Common Side Effects of Stroke: Uncontrollable Crying and Laughing

uncontrollable crying and laughing

Stroke causes cognitive problems

In the U.S., stroke is the 5th leading cause of death and a major cause of adult disability. About 800,000 Americans have a stroke each year and 25% of survivors have a minor disability. 40% have moderate-to-severe disabilities.

When someone is recovering from a stroke, most people think of physical problems like muscle weakness, but cognitive issues can be just as challenging to manage and overcome. One common side effect of stroke is a brain disorder called pseudobulbar affect, or PBA for short.


Pseudobulbar affect (PBA) causes uncontrollable crying and laughing

Pseudobulbar affect is a neurological condition that causes uncontrollable crying or laughing. These responses are exaggerated or inappropriate and usually don’t represent their actual feelings.

Someone with PBA might laugh when hearing sad news, switch quickly from laughing to crying, or cry hysterically over something mildly sad. They could also have spontaneous emotional outbursts, without any type of trigger. The American Stroke Association says these episodes could happen up to 100 times a day.

Even though 53% of stroke survivors have reported PBA symptoms, less than 20% have heard of this disorder. This makes caregiving even more difficult because it’s extra scary when you don’t know what’s wrong or why your older adult is acting so crazy.

These uncontrollable outbursts can be embarrassing, cause problems with social life and relationships, and make your senior unwilling to leave the house.


Why does PBA cause uncontrollable emotional outbursts?

PBA happens when stroke damages areas in the brain that control how emotion is expressed. The damage causes short circuits in brain signals, which trigger these involuntary episodes of laughing or crying.

Stroke is one cause of PBA, but it can also happen in people who have other neurological disorders like ALS, Parkinson’s, traumatic brain injury, multiple sclerosis, dementia, Wilson’s disease, or brain tumors.


PBA is different from depression

Because PBA can cause uncontrollable crying after stroke, it’s often mistaken for depression. That causes it to be underdiagnosed, undertreated, and sometimes inappropriately treated.

In general, depression is an ongoing feeling of sadness or hopelessness that can last for weeks or months. PBA episodes are brief, spontaneous outbursts that might not reflect how your older adult really feels.


PBA coping tips and treatment

It’s important to get a diagnosis to find out if your senior truly does have PBA. If that is the cause of the emotional episodes, the doctor may recommend a PBA drug or an anti-depressant. These drugs are said to help control the symptoms, but may not completely get rid of the outbursts.

To support your older adult, try these 3 tips:

  1. Keep a log of emotional outbursts. By recording each episode, you can help the doctor make an accurate diagnosis.
  2. Remind your senior that their outbursts are a side effect of stroke, not a mental condition.
  3. Let them know you support them, they’re not alone, and that many people suffer from PBA symptoms.

To help your senior cope with PBA symptoms, ask them to try these 5 tips:

  1. Be open about the problem so family and friends aren’t surprised or confused when you have an episode.
  2. When you feel an outburst starting, distract yourself by counting objects on a shelf or thinking about something unrelated.
  3. Take slow deep breaths until you feel more in control.
  4. Relax your forehead, shoulders and other muscles that tense up during an episode.
  5. When you think you are about to cry or laugh, change your body position.


Bottom line

If you’ve been struggling to understand why your older adult has been experiencing uncontrollable crying and laughing after their stroke, PBA could be the reason. Check with their doctor or neurologist to get a diagnosis and find out how to manage the symptoms.


Next Step  Worried that your senior has PBA? Take this quick assessment and discuss the results with their doctor


You might also like:
How to Respond to Signs of Stroke
VIDEO: Stroke Therapy Exercises for Upper and Lower Body
REVIEW: Being There, a Book About Caregiving After Stroke


By DailyCaring Editorial Team
Sources: American Stroke Association, National Stroke Association, Everyday Health,
Image: Wonderslist

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