MARLON JULIANO ROMERO ALIBERTI

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/66, Hospital das Clínicas, Faculdade de Medicina

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  • conferenceObject
    Fog ahead: delirium and post-discharge cognitive impairment in severe COVID-19.
    (2020) AVELINO-SILVA, T.; GARCEZ, F.; DIAS, M.; JACOB-FILHO, W.; ALIBERTI, M.
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  • article 28 Citação(ões) na Scopus
    Comparison of 3 Frailty Instruments in a Geriatric Acute Care Setting in a Low-Middle Income Country
    (2018) LIN, Sumika Mori; ALIBERTI, Marlon Juliano Romero; FORTES-FILHO, Sileno de Queiroz; MELO, Juliana de Araujo; APRAHAMIAN, Ivan; SUEMOTO, Claudia Kimie; JACOB FILHO, Wilson
    Objective: Comparison of frailty instruments in low-middle income countries, where the prevalence of frailty may be higher, is scarce. In addition, less complex diagnostic tools for frailty are important in these settings, especially in acutely ill patients, because of limited time and economic resources. We aimed to compare the performance of 3 frailty instruments for predicting adverse outcomes after 1 year of followup in older adults with an acute event or a chronic decompensated disease. Design: Prospective cohort study. Setting: Geriatric day hospital (GDH) specializing in acute care. Participants: A total of 534 patients (mean age 79.6 +/- 8.4 years, 63% female, 64% white) admitted to the GDH. Measurements: Frailty was assessed using the Cardiovascular Health Study (CHS) criteria, the Study of Osteoporotic Fracture (SOF) criteria, and the FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) questionnaire. Monthly phone contacts were performed over the course of the first year to detect the following outcomes: incident disability, hospitalization, fall, and death. Multivariable Cox proportional hazard regression models were performed to evaluate the association of the outcomes with frailty as defined by the 3 instruments. In addition, we compared the accuracy of these instruments for predicting the outcomes. Results: Prevalence of frailty ranged from 37% (using FRAIL) to 51% (using CHS). After 1 year of follow-up, disability occurred in 33% of the sample, hospitalization in 40%, fall in 44%, and death in 16%. Frailty, as defined by the 3 instruments was associated with all outcomes, whereas prefrailty was associated with disability, using the SOF and FRAIL instruments, and with hospitalization using the CHS and SOF instruments. The accuracy of frailty to predict different outcomes was poor to moderate with area under the curve varying from 0.57 (for fall, with frailty defined by SOF and FRAIL) to 0.69 (for disability, with frailty defined by CHS). Conclusions: In acutely ill patients from a low-middle income country GDH acute care unit, the CHS, SOF, and FRAIL instruments showed similar performance in predicting adverse outcomes. (C) 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
  • article 20 Citação(ões) na Scopus
    Targeted Geriatric Assessment for Fast-Paced Healthcare Settings: Development, Validity, and Reliability
    (2018) ALIBERTI, Marlon J. R.; APOLINARIO, Daniel; SUEMOTO, Claudia K.; MELO, Juliana A.; FORTES-FILHO, Sileno Q.; SARAIVA, Marcos D.; TRINDADE, Carolina B.; COVINSKY, Kenneth E.; JACOB-FILHO, Wilson
    ObjectivesTo develop and examine the validity and reliability of a targeted geriatric assessment (TaGA) for busy healthcare settings. DesignThe TaGA was developed through the consensus of experts (Delphi technique), and we investigated its construct validity and reliability in a cross-sectional study. SettingGeriatric day hospital specializing in acute care in Brazil. ParticipantsOlder adults (N = 534) aged 79.5 8.4, 63% female, consecutively admitted to the geriatric day hospital. MeasurementsThe Frailty Index (FI), Physical Frailty Phenotype, and Identification of Seniors at Risk (ISAR) were used to explore the TaGA's validity. External scales were used to investigate the validity of each matched TaGA domain. The interrater reliability and time to complete the instrument were tested in a 53-person subsample. ResultsIn 3 rounds of opinion, experts achieved consensus that the TaGA should include 10 domains (social support, recent hospital admissions, falls, number of medications, basic activities of daily living, cognitive performance, self-rated health, depressive symptoms, nutritional status, gait speed). They arrived at sufficient agreement on specific tools to assess each domain. A single numerical score from 0 to 1 expressed the cumulative deficits across the 10 domains. The TaGA score was highly correlated with the FI (Spearman coefficient = 0.79, 95% confidence interval (CI)=0.76-0.82) and discriminated between frail and nonfrail individuals better than the ISAR (area under the receiver operating characteristic curve 0.84 vs 0.72; P < .001). The TaGA score also had excellent interrater reliability (intraclass correlation coefficient = 0.92, 95% CI=0.87-0.95). Mean TaGA administration time was 9.5 +/- 2.2 minutes. ConclusionThe study presents evidence supporting the TaGA's validity and reliability. This instrument may be a practical and efficient approach to screening geriatric syndromes in fast-paced healthcare settings. Future research should investigate its predictive value and effect on care.
  • conferenceObject
    Bullseye - targeted geriatric assessment improves prognostication in hospitalized older adults
    (2021) AVELINO-SILVA, T. J.; CAMPORA, F.; CURIATI, J. A.; JACOB-FILHO, W.; ALIBERTI, M.
  • article 0 Citação(ões) na Scopus
    Risk and protective factors for dementia: epidemiological evidence and windows of opportunity
    (2022) SUEMOTO, C. K.; NITRINI, R.; GRINBERG, L. T.; LEITE, R. E. P.; PASQUALLUCCI, C. A.; BERTOLA, L.; VIDAL-FERREIRA, N.; SZLEFJ, C.; CARAMELLI, P.; BENSENOR, I. M.; LOTUFO, P. A.; ALIBERTI, M. J. R.; FERRI, C. P.; JACOB-FILHO, W.
    Background: Most people with dementia already live in low- to middle-income countries (LMIC). However, most evidence regarding dementia prevention comes from high-income countries that have different socioeconomic status (SES) and risk factors prevalence than LMIC. In this session, we will present results on risk and protective factors for dementia from the Longitudinal Study of Adult Health (ELSA-Brasil), the Brazilian Longitudinal Study of Aging (ELSI-Brazil), and the Brazilian Biobank for Aging Studies (BAS). Method: The ELSA-Brasil follows 15,105 public servants since 2008-10. The ELSI-Brazil is a nationally representative study with 9,412 adults aged 50 years and older, who were enrolled in 2015-16. The BAS is a neuropathology study that started in 2004 and is the largest brain bank in Latin America with a collection of 1,441 brains. The focus of this presentation will be on the associations of education, SES, and cardiovascular factors with dementia using data from these three studies. Result: In the BAS, 77% of the sample has less than 5 years of education and 56% unskilled occupations. Compared to the group without education, those with formal education had better cognitive performance (1-4 years: β = -0.99, 95%CI = –1.85; –0.14, p = 0.02; ≥5 years: = –1.42, 95% CI = –2.47; –0.38, p = 0.008). On the other hand, occupation complexity and demands were unrelated to cognition. Similarly, we showed that education and early-life SES were the main contributors to cognitive performance in the ELSA-Brasil, while later SES had a lower influence on cognitive scores. Cardiovascular factors are also important contributors to brain health. Ideal vascular health was related to better cognitive function in the ELSA-Brasil. Participants with intermediate (β = 0.064, 95%CI = 0.033; 0.096) and optimal health (β = 0.108, 95%CI = 0.052; 0.164) had better cognitive z-scores. Moreover, carotid artery atherosclerosis evaluated by morphometric measurements was related to cognitive impairment in BAS and with cognitive decline in the ELSA-Brasil after 8 years of follow-up (β = -0.028, 95%CI = -0.036; -0.020, p<0.001). Finally, hypertension was related to worse cognition (β = -0.09; 95%CI = -0.15, -0.04; p = 0.001) in ELSI-Brazil, mainly in non-frail participants. Conclusion: Studies from LMIC regarding dementia risk factors are essential to implement tailored public policies for dementia primary prevention. © 2022 the Alzheimer's Association.
  • article 22 Citação(ões) na Scopus
    Frailty and cognitive status evaluation can better predict mortality in older adults?
    (2018) APRAHAMIAN, Ivan; SUEMOTO, Claudia Kimie; ALIBERTI, Marlon Juliano Romero; FORTES FILHO, Sileno de Queiroz; MELO, Juliana de Araujo; LIN, Sumika Mori; JACOB FILHO, Wilson
    Objectives: to evaluate the improvement in one-year mortality prediction after adding a 2-min cognitive screening to a simple 1-min frailty detection instrument. Secondary outcomes were new activities of daily living (ADL) disability and falls. Design: Prospective cohort study. Setting: A geriatric day-hospital for intermediate care. Participants: A total of 701 older adults with an acute or decompensated disease (79.5 (8.3) years, 64% female). Measurements: A rapid and simple frailty evaluation was performed using the FRAIL questionnaire. The presence of cognitive impairment was defined by previous diagnosis of dementia or a score of five or less on an education-corrected 10-point cognitive screening tool. Results: Frail participants with normal (hazard risk [HR] 4.0, 95% confidence interval [CI], 1.73-9.25) and impaired cognition had a higher risk of death (HR 4.38, 95% CI, 1.95-9.87) than robust participants. The presence of cognitive impairment increased the risk of death in prefrail (HR 3.60, 95% CI, 1.55-8.34) and robust participants (HR 3.49, 95% CI, 1.22-9.96). Cognitive impairment was associated with an increased risk of incident ADL disability in all frailty categories. The presence of cognitive impairment was associated with a significantly higher risk of fall in robust seniors. The predictive accuracy of the FRAIL scale was lower than expected (between 0.58 and 0.69), and a small improvement was observed after adding the cognitive screening (between 0.61 and 0.72). Conclusion: Despite of significant results in predicting relevant clinical events, the present combination of the FRAIL and 10-CS scales may not be ideal in clinical practice.
  • article 5 Citação(ões) na Scopus
    Dissipating the fog: Cognitive trajectories and risk factors 1 year after COVID-19 hospitalization
    (2023) GONCALVES, Natalia Gomes; ALIBERTI, Marlon Juliano Romero; BERTOLA, Laiss; AVELINO-SILVA, Thiago; DIAS, Murilo Bacchini; APOLINARIO, Daniel; BUSATTO, Geraldo; FORLENZA, Orestes; NITRINI, Ricardo; BRUCKI, Sonia Maria Dozzi; BRUNONI, Andre Russowsky; VIDAL, Kallene Summer Moreira; JACOB-FILHO, Wilson; SUEMOTO, Claudia Kimie
    Introduction: Cognitive impairment is common after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, associations between post-hospital discharge risk factors and cognitive trajectories have not been explored. Methods: A total of 1105 adults (mean age SD 64.9 9.9 years, 44% women, 63% White) with severe coronavirus disease 2019 (COVID-19) were evaluated for cognitive function 1 year after hospital discharge. Scores from cognitive tests were harmonized, and clusters of cognitive impairment were defined using sequential analysis. Results: Three groups of cognitive trajectories we re observed during the follow-up: no cognitive impairment, initial short-term cognitive impairment, and long-term cognitive impairment. Predictors of cognitive decline after COVID-19 were older age (beta = -0.013, 95% CI = -0.023;-0.003), female sex (beta = -0.230, 95% CI = -0.413;-0.047), previous dementia diagnosis or substantial memory complaints (beta = -0.606, 95% CI = -0.877;-0.335), frailty before hospitalization (beta = -0.191, 95% CI = -0.264;-0.119), higher platelet count (beta = -0.101, 95% CI = -0.185;-0.018), and delirium (beta = -0.483, 95% CI = -0.724;-0.244). Post-discharge predictors included hospital readmissions and frailty. Discussion: Cognitive impairment was common and the patterns of cognitive trajectories depended on sociodemographic, in-hospital, and post-hospitalization predictors. Highlights Cognitive impairment after coronavirus disease 2019 (COVID-19) hospital discharge was associated with higher age, less education, delirium during hospitalization, a higher number of hospitalizations post discharge, and frailty before and after hospitalization. Frequent cognitive evaluations for 12-month post-COVID-19 hospitalization showed three possible cognitive trajectories: no cognitive impairment, initial short-term impairment, and long-term impairment. This study highlights the importance of frequent cognitive testing to determine patterns of COVID-19 cognitive impairment, given the high frequency of incident cognitive impairment 1 year after hospitalization.
  • article 6 Citação(ões) na Scopus
    The long and winding road of COVID-19 in survivors of hospitalisation: Symptoms trajectory and predictors of long COVID
    (2023) DIAS, Murilo B.; MEDEIROS, Ana Paula V.; MELO, Sarah S. de; FONSECA, Cecilia S.; JACOB-FILHO, Wilson; AVELINO-SILVA, Thiago J.; ALIBERTI, Marlon J. R.
  • article 6 Citação(ões) na Scopus
    Twelve Months and Counting: Following Clinical Outcomes in Critical COVID-19 Survivors
    (2023) TANIGUCHI, Leandro U.; ALIBERTI, Marlon J. R.; DIAS, Murilo B.; JACOB-FILHO, Wilson; AVELINO-SILVA, Thiago J.
    Rationale: Recent reports suggest that patients with severe coronavirus disease (COVID-19) often experience long-term consequences of the infection. However, studies on intensive care unit (ICU) survivors are underrepresented. Objectives: We aimed to explore 12-month clinical outcomes after critical COVID-19, describing the longitudinal progress of disabilities, frailty status, frequency of cognitive impairment, and clinical events (rehospitalization, institutionalization, and falls). Methods: We performed a prospective cohort study of survivors of COVID-19 ICU admissions in Sao Paulo, Brazil. We assessed patients every 3 months for 1 year after hospital discharge and obtained information on 15 activities of daily living (basic, instrumental, and mobility activities), frailty, cognition, and clinical events. Results: We included 428 patients (mean age of 64 yr, 61% required invasive mechanical ventilation during ICU stay). The number of disabilities peaked at 3 months compared with the pre-COVID-19 period (mean difference, 2.46; 99% confidence interval, 1.94-2.99) and then decreased at 12 months (mean difference, 0.67; 99% confidence interval, 0.28-1.07). At 12-month follow-up, 12% of patients were frail, but half of them presented frailty only after COVID-19. The prevalence of cognitive symptoms was 17% at 3 months and progressively decreased to 12.1% (P = 0.012 for trend) at the end of 1 year. Clinical events occurred in all assessments. Conclusions: Although a higher burden of disabilities and cognitive symptoms occurred 3 months after hospital discharge of critical COVID-19 survivors, a significant improvement occurred during the 1-year follow-up. However, one-third of the patients remained in worse conditions than their pre-COVID-19 status.