Introdução: Com o envelhecimento da população mundial projeta-se o crescimento das taxas de doenças potencialmente relacionadas à idade como as demências, especialmente a doença de Alzheimer (DA). Os sujeitos com Comprometimento Cognitivo Leve (CCL) são considerados uma população de risco para desenvolver demência, no entanto, as taxas de incidência de CCL e conversão para demência apresentam considerável variabilidade em parte atribuída a características da amostra e aos diferentes critérios utilizados. Objetivos: Determinar a incidência de demência e Comprometimento Cognitivo Leve em uma coorte de idosos saudáveis de base comunitária; determinar as variáveis demográficas, clínicas e sociais associadas ao desenvolvimento de prejuízo cognitivo, e avaliar o risco de progressão dos indivíduos com Comprometimento Cognitivo Leve para demência comparada com sujeitos cognitivamente normais. Métodos: Os dados foram derivados de uma coorte de idosos residentes na comunidade (N = 345), inicialmente saudáveis e independentes (Estudo PALA - Porto Alegre Longitudinal Aging - study). O seguimento inicial com duração máxima de oito anos teve o objetivo de avaliar a incidência de DA e CCL. Para avaliar a progressão de CCL para DA partimos de 10 anos de seguimento, incluindo os oito anos da primeira análise e consideramos um máximo de 70 meses (média de 45 meses) para avaliar a ocorrência dos novos desfechos. Os participantes que preencheram os critérios de inclusão do estudo e consentiram em participar foram avaliados com uma detalhada entrevista clínica composta de variáveis demográficas, clínicas e sociais. Os sintomas psiquiátricos foram avaliados pela escala SRQ - Self Report Questionnaire, escala MADRS - Montgomery-Asberg Depression Rating Scale e aplicados os critérios para depressão maior do Manual de Diagnóstico e Estatístico de Transtornos Mentais (4ª Edição; DSM-IV). O Mini Exame do Estado Mental (MEEM) e a Escala Clínica de Demência (CDR – Clinical Dementia Rating) foram aplicados para avaliação cognitiva. Adicionalmente a independência para as atividades da vida diária foram acessadas pela escala ADL - Activities of Daily Living. Para diagnóstico dos casos incidentes de doença de Alzheimer foi utilizado os critérios diagnósticos do DSM-IV e do NINCDS/ADRDA, associado à descrição dos critérios de Kawas para DA consistente. Para diagnóstico de Comprometimento Cognitivo Leve, o critério da Clínica Mayo foi aplicado para a primeira análise, e o critério para CCL do tipo Alzheimer (ou DA prodrômica) foi utilizado para a segunda análise tendo em vista a incorporação de dados disponíveis e a evolução dos critérios. As trajetórias possíveis do CCL foram classificadas em três categorias: conversão, estabilização e reconversão. Os sujeitos considerados para a primeira análise - casos incidentes de CCL e DA foram os participantes que apresentavam pelo menos uma visita de seguimento no período de oito anos a partir da linha de base (N = 245) e as análises estatísticas foram baseadas no diagnóstico estabelecido na última visita de seguimento. Para os falecidos durante o período, dados retrospectivos foram obtidos através de uma entrevista telefônica com um informante confiável. Os dados clínicos e demográficos de linha de base foram utilizados para cálculo dos fatores preditivos dos desfechos do estudo. Para a segunda análise – risco de conversão de CCL para DA – trajetórias do CCL, a amostra foi composta dos 21 indivíduos que desenvolveram CCL e 220 indivíduos cognitivamente normais (N = 241). Resultados: Os resultados da primeira análise mostraram taxa de incidência de CCL de 13,2 por 1.000 pessoas-ano e incidência de DA de 14,8 por 1.000 pessoas-ano. O desenvolvimento de prejuízo cognitivo foi associado com educação (razão de chance [RC] = 0,86) e o escore do MEEM de base (RC = 0,81). Os resultados da segunda análise mostraram que dos 21 sujeitos com CCL, 38% desenvolveram demência, 24% permaneceram estáveis e 38% melhoraram. A taxa de conversão anual para DA foi de 8,5%, CCL foi associado significativamente a maior risco de conversão para DA (HR = 49,83; p = 0,004), mesmo ajustado para idade, escolaridade, sexo e escore no MEEM. Conclusão: A incidência de DA nessa amostra foi maior do que a descrita em estudo prévio realizado no Brasil, mas está dentro da variabilidade observada internacionalmente. Escores mais baixos no Mini Exame do Estado Mental na linha de base, mesmo que dentro da normalidade, e níveis mais baixos de educação foram preditores da ocorrência de prejuízo cognitivo. Quanto à trajetória do CCL, independentemente da heterogeneidade observada, os participantes com CCL do tipo Alzheimer apresentaram risco significativamente maior de desenvolver demência na DA, demonstrando o impacto do uso destes critérios que enfatizam o comprometimento da memória episódica de longo prazo e buscam identificar sujeitos com maior probabilidade de ser portadores de patologia Alzheimer. / Background: The increase of the rates of age-related diseases as dementia, especially Alzheimer's disease (AD), is projected with the aging of the world population. Subjects with Mild Cognitive Impairment (MCI) are considered a population at risk for developing dementia. However, MCI incidence rates and rates of conversion to dementia have shown considerable variability that could be partially attributed to characteristics of the sample and to different criteria. Objective: To determine the incidence of dementia and mild cognitive impairment in a cohort of community-based healthy elderly individuals; to determine the demographic, clinical and social variables associated with the development of cognitive impairment; and to assess the risk of progression of individuals with mild cognitive impairment to dementia compared with cognitively normal subjects. Methods: Data were derived from a cohort of elderly community residents (N = 345), who were initially healthy and independent (PALA – Porto Alegre Longitudinal Aging – study). The follow-up of a maximum of eight years was used to evaluate the incidence of AD and MCI. To evaluate the progression of MCI to dementia due to AD we set off the 10-year follow-up, including the previous 8-year of the first analysis, and consider the maximum of 70 months (mean 45 months) for these new outcomes. Participants who met the inclusion criteria of the study and consented to participate were evaluated with a detailed clinical interview consisted of demographic, clinical and social variables. Psychiatric symptoms were assessed with the SRQ scale (Self Report Questionnaire), the MADRS (Montgomery-Asberg Depression Rating Scale), and the Diagnostic and Statistical Manual of Mental Disorders (4th edition, DSM-IV) criteria for Major Depression. Cognitive assessment was checked with the Mini Mental State Examination (MMSE) and the Clinical Dementia Rating Scale (CDR). Independence for the activities of daily living was assessed with the ADL scale (Activities of Daily Living). Incident cases of probable Alzheimer's disease were assigned through the DSM-IV and the NINCDS-ADRDA diagnostic criteria, with the additional designation from Kawas and colleagues of consistent AD. Detection of Mild Cognitive Impairment for the first analysis was carried out with the MCI Mayo Clinic criteria. The MCI of the Alzheimer type criteria (or Prodromal AD) were used for the second analysis, incorporating available data of the sample and the ongoing evolution of the criteria. The possible MCI trajectories were classified into three categories: conversion, stabilization, and reconversion. The subjects for the first analysis – MCI and AD incidence – were the participants who had at least one follow-up visit in the 8-year period from the baseline (N = 245), and the statistical analyzes were based on the diagnosis established in last follow-up interview. For the deceased during the period, retrospective data were obtained through a telephone interview with a knowledgeable collateral source focusing on dementia. The baseline clinical and demographic data were analyzed as predictors of the study outcomes. For the second analysis – risk of MCI progression to AD, and MCI trajectories – the sample was composed of 21 individuals who developed MCI and 220 cognitively normal subjects (N = 241). Results: The results of the first analysis showed the MCI incidence rate of 13.2 per 1,000 person-years and the AD incidence of 14.8 per 1,000 person-years. The development of cognitive impairment was associated with education (odds ratio [OR] = 0.86) and baseline MMSE scores (OR = 0.81). The results of second analysis showed that of the 21 MCI subjects, 38% developed dementia, 24% remained stable, and 38% improved. The annual AD conversion rate was 8.5%, and MCI was significantly associated with increased risk of progression to AD (HR = 49.83; p = 0.004), even adjusted for age, education, gender and MMSE scores. Conclusion: The AD incidence in this sample was higher than that described in a previous study carried out in Brazil, but was within the international estimates. Lower baseline scores on the Mini Mental State Examination, although within the normal range, and lower levels of education were predictors of cognitive impairment. Regardless the observed heterogeneity of the MCI trajectories, participants with MCI of the Alzheimer type showed significantly higher risk of developing dementia due to AD, demonstrating the impact of the emphasis on the episodic long-term memory impairment of the criteria, which finally searches to identify those individuals more likely to have Alzheimer's pathology.

Ce travail de thèse s’intéresse à la Théorie de l’Esprit (TdE) dans les stades précoces de la maladie d’Alzheimer (MA) et le Mild Cognitive Impairment (MCI). La TdE est un processus central de la cognition sociale permettant d’inférer les états mentaux d’autrui et de nous adapter aux interactions sociales auxquelles nous sommes confrontés chaque jour. Des travaux ont mis en évidence un déficit de TdE chez le patient MA mais son authenticité reste discutée et celui-ci est attribuer aux autres troubles cognitifs des patients. Par ailleurs, une seule étude à ce jour s’était intéressée à la TdE chez le patient MCI, laissant un champ d’étude inexploré malgré l'intérêt de cet état pour le diagnostic précoce des pathologies dégénératives. Ce travail a pour but d’approfondir les données existantes sur le fonctionnement de la TdE dans la MA et le MCI et présente également l’ambition d’évaluer, pour la première fois dans ces populations, la TdE au plus près de son fonctionnement quotidien dans une tâche impliquant le patient dans une vraie interaction sociale. Les résultats montrent que les patients présentent bien un déficit de TdE y compris sur la tâche immersive, suggérant que ce déficit est observable dans des situations proches de la vie quotidienne. Les patients présentent également un déficit sur une tâche plus classique de TdE, la nature de leurs erreurs témoignant de l’authenticité de ce déficit. Ce travail tend donc à confirmer la présence d’un dysfonctionnement de la TdE dans les stades débutants de la MA et dans le MCI. Ce déficit est précoce, authentique et observé pour la première fois dans une situation d’interaction sociale réelle. / This work investigates Theory of Mind (ToM) ability in early Alzheimer’s disease (AD) and Mild Cognitive Impairment (MCI). ToM is a core feature of social cognition allowing us to infer and understand other’s mental states (i.e. beliefs, intentions, knowledge), in order to adapt our behavior in everyday social interactions. Previous works evidenced ToM deficit in AD patients, but the authenticity of this deficit is still debated and is attributed to other cognitive dysfunctions of patients. Moreover, only one study investigated ToM in MCI. This area thus requires further investigation since MCI represents an interesting concept for early diagnosis of neurodegenerative disorders. The purpose of this work is to further investigate ToM functioning in both AD and MCI with the ambition to evaluate for the first time ToM in close-to-everyday conditions with a task involving the patient in a real interaction. Results show that patients present ToM impairment even in a real interactive task suggesting that this deficit is noticeable in naturalistic conditions closed to everyday interactions. Patients also present difficulties in a classical ToM task, the nature of their errors suggesting genuine ToM difficulties. This work therefore confirms the presence of a ToM impairment in early AD and MCI. This impairment is precocious, authentic and is observed for the first time in a real social interaction.

Lightweight aluminium-silicon alloy is an attractive material for making engine cylinders in automobiles. It imparts good power to weight ratio to the engine. High silicon containing aluminium alloys are used in current engine block castings where the bore surface is etched or honed to partially expose the silicon particles to provide the primary contact between the piston ring and certain regions of the piston and the cylinder. Piston reversal near the top dead centre however causes starvation of lubrication which leads to wear. To explore the wear behaviour of etched aluminium-silicon alloys under nominally dry conditions and extreme lubricated conditions, a host of mechanical and spectroscopic techniques are used here to characterize mechanical and chemical changes caused by wear. In the absence of complex chemical transformations on the wear surface in dry condition, allows a close examination of surface and subsurface microstructures. Given this understanding of the wear under dry condition, we explore the effect of boundary lubrication, where chemical transformations leading to surface modifications are involved. In dry sliding tribology of aluminium-silicon alloy slid against a steel ball four stages of wear are identified; ultra-mild wear, mild wear, severe wear and post severe oxidative wear. In the ultra-mild wear regime silicon particles bears the load. Transition to mild wear occurs when the protruded silicon particles disappear(by sinking and fracture) under higher pressure and sliding. The sinking of silicon particles under normal loading is further investigated using a naoindenter. It is found that the resistance to sinking of such particles into the matrix increases with the unexposed surface area to the buried volume of the particles. In that sense, small particles are seen to provide the stiffest resistance to sinking. While in ultra-mild wear regime the basic energy dissipation mechanism is sinking/tilting, in mild wear regime the subsurface is either in an elastic or an incipiently plastic state. Subsurface plasticity in mild wear regime leads to a grain refinement, fracture of silicon and nucleation of cracks at silicon-matrix interfaces but does not promote large scale flow of the matrix. Transition to severe wear occurs when the contact pressure exceeds the plastic shakedown limit. Under this condition gross plasticity leads to a severe fragmentation of silicon particles and the fragmented silicon are transported by the matrix as it undergoes incremental straining with each cyclic contact at the asperity level. A large reduction in the inter-particle distance com-pared to that in a milder stage of wear, gives rise to high strain gradients in the severe wear regime which contribute to the enhancement of dislocation density. The resulting regions of very high strains at the boundaries of the recrystallised grains as well as within the subgrains lead to the formation of microvoids/ cracks. This is accompanied by the formation of brittle oxides at these subsurface inter-faces due to enhanced diffusion of oxygen. We believe that the abundance of such microcracks in the near surface region, primed by severe plastic deformation, is what distinguishes a severe wear regime from that in the mild wear. The transition from severe wear to post severe oxidative wear is thermally induced and it transfers the metal to metal contact interaction to metal to ceramic interaction. A thick oxide layer is abraded and spalls while the metal underneath continues to flow and delaminate. A study of lubricated tribology of ultra-mild and mild wear regime of aluminium-silicon alloy shows that the initial stages of sliding friction is controlled by the abrasion of the steel pin by the protruding silicon particles of the aluminium-silicon disc. Thegeneration of nascent steel chips helps to breakdown the additive in the oil by a cationic exchange that yields chemical products of benefits to the tribology. The friction is initially controlled by abrasion, but the chemical products gain increasing importance in controlling friction with sliding time. After long times, depending on the contact pressure, the chemical products determine sliding friction exclusively. In the mild wear chemically induced low friction is achieved in short periods of time whereas in ultra-mild wear regime it takes very long time to reach this low friction state. While the basic dissipation mechanisms are the same in the ultra-mild wear and mild wear regimes ,the matrix remains practically unworn in the low pressure ultra-mild wear regime. In the higher pressure mild wear regime at long sliding times a small but finite wear rate prevails. Incipient plasticity in the subsurface controls the mechanism of wear.

The process of controlling executive and motor behaviours is central to one’s ability to self-regulate and accomplish day-to-day goals across the lifespan. Executive and motor control share a set of underlying neural substrates that support a common set of processes, including planning, sequencing and monitoring of behaviour. They share a bidirectional relationship, such that gains or deficits in one area can have profound effects on the other. This doctoral dissertation examines the interplay between executive and motor control at three distinct stages of life and in the context of neurological conditions whose clinical manifestations shed additional light on the nature of the constructs. Central to each investigation is the methodological theme of intraindividual variability, as a means of leveraging valuable data within-persons. Chapter 2 examines executive and motor control in typically developing children and children with attention-deficit/hyperactivity disorder (ADHD). Findings suggest that dysregulation of motor processes accounts for hyperactive symptoms in ADHD and detracts from higher-order executive control. Chapter 3 examines the impact of mild traumatic brain injury (mTBI) in young adult varsity athletes, who routinely practice executive motor control by virtue of their level of play. Findings suggest that the impacts of mTBI are discernible through a dampened electrophysiological response during computerized tests of higher order executive functioning, and may not outweigh the otherwise myriad health benefits of athletic engagement. Chapter 4 examines the impact of dementia on executive motor control during gait dual-tasking in older adults. Findings suggest that the consistency of performance across multiple indicators of gait is sensitive to dementia, and that engagement in cognitive and social lifestyle behaviours is protective against likelihood of both dementia and mild cognitive impairment (MCI) classification. On mass, these findings highlight the importance of assessing executive motor control to understand the pathophysiology of neurological conditions. The potential benefits that may generalize from one area to the other offer unique opportunities for preventative and rehabilitative efforts. / Graduate

Le premier objectif de cette thèse était d’explorer l’effet de référence à soi (ERS) sur la mémoire dans le vieillissement, l’amnestic Mild Cognitive Impairment (aMCI) et la maladie d’Alzheimer (MA) à un stade précoce de l’évolution. Le second fut de revisiter les théories actuelles pour expliquer ce bénéfice mnésique, puis de tenter d’élucider ses mécanismes. Nous avons montré que l’ERS sur les représentations sémantiques de ses propres traits de personnalité (qui est une composante de notre identité) était préservé dans le vieillissement. Par ailleurs, nous avons montré que la profondeur de traitement, longtemps considérée comme le processus sous-tendant l’ERS, n’intervenait pas dans ce dernier. A contrario, l’interaction de l’âge et de l’estime de soi, ainsi que les expériences de vie des individus modulaient l’ERS. Nous avons montré que l’ERS pouvait résulter de deux processus : celui de la consistance des traits de caractère et celui de l’élaboration automatique des traits de caractère avec l’identité des individus. Nous avons par ailleurs rapporté pour la première fois que ce bénéfice mnésique s’opérait chez des patients atteints d’aMCI, un stade symptomatique et pré-démentiel de la MA, et qu’il pouvait s’observer dans une moindre mesure chez des patients MA. En outre, l’ERS agit comme mécanisme de self-défense chez les patients aMCI et MA, en les protégeant d’informations menaçantes pour l’intégrité de leur soi. Nous suggérons en dernier lieu que la référence à soi pourrait servir d’outil de réhabilitation sociale ou clinique pour augmenter l’estime de soi de certains individus et préserver leur mémoire et leur bien-être. / The first aim of this thesis was to examine the self-reference effect (SRE) on memory in aging, amnestic mild cognitive impairment (aMCI) and early-stage of Alzheimer’s disease (AD). The second aim was to review the whole literature on the SRE and to attempt understanding its mechanisms. We showed that the SRE on semantic summary representations of one’s traits (which is a component of identity) was preserved in aging. Besides, we showed that depth of processing, which was hitherto regarded as the mechanism responsible for the SRE, did not actually play a role in the latter. By contrast, the interaction of age and self-esteem, as well as individuals’ life experiences modulated the SRE. We showed that the SRE resulted from two processes: the congruency of traits as well as the elaboration of traits with individuals’ identity. We also reported for the first time that aMCI patients benefited from the SRE, as well as AD patients in the early stage of the disease to a lesser extent. Furthermore, the SRE acted as a self-defense mechanism in patients with aMCI and AD by protecting them from negative feedback that constituted a threat to the integrity of their selves. Finally, we suggest that referencing the self could serve as a tool for social or clinical rehabilitation programs, by increasing the self-esteem of some individuals and preserving their memory and well-being.

Dans le contexte du diagnostic précoce de la maladie d’Alzheimer, une direction de la recherche émerge autour de l’informatisation de tests cognitifs. Nous avons conçu un test de barrage informatisé sur tablette (test e-CT), développé à partir d’un test de barrage papier-crayon. Nous avons étudié les variables influençant les performances au test e-CT et ses propriétés psychométriques. Nous avons observé que chez les sujets âgés sains, la seule variable influençant était l’âge. Les performances au test e-CT n’étaient pas influencées par l’expérience avec un appareil informatique. Cependant, chez les patients présentant des troubles cognitifs, ceux qui utilisaient quotidiennement un appareil informatique avaient une meilleure performance que ceux qui n’avaient pas un usage quotidien. En effet, les patients utilisant quotidiennement un appareil informatique présentaient de meilleures capacités cognitives. Le test e-CT était corrélé avec plusieurs tests des fonctions exécutives (validité convergente), mais pas avec le test de la mémoire épisodique (validité divergente). Il présente aussi une bonne fidélité test-retest. Le test e-CT présente des bonnes performances diagnostiques, permettant de différencier les personnes âgées saines des patients présentant des troubles cognitifs. En conclusion, le test e-CT présente des propriétés psychométriques satisfaisantes et peut être utilisé pour l’évaluation cognitive chez le sujet âgé. / In the context of early detection of cognitive impairment associated with dementia, an area of research focus concerns development and validation of computerized tests. We have developed a tablet-based cancellation test (e-CT), based on an existing paper-and-pencil cancellation test (K-T test). We studied the variables influencing performance on the e-CT and its psychometric properties. Among healthy older adults, only age was found to be an influencing variable. The performance on the e-CT was not influenced by experience with a computer-based device. However, for patients suffering from cognitive impairment, those using a computer-based device daily outperformed those who were not daily users. Further analyses showed that daily users conserved better cognitive capacities than non-daily users. The e-CT showed significant correlations with several measures of executive functions (convergent validity), but there was no relationship between the e-CT and the episodic memory test (divergent validity). It showed good test-retest reliability. The e-CT had good diagnostic accuracy in differentiating between healthy elderly subjects and patients with cognitive impairment. In conclusion, the e-CT test shows satisfying psychometric properties and is a promising tool for neuropsychological assessment in older adults

Les hypersignaux de la substance blanche (HSB) ont été associés à des déficits exécutifs et mnésiques et à une atteinte des circuits corticaux et sous-corticaux frontaux. Leur présence, en plus du dépôt ß-amyloïde chez de nombreux patients avec un MCI (Mild Cognitive Impairment ou trouble cognitif léger) augmenterait le risque de conversion vers une maladie d'Alzheimer (MA). Un des enjeux importants dans la phase préclinique de la maladie est d'explorer le potentiel des interventions cognitives pour prévenir le déclin cognitif et la progression vers une MA. Alors que les HSB sont de plus en plus considérés comme un des facteurs déterminant l'hétérogénéité des patients MCI, peu d'étude ont pris en compte leur présence dans les interventions cognitives. L'hypothèse qu'une intervention pourrait induire des effets différentiels selon l'existence ou non d'hypersignaux dans le MCI reste inexplorée à notre connaissance, et est au cœur de ce travail de thèse. / White matter hyper signals (WMH) were associated with executive and memory deficits and impairment of the cortical and subcortical frontal circuits. Their presence, in addition to amyloid deposition in many patients with Mild Cognitive Impairment (MCI), would increase the risk of conversion to Alzheimer's disease (AD). An important issues in the preclinical phase of MCI is to explore the potential of cognitive interventions to prevent cognitive decline and progression to AD. While WMH are increasingly considered as one of factors determining the heterogeneity of MCI patients, few studies have take into account their presence in cognitive interventions. The hypothesis that an intervention could induce differential effects according to the existence or not of WMH in MCI remains unexplored to our knowledge, and is at the heart of this work of thesis.

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Varje år insjuknar 20 000-25 000 personer i kognitiv sjukdom i Sverige, och för närvarande lever 130 000-150 000 med dessa sjukdomar. Personer med kognitiv sjukdom kan ha komplexa behov varför insatserna behöver vara individanpassade med en helhetssyn på personen med kognitiv sjukdom. Tjänsterna inom vården kan vara otydliga och svåra att få tillgång till. Personer med kognitiv sjukdom löper en högre risk för att inte få den vård de behöver. Syfte: Syftet var att beskriva upplevelser av stöd från hälso- och sjukvården till äldre personer med kognitiv sjukdom i samband med diagnos. Metod: En allmän litteraturöversikt med systematisk metod. Databassökningen i databaserna PubMed, Cinahl och PsycInfo genererade 12 artiklar som besvarade arbetets syfte. Även manuell sökning utfördes, vilket genererade tre artiklar. Totalt inkluderades 15 vetenskapliga artiklar av kvalitativ, kvantitativ ansats samt mixad metod. Med hjälp av en kvalitetsbedömningsmall har artiklarnas granskats och därefter har en integrerad dataanalys genomförts för att besvara arbetes syfte. Resultat: Två huvudkategorier framkom; Personer med kognitiv sjukdoms erfarenheter av hälso-och sjukvårdens stöd och Uttryckta behov av förbättringar av hälso- och sjukvårdens stöd och fyra underkategorier; Informationens betydelse, Personalens förhållningssätt och vårdrelationens betydelse för stödet, Individanpassat stöd och Information om framtida stödbehov, prognos och behandling. Resultatet visade att många personer med kognitiv funktionsnedsättning saknar stöd och lotsning i samband med diagnos. Vissa kände sig övergivna och ensamma och att sjukvården inte hade tillräckliga bra strategier och rutiner för uppföljning och vårdplaner.  Slutsats: Hälso- och sjukvården har i samband med diagnos vid kognitiv sjukdom ansvar att anpassa informationen till personen. Personerna uttryckte en önskan om mer individanpassade strategier och möjlighet till upprepad information. Mer personcentrerade insatser behövs för att möta behoven hos personer med kognitiv sjukdom och därigenom förbättra deras livskvalitet. / Every year, 20,000-25,000 people fall ill with cognitive disorders in Sweden, and currently 130,000-150,000 are living with these diseases. People with cognitive disorders may have complex needs, which is why interventions need to be individualized with a holistic view of the person with cognitive disease. Healthcare services may be unclear and difficult to access. People with cognitive disorders are at a higher risk of not getting the care they need. Purpose: Experiences of support from health care for older people with cognitive disorder in connection with diagnosis Method: A literature review with a systematic method. The database search in the databases PubMed, Cinahl and Psycinfo generated 12 articles that answered the purpose of the work. A manual search was also performed, which generated three articles. A total of 15 scientific articles of qualitative, quantitativ approach and mixed method were included. With the help of a quality assessment template, the articles has been reviewed and then an integrated data analysis has been used to answer the purpose of this study. Results: The result presents two main categories; People with cognitive disorder experiences of health care support and Expressed needs for improvement of health care support and four subcategories; The importance of information and The staff's approach and the importance of the care relationship for the support and Individualized support. Information about future support needs, prognosis and treatment. The results showed that many people with cognitive impairment lack support and guidance in connection with diagnosis. Some felt abandoned and lonely, and that the healthcare system did not have good enough strategies and routines for follow-up and care plans. Conclusion: In connection with the diagnosis of cognitive disease, the health care system has a responsibility to adapt the information to the person. The participants expressed a desire for more individualized strategies and the possibility of repeated information. More personcentred interventions are needed to meet the needs of people with cognitive disease and thereby improve their quality of life.

Approximately forty percent of youths’ waking hours are unrestricted and not committed to activities such as eating, sleeping or going to school. Many of this free time is spent without companionship or supervision from adults, which puts them at risk of spending their time out on the streets, where the risk of succumbing to peer pressure and becoming involved in inappropriate or illegal activities is increased. The absence of structured activities, stimulation and support can lead to youth becoming involved in rebellious and unwanted behaviour, partly due to their continuous search for adventure and excitement. Learners with Mentally Mild Learning Disabilities (MMLD) can be seen as youth at risk because of their academic and behavioural problems. Learning disabilities can increase the risk factors for delinquency and substance dependence. Previous research suggests that adventure-based experiential programmes (AEPs), which are highly structured, can thus be a very powerful intervention or prevention medium to empower youth at risk to overcome obstacles through the acquisition and practise of skills. The purpose of the study was firstly to determine what the personal functioning profile of MMLD youth looks like, which was done in order to gain insight into the different aspects of the personal functioning, which were focused on when developing the AEP. The study was secondly done to determine what the role of an AEP is on the personal functioning of learners with MMLD. Books, journals, dissertations, theses and internet sources were used to do a thorough literature review. The literature review was done in order for readers to understand the link between MMLD youth and an AEP. The literature review gave an introduction to the phenomenon of MMLD youth and also explained how an AEP could be beneficial towards them. A qualitative research design was used by the researcher in the form of an instrumental case study. Case studies make it possible for the researcher to use qualitative as well as quantitative constructs for data gathering purposes. Sampling of participants was done in two steps. A school for Learners with Special Education Needs (LSEN) (Die Wilge High School) was sampled through purposeful sampling by means of criterion-based sampling techniques. The second step was to sample fourteen male learners from Die Wilge High School through purposive sampling. The personal functioning was determined by using the Youth at Risk Assessment Scale (YAR3) Questionnaire 3. The researcher made use of semi-structured, one-on-one interviews and field notes in order to gather data. The field notes and transcribed interviews were analysed in order to obtain a clear picture of the content, which was then used to identify the codes. After the data was analysed four main themes, each with its own categories, were identified. The themes related to the personal functioning of the youth and consisted of interpersonal relationships, trust, self-worth and perseverance. The learners had positive feedback regarding their interpersonal relationships, trust, self-worth and perseverance before participation in the AEP. This was attributed to the Strengths-based Approach which the researcher followed in the development of the AEP. Despite this positive feedback, the learners still felt that there was an improvement after the AEP in all of the areas. Most of the learners attributed the improvement to learning more about each other, learning to work together and building friendships among each other. These new found friendships made it easier to trust each other and believe in themselves. The learners also realised that they experienced more positive feelings from persevering than when they quit. The results were used to discuss the objective of the study and to determine if the researcher met the objective. / MA (Recreational Science), North-West University, Potchefstroom Campus, 2015