Ask the Doctor: Pseudobulbar Affect; Alcohol’s Effect on Memory; Vital Exhaustion
Q: My wife has experienced episodes of unexplained weeping or laughing since her stroke last year. She has been told she has pseudobulbar affect, or PBA. What is PBA?
A: Pseudobulbar affect (PBA) is a neurologic disorder in which an individual experiences episodes of uncontrollable emotional reactions, such as crying or laughing, in response to events or circumstances. These episodes may be at odds with feelings aroused by the events, or they may be appropriate but highly exaggerated. Individuals with PBA may, for example, cry uncontrollably in response to good news. PBA can be triggered by brain injury, disease, or—as in your wife’s case—a stroke (as many as 52 percent of older stroke patients develop PBA). It is thought that these diseases and injuries to the brain affect chemical signaling, disrupting neurological pathways that control emotional expression. PBA generally occurs in the acute phases following a stroke. Symptoms, which generally come on suddenly and may endure as long as several minutes, may appear several times a day. Individuals with PBA often suffer emotional distress and depression because of their involuntary outbursts, and may tend to socially isolate themselves. The understanding and reassurance of family and friends is therefore very important. Antidepressant medications are often prescribed, with good results, and a new medication, Neudexta™, which recently received FDA approval for use for PBA, appears to be very helpful in managing symptoms.
Q: My friend told me about a recent study that found that drinking alcohol can improve an older person’s memory. Is this true?
A: It is true that a study published in the Sept. 7, 2014 issue of the American Journal of Alzheimer’s Disease and Other Dementias found an association be-tween moderate alcohol consumption among older adults and better memory. The researchers studied data on 660 older participants in a long-term study who had received brain scans, provided demographic information, undergone neuropsychological assessment, and answered a survey on drinking habits. Individuals who reported drinking large amounts of alcohol, which can be damaging to the brain, were excluded. The scientists found that compared to participants who did not drink, those who reported consuming light or moderate amounts of alcohol in older age had a larger hippocampus, a key memory region of the brain, and better memory for autobiographic events, such as times, places, and emotions. The research is interesting, but should be viewed with caution. The findings do not suggest that drinking alcohol in older age is the cause of better memory, but merely that there is a correlation. It is possible that individuals who are able to consume alcohol in later years are generally healthier than are those who must limit alcohol because of medications or illness. It’s also true that other studies have found a number of negative associations with alcohol consumption, such as greater risk for cancer, liver disease, depression, and, of course, addiction. For this reason, I would not advise abstainers to take up drinking simply to improve their memory.
Q: Please explain “vital exhaustion” and how it can be overcome.
A: Vital exhaustion is a mixture of irritability, fatigue, and discouragement that is often associated with unmanaged long-term stress. The individual may be healthy, but feel deeply tired and lacking in energy for no physical reason, and develop an ongoing sense of demoralization and irritation. Re-cent research suggests that, if not addressed, vital exhaustion can increase risk for heart disease by 36 percent, possibly owing to the effects of stress hormones that promote inflammation and interfere with the immune response. Lowering stress levels and learning relaxation techniques are strategies that may help ease vital exhaustion.
—Editor-in-Chief Maurizio Fava, MD
The post Ask the Doctor: Pseudobulbar Affect; Alcohol’s Effect on Memory; Vital Exhaustion appeared first on University Health News.
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