Prevalence of Pseudobulbar Affect following Stroke: A Systematic Review and Meta-Analysis

Abstract

Background: Several studies have reported that emotional lability is a common consequence of stroke. However, there is uncertainty about the "true" prevalence of the condition because, across these studies, patients have been recruited at different stages of recovery, from different settings, and using different diagnostic methods. There have been no systematic reviews of the published evidence to ascertain how the prevalence of poststroke pseudobulbar affect (PBA) might vary according to these factors.

Methods: A systematic review and meta-analysis of the published literature were undertaken.

Results: A total of 15 studies (n = 3391 participants) met inclusion criteria for the review. Meta-analysis estimated that the prevalence of PBA was 17% (95% confidence interval 12%-24%) acutely (<1 month post stroke), 20% (14%-29%) post acutely (1-6 months post stroke), and 12% (8%-17%) in the medium to longer term (>6 months post stroke). The evidence from the published literature, although limited, is that crying is a more common PBA presentation following stroke than laughter.

Conclusions: PBA is a common condition that affects approximately 1 in 5 stroke survivors at the acute and postacute phases, and 1 in 8 survivors beyond 6 months post stroke. These prevalence data are very important for clinicians and the commissioners of services.

Keywords: Stroke; meta-analysis; pseudobulbar affect; systematic review.