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| 2. |
- Hagell, Peter, et al.
(författare)
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Apomorphine formulation influences subcutaneous complications in continuous apomorphine pump therapy for Parkinson’s disease
- 2017
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Objective: To explore if the occurrence and severity of subcutaneous (sc) nodules is influenced by the pharmaceutical formulation of apomorphine used for sc infusion in advanced Parkinson’s disease (PD). Background: Apomorphine infusion is an effective therapy in advanced PD, but a limitation is troublesome sc nodules. Various chemically non-identical apomorphine formulations are available. Anecdotal clinical experience has suggested that shifting from one of these (Apo-Go PumpFill; apoGPF) to another (Apomorphine PharmSwed; apoPS, developed in Sweden) may influence the occurrence and severity of sc nodules. Methods: In this multicenter open-label prospective observational study, 15 people with advanced PD (mean PD- duration, 13.4 years; median Hoehn & Yahr, IV) on apoGPF since a mean of 2.1 years and with troublesome sc nodules were switched to apoPS. Ongoing interventions to treat existing nodules (ultrasound, massage, Hirudoid cream) continued, and apomorphine as well as other drugs was managed accordingto clinical routines. Data were collected between May 2015 and March 2017; at baseline, at the time of switching (about 2 weeks later), and up to 1.7-4.2 (mean, 2.5) months post-switch follow-up. Primary outcomes were total nodule numbers, size (mm diameter for the 5 worst nodules), consistency (scored 0-3 for the 5 worst nodules), and associated skin changes (scored 0-4 for the 5 worst nodules) and pain (scored 0-5). Patients also rated their perceived PD severity and motor complications (UPDRS IV). Patient preferences 5-12 months post-switch (2-9 months after follow-up) were also recorded. Results: Apomorphine and L-dopa doses did not change over the observation period (P≥0.400). Baseline nodule numbers (7.4 vs. 4.6; P<0.003), size (92.9 vs. 54.1 mm; P=0.016), consistency (11 vs. 5; P=0.003), skin changes (3 vs. 1.5; P=0.205), and average pain (1 vs. 0; P=0.020) improved 11 weeks post-switch. Patient-reported PD severity (P=0.020) and motor fluctuations improved (P=0.051), whereas dyskinesias tended to increase (P=0.205). At 5-12 months post-switch, 13 patients had decided to remain on apoPS; mainly due to improved nodules. Conclusions: These observations suggest that apoPS may have a better safety profile compared to apoGPF in terms of sc nodule occurrence and severity. There is a need for larger, randomized controlled studies for firmer conclusions.
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| 3. |
- Hagell, Peter, et al.
(författare)
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Apomorphine formulation may influence subcutaneous complications from continuous subcutaneous apomorphine infusion in Parkinson's disease
- 2020
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Ingår i: Journal of Neurology. - : D. Steinkopff-Verlag. - 0340-5354 .- 1432-1459. ; 267:11, s. 3411-3417
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Tidskriftsartikel (refereegranskat)abstract
- Continuous subcutaneous (s.c.) apomorphine infusion is an effective therapy for Parkinson's disease (PD), but a limitation is the formation of troublesome s.c. nodules. Various chemically non-identical apomorphine formulations are available. Anecdotal experiences have suggested that shifting from one of these (Apo-Go PumpFill®; apoGPF) to another (Apomorphine PharmSwed®; apoPS) may influence the occurrence and severity of s.c. nodules. We, therefore, followed 15 people with advanced PD (median PD-duration, 15 years; median "off"-phase Hoehn and Yahr, IV) on apoGPF and with troublesome s.c. nodules who were switched to apoPS. Data were collected at baseline, at the time of switching, and at a median of 1, 2.5, and 7.3 months post-switch. Total nodule numbers (P < 0.001), size (P < 0.001), consistency (P < 0.001), skin changes (P = 0.058), and pain (P ≤ 0.032) improved over the observation period. PD severity and dyskinesias tended to improve and increase, respectively. Apomorphine doses were stable, but levodopa doses increased by 100 mg/day. Patient-reported apomorphine efficacy tended to increase and all participants remained on apoPS throughout the observation period; with the main patient-reported reason being improved nodules. These observations suggest that patients with s.c. nodules caused by apoGPF may benefit from switching to apoPS in terms of s.c. nodule occurrence and severity. Alternatively, observed benefits may have been due to the switch itself. As nodule formation is a limiting factor in apomorphine treatment, a controlled prospective study comparing local tolerance with different formulations is warranted.
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| 5. |
- Davidson, Per, et al.
(författare)
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A daytime nap does not increase mnemonic discrimination ability
- 2020
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Ingår i: Journal of Sleep Research. - : Wiley-Blackwell Publishing Ltd. - 0962-1105 .- 1365-2869.
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Tidskriftsartikel (refereegranskat)abstract
- It has been proposed that sleep readies the brain for novel learning, and previous work has shown that sleep loss impairs the ability to encode new memories. In the present study, we examined if a daytime nap would increase mnemonic discrimination (MD) performance. MD is the ability to differentiate between memories that are similar but not identical. Participants performed the Mnemonic Similarity Task (MST) twice, once in the morning and once in the afternoon. The goal of this task is to distinguish stimuli that have been seen before from novel stimuli that are similar but not identical. After the morning MST, participants were randomly allocated into either a sleep or a wake group. The sleep group had a 2-hr nap opportunity, whereas the wake group spent a similar amount of time passively resting. All participants then performed a second MST in the afternoon with a novel set of images. Results did not show any support for increased MD ability after a nap. There was, however, a correlation showing that an increase in sleepiness between sessions predicted a decrease in MD performance. Future work must systematically examine how strong sleep manipulations that are needed for sleep to have an effect on encoding ability, as well as which kind of memory tasks that are sensitive to sleep manipulations. More knowledge about the relationship between sleep and the ability to differentiate similar memories from each other is important because impaired MD ability has previously been reported in various groups in which sleep disturbances are also common.
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| 6. |
- Davidson, Per, et al.
(författare)
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A daytime nap does not increase pattern separation ability
- 2019
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Ingår i: Sleep. - : Oxford University Press. - 0161-8105 .- 1550-9109. ; 42:1, s. 42-42
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Tidskriftsartikel (refereegranskat)abstract
- Introduction A large body of studies has showed that the ability to learn new information is impaired when we are sleep deprived. Pattern separation (PS), the ability to form distinct memories for events that are highly similar and share overlapping features, has also previously been found to be impaired by sleep deprivation. In the present study, we examined if a daytime nap would increase PS performance. Methods 108 young healthy participants came to the lab in the morning and completed the Mnemonic Similarity Task (MST). This task starts with an encoding phase where participants view images of common everyday objects and are asked to classify them as indoor or outdoor objects. During a subsequent memory test, participants view three different kinds of objects; ‘old’ objects that were also present during the encoding phase, ‘new’ objects that have not been seen before, and ‘lure’ objects that are similar to, but not exactly the same as, objects viewed during encoding. The task of the participants during the re-test is to say if the objects presented are ‘old’, ‘new’ or ‘similar’. This test gives two different outcome measures: General Recognition (GR) - the ability to separate old objects from new ones, and PS - the ability to separate similar objects from old ones. After this task, participants were randomly allocated to either a sleep or a wake group. The sleep group had a two-hour nap opportunity and the wake group spent an equal amount of time resting. After this delay interval, participants completed the MST for a second time with a new set of images. Results Results revealed no support for sleep in increasing either GR or PS ability. Within the sleep group, there were no correlations between changes in PS ability and time spent in any sleep stage. Conclusion Previous studies that have found a role of sleep for PS ability has done so using larger manipulation of sleep. Based on the present study however, just a short daytime nap does not seem to have any effect on PS ability.
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| 7. |
- Davidson, Per, et al.
(författare)
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A more generalized fear response after a daytime nap
- 2018
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Ingår i: Neurobiology of Learning and Memory. - : Elsevier BV. - 1074-7427 .- 1095-9564. ; 151, s. 18-27
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to examine how a daytime nap affected the consolidation of fear learning. Participants first underwent fear conditioning during which they were exposed to a large and a small circle. One of these was repeatedly paired with an electric shock (making it the CS+), whereas the other circle was never paired with the shock (the CS−). After a delay interval containing either a nap or wake, participants again viewed the CS+ and the CS− intermixed with eight novel circles that varied in size between the two stimuli seen before, as well as a blue triangle that served as a novel stimulus without prior fear relevance. We examined both fear retention (the difference between the CS+ and the CS−) and fear generalization (responses to the novel stimuli based on their similarity to the original CS+). Contrary to previous studies, results from the participants who acquired a differentiated fear response during the acquisition phase revealed that the wake group showed significantly larger skin conductance responses to the CS+ compared to the CS−, whereas no such difference was present in the sleep group. These results were not driven by differences in explicit memory or by differences in general reactivity. Analyzing responses to the novel stimuli revealed a tendency towards a more generalized response in the sleep group, with no differences between the CS+ and any other stimulus, whereas the wake group showed increased responses to the stimuli depending on their similarity to the original CS+. This effect was however only present when controlling for baseline differences in worry.
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| 8. |
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| 9. |
- Davidson, Per, et al.
(författare)
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Sleep and the generalization of fear learning
- 2016
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Ingår i: Journal of Sleep Research. - : Wiley-Blackwell Publishing Ltd. - 0962-1105 .- 1365-2869. ; 25:1, s. 88-95
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Tidskriftsartikel (refereegranskat)abstract
- Fear conditioning is an important survival mechanism, as is the ability to generalize learned fear responses to stimuli that are similar to the original conditioned stimulus. Overgeneralization of fear learning, prominent in many anxiety disorders, is however highly maladaptive. Because sleep is involved in the consolidation of fear learning, and in active processing of information, the present study explored the effect of sleep on generalization of fear learning. Participants watched a random sequence of pictures of a small and a big circle, one of them coupled with an aversive sound. Then, after a delay period containing either a nap or wake, generalization was examined as participants watched the two circles again, together with eight novel circles that gradually varied in size between the former two. Results showed that the fear response increased as a function of similarity to the conditioned response. However, there was no difference in the degree of generalization between the sleep and the wake group.
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| 10. |
- Davidson, Per, et al.
(författare)
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Suppression-induced forgetting diminishes following a delay of either sleep or wake
- 2020
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Ingår i: Journal of Cognitive Psychology. - : Informa UK Limited. - 2044-5911 .- 2044-592X. ; 32:1, s. 4-26
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Tidskriftsartikel (refereegranskat)abstract
- We investigated the duration of suppression-induced forgetting (SIF), and the extent to which retrieval suppression differs between negative and neutral memories. We further examined if SIF was differently affected by sleep versus wake during the delay interval between retrieval suppression and re-test. Fifty participants first learned to associate neutral words with either neutral or negative images. Then, a subset of the words was shown again, and participants were asked to either recall (Think), or to suppress retrieval of (No-Think) the associated images. Finally, a memory test for all items was performed either immediately after the Think/No-Think (T/NT) phase (No Delay), or after a 3.5 h delay interval containing either sleep or wake. Results revealed a SIF effect only in the No Delay group, indicating that this forgetting effect dissipates already after a 3.5 h delay interval. Negative items were experienced as more intrusive than neutral ones during the T/NT phase.
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