Using an evidence-based perspective and key concepts from the Occupa­tional Therapy Practice Framework, this guideline provides an overview of the occupational therapy process for adults with neurodegenerative diseas­es, specifically multiple sclerosis, amyotrophic lateral scle­rosis, and Parkinson’s disease. It defines the occupational therapy domain and interventions that occur within the boundaries of acceptable practice. Topics include interven­tions focusing on activity and participation such as fatigue management, health promotion, and functional mobility; interventions focusing on client factors and performance skills, such as cognitive or memory training and exercise or motor training; self-management and cognitive–behavioral strategies to improve task and occupational performance; and palliative care. These guidelines should be useful to the many entities involved in providing occupational therapy services to people with neurodegenerative diseases, such as occupational therapy practitioners, team members, educators, clients, families, caregivers, third-party payers, and policymakers.