The objective of this study was to characterize the epidemiology of using potentially inappropriate medications associated with dementia exacerbation (DPIMs) in elderly outpatients with dementia. Electronic medical records were retrospectively reviewed for geriatric patients with dementia who were prescribed at least one medication in 2016 at a tertiary, university-affiliated hospital. The 2015 Beers criteria were used to define DPIMs. Logistic regression was performed to identify factors associated with prescribing DPIMs in patients with dementia. Among 2100 patients included in our study, 987 (47.0%) patients were prescribed at least one DPIM. Benzodiazepines were the most frequently prescribed DPIM followed by anticholinergics, histamine H2-receptor blockers, and zolpidem. The risk of prescribing DPIMs was significantly increased in female patients (odds ratio (OR) 1.355) with polypharmacy (OR 5.146) and multiple comorbidities (OR 1.129) (p < 0.05 for all). Coexistence of Parkinson’s disease (OR 1.799), mood disorder (OR 1.373), or schizophrenia (OR 4.116) in patients with dementia further increased the likelihood of receiving DPIMs. In conclusion, DPIMs were commonly used in elderly patients with dementia in Korea with benzodiazepines most frequently prescribed followed by anticholinergics. Female patients using polypharmacy with multiple comorbidities should be closely monitored to minimize unnecessary DPIM use and, ultimately, DPIM-related harms.

Previously, we first reported the identification of four p-coumaroyl anthocyanins (petanin, peonanin, malvanin, and pelanin) from the tuber epidermis of colored potato (Solanum tuberosum L. cv JAYOUNG). In this study, we investigated the anti-oxidative and anti-inflammatory effects of a mixture of peonanin, malvanin, and pelanin (10 : 3 : 3; CAJY). CAJY displayed considerable radical scavenging capacity of 1, 1-diphenyl-2-picryl-hydrazyl (DPPH), increased mRNA levels of the catalytic and modulatory subunit of glutamate cysteine ligase, and subsequent cellular glutathione content. These increases preceded the inhibition of lipopolysaccharide (LPS)-induced intracellular reactive oxygen species (ROS) production. CAJY inhibited inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) in a concentration-dependent manner at the protein, mRNA, and promoter activity levels. These inhibitions caused attendant decreases in the production of prostaglandin E 2 (PGE 2 ). CAJY suppressed the production and mRNA expression of tumor necrosis factor (TNF)-α and interleukin (IL)-6. Molecular data revealed that CAJY inhibited the transcriptional activity and translocation of nuclear factor κB (NF-κB) and phosphorylation of signal transducer and activator of transcription 1 (STAT1) and STAT3. Taken together, these results suggest that the anthocyanin mixture exerts anti-inflammatory effects in macrophages, at least in part by reducing ROS production and inactivating NF-κB and STAT 1/3. Key words anthocyanin; macrophage; antioxidant; anti-inflammatory; nuclear factor κB; signal transducer and activator of transcription Reactive oxygen species (ROS) are important in various biological processes at the levels of gene expression, protein translation, post-translational modification, and protein interactions.1) Cell-derived ROS independently or cooperatively regulate cellular signaling in response to environmental cues. 1)A sustained pro-inflammatory state characterized by excessive ROS production is the common aspect in the development, progression, and complication of obesity, infections, cardiovascular and neurodegenerative diseases, and cancer.2-4) The shift in the balance between oxidants and anti-oxidants in favor of oxidants is termed oxidative stress. This stress contributes to many pathological conditions.Aerobic organisms have integrated anti-oxidant systems, which include enzymatic and non-enzymatic antioxidants, that are usually effective in blocking harmful effects of ROS. 5)Anti-oxidant defense systems comprise glutathione (GSH) and its synthesis, phase II detoxifying enzymes, and ROS inactivating enzymes, which play key roles in protecting cells upon oxidative damage. 6) GSH effectively protects cells from various oxidative stresses caused by scavenging free radicals, suppression of lipid peroxidation, and removal of hydrogen peroxides in cells.7) Glutamate cysteine ligase (GCL) is the rate-limiting enzyme for de novo GSH synthesis and comprises a heterodimer formed of a catalytic subunit (GCLC) and a modulator...