After validation of these candidate markers by clinical protocols, these SNPs may become useful for physicians (may help to improve treatment of patients) and for the general population (a lifestyle choice preventing aggressiveness-related complications).