People with neurocognitive disorders (NCD) condition called dementia are mainly taken care by family members. The number of people suffering from neurocognitive disorders is estimated to increase. Providing care for the person with NCD can be stressful and demanding which is why effective interventions to support caregivers are needed. Occupational therapy practitioners have unique knowledge of the person, environment and occupation and how those factors influence on individuals occupational performance. Occupational therapy ́s interventions to support caregivers with NCD have mainly concentrated on problems in the behaviour of person with NCD. The aim of this scoping review was to identify why some caregivers are managing better as a caregiver before any interventions have been done. What are those aspects of Person (P), Occupation (O) and Environment (E) that facilitate occupational performance (OP) when taking care for a person with NCD. PEO-model by Law et. al (Law et al., 1996) was utilized to formulate research question, in search words and in summarizing the results. The search from Ageline, Cinahl, Psycinfo and PubMed databases was done in January 2018 and went back 10 years. Results found 23 relevant articles for inclusion in the scoping review. Facilitating factors emphasized the supports of relationship seen as an overlap of caregivers and individuals with NCD on occupational performance. Facilitating personal factors of resilience, finding gains in caregiving, self -efficacy and religiosity were found to have an impact on care that the caregiver provides. Facilitative aspects of occupations highlighted importance of daily occupations as a source of well-being for both caregiver and person with NCD. In conclusion, facilitating aspects of relationships, personal factors and engagement in activities and hobbies supported occupational performance of both the caregiver and a person with NCD. Taking these factors into consideration could help target interventions more precisely to meet caregivers needs.

This chapter will address the issue of risk for HIV-associated neurocognitive disorder (HAND), focusing on HIV-associated dementia (HAD), among persons living with HIV in relationship to the risk for other dementias. Advances in effective antiretroviral therapy (ART) have led to an increase in the prevalence of older persons surviving with HIV – in addition to older persons who become infected by HIV later in life. Hence, HIV is no longer a disease of younger persons, and additional attention has been brought to bear against the plight of older persons living with HIV – not only as it pertains to treatment but also to prevention. The additional risk caused by aging among older persons living with HIV is complex to asses, and HIV infection is a research area that requires a robust approach to multiple other factors causing neurocognitive impairment with older age. The long-term and potentially neurotoxic exposure to ART and the deleterious consequences of chronic infection with HIV and its associated neuro-inflammation have been described for health. This aids in the understanding of dementia risk factors in this patient population, but the comorbidities (HIV- and non-HIV-associated) occurring among older persons living with HIV must also be addressed to properly assess the overall impact on dementia risk in this group. This need also warrants our examination of the risk factors for other dementias (and comorbid dementias) in persons living with HIV versus the general population through the assessment and quantification of modifiable and non-modifiable risk factors identified as major contributors toward dementia.

[pt] Além da utilização como teste de rastreio, tem-se utilizado o Teste do Desenho do Relógio (TDR) também na avaliação de funcionamento executivo em idosos. Em dissertação de mestrado, construiu-se e validou-se um método de pontuação que classificou as estratégias de construção do TDR. A presente tese tem o objetivo de investigar as estratégias de construção do TDR em idosos com comprometimento cognitivo. 86 idosos (28 controle, 45 com transtorno neurocognitivo leve e 13 com transtorno neurocognitivo maior) participaram dos dois estudos que compuseram a tese. O primeiro analisou as estratégias de construção do TDR e o perfil neuropsicológico dos idosos e o segundo verificou a validade clínica do sistema. Os resultados apresentaram que as subcategorias associadas a melhor funcionamento executivo diminuem ocorrência à medida que o comprometimento cognitivo se acentua e as subcategorias associadas a pior funcionamento executivo aumentam frequência. Verificou-se também que a Estratégia de Sequência Geral Atípica evidenciou validade clínica para diferenciar idosos com transtorno neurocognitivo maior dos demais grupos. Conclui-se que a análise qualitativa das Estratégias de Construção do TDR tem utilidade clínica como medida de funcionamento executivo. / [en] Besides being used as a screening test, the Clock Drawing Test (CDT) has also been used to assess executive functioning in the elderly. In previous study, a scoring method that classified the Construction Strategies of the CDT was constructed and validated. This tesis aims to investigate construction strategies of CDT in elderly with cognitive impairment. 86 elderly (28 controls, 45 with mild neurocognitive disorder and 13 with major neurocognitive disorder) were the participants of the thesis. It was subdivided in two studies. The first one analyzed older adult s Construction Strategies of the CDT and neuropsychological profiles. The second one verified clinical validity of the system. Results showed that the subcategories associated with better executive functioning decrease occurrence as cognitive impairment increases while the subcategories associated with worse executive functioning increase frequency. Atypical General Sequence Strategy also showed clinical validity to differentiate older adults with major neurocognitive disorder from other groups. As conclusion, it is verified that qualitative analysis of the Construction Strategies of the CDT has clinical utility as a measure of executive functioning.